Communication During the COVID-19 Pandemic

Commenting on the findings, Kenneth Lin, MD, MPH, Professor of Clinical Family Medicine, Georgetown University School of Medicine suggested that the explicit responses to patients’ emotional expressions, referred to in Dr Beach’s study, constituted a less empathetic communication style and that readers should judge for themselves if saving such a short time per visit is “worth what was potentially lost in these encounters.”

In his perspective, “attending to patients’ emotions doesn’t really take much longer than not attending to them and for me, those few minutes per visit are worth it.” In fact, reports Dr Lin, “they’re a major reason I went into primary care in the first place.”

On the other hand, Dr Lin, who is the Deputy Editor of American Family Physician, said he can “certainly see the flip side of the argument another clinician might make, that if they are seeing 25 to 30 patients a day times 4 days per week, that adds up to quite a lot of extra time spent at the office that could negatively impact work and home life.”

Nevertheless, relationships in primary care are important to building trust between patients and clinicians, which is particularly critical during the COVID-19 pandemic when trust in medicine is at a “low ebb,” due to a “small but vocal minority of health professionals” who oppose COVID-19 vaccination, Dr Lin stated in an accompanying editorial.4 “As mass vaccination campaigns have stalled, recommendations from trusted primary care clinicians have become critical to overcoming vaccine hesitancy,” according to Dr Lin.

“Certainly, more primary care physicians are feeling burned out by the pandemic and its demands on them, but regularly having this sort of emotional exchange with patients can actually be invigorating, providing positive human connection that can outweigh the negative social media nonsense from the anti-vaxxers and anti-maskers and others whose actions or inaction, such as not getting vaccinated, have prolonged the pandemic in the US,” he said.

“Although Beach and colleagues did not look at how physicians and patients ‘felt’ after these clinical encounters, I suspect that the attending-to-emotion type, although slightly longer, were more satisfying,” Dr Lin suggested.

His take-home message to busy clinicians “is not to be discouraged that doing the right thing for patients isn’t a time saver, but to be encouraged that it has benefits for both sides of the patient-physician relationship.”

Dr Beach noted that the study was conducted before the onset of the COVID-19 pandemic, so it does not provide data to suggest how clinicians can respond to patients’ emotions when they are so overtaxed themselves. “We do know that clinicians under stress have less time to spend with each patient, and this definitely puts pressure on them not to address anything that isn’t urgent,” she said.

References

  1. Beach MC, Park J, Han D, Evans C, Moore RD, Saha S. Clinician response to patient emotion: Impact on subsequent communication and visit length. Ann Fam Med. 2021 Nov-Dec;19(6):515-520. doi:https://doi.org/10.1370/afm.2740
  2. Levinson W, Gorawara-Bhat R, Lamb J. A study of patient clues and physician responses in primary care and surgical settings. JAMA. 2000 Aug 23-30;284(8):1021-7. doi:10.1001/jama.284.8.1021
  3. Zimmermann C, Del Piccolo L, Bensing J, Bergvik S, De Haes H, Eide H, et al. Coding patient emotional cues and concerns in medical consultations: the Verona coding definitions of emotional sequences (VR-CoDES). Patient Educ Couns. 2011 Feb;82(2):141-8. doi.org/10.1016/j.pec.2010.03.017
  4. Lin KW. Trust and relationships remain at the heart of primary care. Ann Fam Med. 2021 Nov-Dec;19(6):482-483. doi:https://doi.org/10.1370/afm.2752.