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Bedside and chairside manner pinpointed: Compassion in doctor-patient talks

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When you talk to your physician, does the compassion reach you? Do you get the feeling of empathy? Compassion differs from empathy. What does compassion sound like? "Good to see you. I’m sorry. It sounds like you’ve had a tough, tough, week.” Spoken by a doctor to a cancer patient, that statement is an example of compassionate behavior observed by a University of Rochester Medical Center team in a new study published by the journal Health Expectations. Bedside and chairside manner in physicians, nurses, dentists and caregivers has long been discussed by patients. What is meant by bedside manner is compassion.

Rochester researchers believe they are the first to systematically pinpoint and catalog compassionate words and actions in doctor-patient conversations. By breaking down the dialogue and studying the context, scientists hope to create a behavioral taxonomy that will guide medical training and education. Compassion is a holistic way of establishing emotional or behavioral ties with another person.

Compassion unfolds over a period of time. Empathy is an immediate response. Empathy is more like, "I'm feeling you're pain. I'm in there suffering and writhing with you." Compassion is a step back from empathy, as when a person expresses behavior by taking action to be of help or consolation rather than engaging in emotion as in cringing or grimacing with a downturned mouth when you reveal that you feel pain. On the other hand, alexithymia is an inability to describe emotions in a verbal manner.

Bedside manner

Walking a mile in another person's shoes is empathy because you did the walk and feel the results of its effects, same as the other person feels. Compassion is soothing, treating, and healing the injured foot after it has walked in shoes that didn't fit. But you don't necessarily have to don the ill-fitting shoes and take the same exhausting journey. You can heal without experiencing the same injury. Compassion is realizing what the other person goes through without feeling the same effects the other person experiences. You can step back and solve the problem, get at the root cause of the symptom, and help heal the cause instead of putting a band-aid on the symptom with a concoction that gives a person more symptoms in other places.

“In health care, we believe in being compassionate but the reality is that many of us have a preference for technical and biomedical issues over establishing emotional ties,” said senior investigator Ronald Epstein, M.D., professor of Family Medicine, Psychiatry, Oncology, and Nursing and director of the UR Center for Communication and Disparities Research, according to the December 26, 2013 news release, "What does compassion sound like? "Epstein is a national and international keynote speaker and investigator on mindfulness and communication in medical education.

His team recruited 23 oncologists from a variety of private and hospital-based oncology clinics in the Rochester, N.Y., area. The doctors and their stage III or stage IV cancer patients volunteered to be recorded during routine visits. Researchers then analyzed the 49 audio-recorded encounters that took place between November 2011 and June 2012, and looked for key observable markers of compassion.

In contrast to empathy – another quality that Epstein and his colleagues have studied in the medical community -- compassion involves a deeper and more active imagination of the patient’s condition

An important part of this study, therefore, was to identify examples of the three main elements of compassion: recognition of suffering, emotional resonance, and movement towards addressing suffering.

Emotional resonance, or a sense of sharing and connection, was illustrated by this dialogue: Patient: “I should just get a room here.” Oncologist: “Oh, I hope you don’t really feel like you’re spending that much time here.”

Another conversation included this response from a physician to a patient, who complained about a drug patch for pain: “Who wants a patch that makes you drowsy, constipated and fuzzy? I’ll pass, thank you very much.”

Some doctors provided good examples of how they use humor to raise a patient’s spirits without deviating from the seriousness of the situation. In one case, for example, a patient was concerned that he would not be able to drink two liters of barium sulfite in preparation for a CT scan.

Doctor: “If you just get down one little cup it will tell us what’s going on in the stomach. What I tell people when we’re not being recorded is to take a cup and then poor the rest down the toilet and tell them you drank it all (laughter)… Just a creative interpretation of what you are supposed to take.”

Patient: “I love it, I love it. Well, I thank you for that. I’m prepared to do what I’ve got to do to get this right.”

Researchers evaluated tone of voice, animation that conveyed tenderness and understanding, and other ways in which doctors gave reassurances or psychology comfort

Here’s an instance in which an oncologist encouraged a reluctant patient to follow through with a planned trip to Arizona: “You know, if you decide to do it, break down and allow somebody to meet you at the gates and use a cart or wheelchair to get you to your next gate and things like that. And having just sent my father-in-law off to Hawaii and told him he had to do that, he said no, no, I can get there. Just, it’s okay. Nobody is gonna look at you and say, ‘What’s an able-bodied man doing in a cart?’ Just, it’s okay. It’s part of setting limits.”

Researchers also observed non-verbal communication, such as pauses or sighs at appropriate times, as well as speech features and voice quality (tone, pitch, loudness) and other metaphorical language that conveyed certain attitudes and meaning. You may wish to check other articles on compassion and physicians not related to this particular study, "Has Medicine Lost Its Compassion And Humanism?" Or see the article, "Physicians who are able to feel compassion - KevinMD.com."

Compassion unfolds over time, researchers concluded

During the process, physicians must challenge themselves to stay with a difficult discussion, which opens the door for the patient to admit uncertainty and grieve the loss of normalcy in life. “It became apparent that compassion is not a quality of a single utterance but rather is made up of presence and engagement that suffuses an entire conversation,” the study said, according to the December 26, 2013 news release, "What does compassion sound like?"

First author, Rachel Cameron, B.A., is a student at the University of Rochester School of Medicine and Dentistry. Audio-recordings were reviewed by a diverse group of medical professionals with backgrounds in literature and linguistics, as well as palliative care specialists. The National Cancer Institute funded the study.

Other articles on compassion not related to the study include, "Physicians for Compassionate Care Education Foundation," "Dr. Larry Dossey: Bedside Manner: The Case For Compassion," and "Fostering compassion in young doctors - Emory News Center."

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