Physicians' perceptions and responses to patient emotion: implications for social work practice in health care

Role expectations from doctors and effects on nonmedical outcomes

RATIONALE, AIMS, AND OBJECTIVES

The predominant assumption of doctor professionalism may be prone to unpredicted alterations in the face of "a new age of doctoring." The aim in this study is to explore one dimension in the doctor-patient dyadic relationship: the face-to-face interaction between doctors and patients and whether satisfaction of role expectations affects service outcomes as perceived by the patient-consumer.

METHODS

In the first qualitative phase, 10 physicians and 11 patients were interviewed in-depth for the purposes of understanding the variations in role expectations from doctors. These details were then used to construct the scenarios to be used in the second quantitative phase. Scenario-based experimental data were collected using a cross-sectional sample consisting of 432 individuals.

RESULTS

Although positive emotions lead to positive outcomes when the doctor is role-congruent, positive emotions lead to even better outcomes when the doctor is behaving too friendly. In addition, negative emotions lead to negative outcomes in both scenarios; however, outcomes become worse when the doctor is role-incongruent.

CONCLUSIONS

Role expectations play a moderating role between emotions and service outcomes. The medical performance can be perceived good or bad depending on whether the doctor smiles "too much" or not. Results are discussed within the context of role expectation theory and the changing nature of service relationships in the health care sector.

Assessing empathy development in medical education: a systematic review

CONTEXT

Empathy in doctor-patient relationships is a familiar topic for medical scholars and a crucial goal for medical educators. Nonetheless, there are persistent disagreements in the research literature concerning how best to evaluate empathy among physicians, and whether empathy declines or increases across medical education. Some researchers have argued that the instruments used to study 'empathy' may not measure anything meaningful to clinical practice or patient satisfaction.

METHODS

We performed a systematic review to learn how empathy is conceptualised in medical education research. We examined how researchers define the central construct of empathy and what they choose to measure, and investigated how well definitions and operationalisations match.

RESULTS

Among the 109 studies that met our search criteria, 20% failed to define the central construct of empathy at all and only 13% used an operationalisation that was well matched to the definition provided. The majority of studies were characterised by internal inconsistencies and vagueness in both the conceptualisation and operationalisation of empathy, constraining the validity and usefulness of the research. The methods most commonly used to measure empathy relied heavily on self-report and cognition divorced from action, and may therefore have limited power to predict the presence or absence of empathy in clinical settings. Finally, the large majority of studies treated empathy itself as a 'black box', using global construct measurements that are unable to shed light on the underlying processes that produce an empathic response.

CONCLUSIONS

We suggest that future research should follow the lead of basic scientific research that conceptualises empathy as relational - an engagement between a subject and an object - rather than as a personal quality that may be modified wholesale through appropriate training.

Patient satisfaction with physician errors in detecting and identifying patient emotion cues

OBJECTIVE

Previous research has examined physicians' ability to respond to or identify the type of emotion cues. Yet in physician-patient interactions, identification and response are preceded by the ability to detect whether an emotion cue has occurred. This research assesses consequences of emotion detection errors for patient satisfaction.

METHODS

Participants responding to an online survey read one of six randomly assigned descriptions of a physician-patient interaction varying on: whether the patient presented an emotion cue; whether the physician detected an emotion cue; and whether the physician correctly identified the cue. Participants then rated satisfaction with the physician.

RESULTS

Satisfaction was highest when the physician correctly detected the patient's emotion cue and lowest when the physician failed to detect the patient's emotion. Failing to detect the emotion cue had lower satisfaction than other emotion processing errors, including falsely detecting an emotion cue that was not there or incorrectly identifying the type of emotion.

CONCLUSIONS

Emotion cue detection has implications for patient satisfaction distinct from emotion identification.

PRACTICE IMPLICATIONS

Results suggest it may be better for physicians to incorrectly identify than miss an emotion. Training for healthcare providers should consider incorporating emotion detection.