talking to your doctor

Empathy in Patient-Centered Medicine

David Mendosa Health Guide September 25, 2012
  • When I moved to Colorado in 2004, one of my problems was finding a whole new set of doctors. In addition to a primary care physician, I had to find an ophthalmologist, a dermatologist, a podiatrist, a chiropractor, a dentist, and other specialists for passing problems. I didn’t even try to find an endocrinologist here. I can remember at least 20 doctors who treated me in the past eight years.

    Ever since I began to manage my diabetes I have been extraordinarily healthy. So that’s not why I am so familiar with doctor’s offices. All of us who have diabetes need a primary care physician and some of these specialists. The main reason why I kept changing doctors was because I didn’t like a lot of them.


    Finally, I like all of them who I go to now. I even count two of them, my primary care physician and my chiropractor, as personal friends. My current medical team consists of six essential doctors.

    But the great number of doctors that I have run through led me to wonder if perhaps I was being too picky. Maybe, I reflected, I shouldn’t use how well we get along as one of my criteria.


    But a new study validates my feelings about the doctors who I engage to treat me. Empathy between doctor and patient, it turns out, does have a lot to do with how well we do.

    Actually, the study shows that when our doctors have more empathy to us we do better than when our doctors have low empathy scores. Since their empathy plays a huge role in how much we like then, I now feel justified in seeking out doctors I like.

    They base this large study on a well-validated questionnaire called the Jefferson Scale of Empathy. The doctors gave numerical answers to 20 questions that show how much they understand our worries, concerns, pain, and suffering as well as their ability to communicate this to us.

    The study included 242 doctors who treated 20,961 patients in Italy who have diabetes and compared outcomes, specifically what they called “acute metabolic complications.” Specifically, they tracked the rate of high blood sugar, extremely low insulin production, and diabetic comas among the patients of these doctors. The level of complications among those people with diabetes who went to the doctors with the greatest empathy was about two-thirds that of those whose doctors scored lower on the questionnaire.

    Researchers from Thomas Jefferson University in Philadelphia conducted the study. The full-text is online in the September issue of Academic Medicine.

    The empathy that our doctors have with us is an important facet of patient-centered medicine, which the medical profession is beginning to seriously consider. I just returned home from participating in a review of a joint position statement about it by the American Diabetes Association and the European Association for the Study of Diabetes. I served as the patient advocate and only person with diabetes on a panel of 18 medical professionals that considered how best to teach this new emphasis to other doctors.


  • The ADA published this position statement in the June issue of Diabetes Care. The full-text is online at “Management of Hyperglycemia in Type 2 Diabetes: A Patient-Centered Approach.”


    This position statement says in one place that, “These recommendations should be considered within the context of the needs, preferences, and tolerances of each patient.” The cornerstone of success, it adds, is  “individualization of treatment.”

    When I mentioned to some of my friends who have diabetes that are doctors are beginning to think along these lines, the universal response was something along this line: “Of course! What took them so long?”

    I agree and have often said that we have to think of our doctors as working for us, since they are our consultants who we pay for services. But the point is that they are beginning to recognize this fact and that they are changing for the good.

    One of the doctors in the panel where I served as the patient advocate wrote me afterwards that while he knows how vitally important it is that they understand the medicine, he recognizes that many doctors miss the personal part of patient care.

    “We have so much to learn in medical school, but how to act therapeutically is the most important part,” he continued. For example, “I can tell someone the exact same words in two different manners and have a very different therapeutic impact.”

    This doctor gets it. He will be going out now to spread the word to his peers.

    He has empathy and a patient-centered approach. I like him. Unfortunately for me his practice is a long way from where I live, but fortunately I’ve finally found great doctors here.

    How do you like the people in your medical team?