Can a computer program teach patient empathy?

Expressing empathy -- identifying and understanding a patient's feelings and motives -- is a clinical skill that even experienced physicians can have trouble mastering, research shows. But what if it could be taught by something that seems unfeeling: a computer program?

Apparently, it can, according to a recent study that examined how often oncologists empathize when patients relay feelings such as fear, sadness or distress.

Nearly 50 oncologists at two academic medical centers heard a one-hour lecture on communication skills, and more than 260 of their visits with patients were recorded on audio and analyzed. Half of the oncologists also took a one-hour, computer-based tutorial that incorporated audio recordings of earlier patient visits and pointed out times when physicians could have done a better job of empathizing with their patients.

The physicians who took the computer tutorial, provided on CD-ROM, were 30% likelier to make empathic statements during their visits with patients than those who didn't take the tutorial. The computer-trained doctors were twice as likely to respond to patients' emotional expressions with empathic statements rather than immediately changing the subject back to the cold, hard clinical facts, according to the Nov. 1 Annals of Internal Medicine study (link).

"Communication is fundamentally important to good patient care, and that's not just a matter of being nice," said James A. Tulsky, MD, lead author of the study. "Good communication also improves patient adherence and real hard outcomes of various sorts, and it certainly affects issues such as patient satisfaction and quality of life."

The financial stakes related to improving communication have risen, with more than 60% of health care organizations using patient satisfaction scores to determine physician bonus pay, according to a report released in October by the Hay Group, a Philadelphia consulting firm.

The computerized approach to empathy training is not only effective but efficient, Dr. Tulsky said. Spending an hour with a computer program takes a lot less time and money than other kinds of communication training for oncologists, such as a multiday course he helped develop that involves lectures, group discussions and exercises using standardized patients.

Beyond oncology

Incorporating audio recordings of physician-patient encounters into teaching modules for those doctors also can be used to help specialists outside oncology. Dr. Tulsky and his team are testing the effectiveness of a program designed to help family physicians and pediatricians improve their healthy-weight counseling for overweight and obese teenage patients.

"We were drawn to oncology because the stakes are so high and so obvious. Everyone recognizes that cancer is a serious illness, and it's natural to assume high levels of distress in cancer patients," said Dr. Tulsky, a general internist who directs the Duke University School of Medicine Center for Palliative Care in North Carolina. "That said, we are now moving into work with other specialists, such as nephrologists, geriatricians and cardiologists. We could easily adapt the kind of work we did in this CD-ROM to any of those groups."

Even with extra training, physicians often are reluctant to express empathy, responding to patients' emotions less than once every other visit, the study found.

"Physicians are worried about opening up a huge can of worms," Dr. Tulsky said. But taking a moment to feel patients' emotional pain adds less than half a minute to the typical clinical encounter, he said, describing previous research.

"Empathy is a drug, and it doesn't take a lot to be effective," he added.