Cancer Docs Often Miss Patient Fears
Doctors Respond With Empathy Only One-Fourth of Time, Study Shows
Dec. 18, 2007 -- Cancer patients who expect their oncologist to lend an
empathetic ear are often disappointed, new research suggests.
Researchers found that the emotional concerns of patients with advanced
cancer often went unrecognized or unaddressed by the doctors treating them.
The researchers recorded close to 400 conversations between oncologists and
patients and then counted how often the patients sought empathy from the
doctors and how often the doctors responded empathetically to patient
Showing support or asking patients to elaborate on their concerns,
legitimizing the expressed emotion and praising patients for their strength
were all considered empathetic responses.
When the patients expressed concerns and negative emotions, the oncologists
responded empathetically 22% of the time.
Researcher Kathryn Pollak, PhD, of Duke Comprehensive Cancer Center, says
the findings illustrate the need for teaching oncologists better communication
"We know that oncologists care deeply for their patients," she tells
WebMD. "They wouldn't be in the field if they weren't caring people. But
they often don't verbalize their feelings to their patients."
Difficult Questions, Difficult Answers
Pollak recounted one exchange from the recorded conversations that went like
this: When the patient told her oncologist that she had been really depressed
lately, the oncologist responded, "So are you still smoking?"
Pollak says patients often ask difficult questions in indirect ways, and
their doctors may or may not pick up on this.
"Patients may ask if their tumors are getting bigger, but what they are
really saying is they are scared their cancer is getting worse," she
The researchers found that younger oncologists were more likely to respond
empathetically than older ones, possibly because training in communication is
being stressed more in medical schools today.
Carma Bylund, PhD, who runs a communications skills training course for
oncologists at New York's Memorial Sloan-Kettering Cancer Center, tells WebMD
the younger doctors in her program have often had courses in patient
"There has been a definite shift," she says. "Younger residents
and interns tell me they did a lot of this in medical school, while older
fellows or attending physicians say no one ever talked about it."
Downsides to Good Bedside Manner
Atlanta oncologist Otis Brawley, MD, believes most of his patients would
rate him high on the empathy scale.
But he adds that there are definite downsides to being too emotionally
involved with very ill patients.
"We really have to develop emotional calluses, for lack of a better
word, to keep our focus on our work," he says. "Being very empathetic
can affect decision making. Physicians who spend a lot of time dealing with the
emotional aspects of their patient's disease may be shortchanging them in other
Physician burnout is also a huge issue in oncology, in part because the
emotional toll can be so great.
A professor of oncology at Atlanta's Emory University, Brawley says he
became an academic doctor and administrator, in part, to protect himself from
He does agree that communication is critical when it comes to the medical
aspects of cancer care.
"In my opinion, a patient who can't talk to their doctor about their
disease needs to find another doctor," he says. "But a doctor who is
somewhat cold or emotionally detached may be providing very high-quality