Fast Fact and Concept #29: Responding to patient emotions

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Title: Fast Fact and Concept #29: Responding to patient emotions

Author(s): Bruce Ambuel, PhD; David E. Weissman, MD

Listening to, recognizing, and responding to patient emotions is an essential skill for physicians who care for dying patients. We often think of this skill as innate-either we have the skill as an attribute of our personality, or we don't. In fact the skill of responding empathetically to patient emotions can be learned. Here are 8 tasks that guide you in responding to patient emotion:

Listen to the patient. Listen; Do not interrupt while the patient is talking. Patients and families facing end-of-life decisions want an opportunity to talk with their doctor about what they are thinking and feeling.

Listen to yourself. Be aware of your own emotions. Your feelings of sadness, anger, anxiety, fear or happiness are often the first clue that a patient is communicating an important emotional message. Avoid the trap of quickly acting on your emotions. For example, if you find yourself feeling angry, do not tell the patient you are angry; instead use your feeling of anger as a cue to find out more about what the patient is saying.

Reflect thoughts, feelings and behavior. Reflection means re-stating what a patient has said using their own words and phrases. Reflection 1) tells the patient that you are listening and care, giving permission to discuss sensitive topics; 2) allows the patient to listen to their own thoughts, heightening their self-awareness; 3) allows the patient to confirm, correct or amplify upon your understanding.

Example #1: Reflecting thoughts:

Patient: "This is a tough decision... I just can't decide whether I want to enter a hospice program or continue with chemotherapy."

Physician: "You are having a hard time deciding between hospice and chemotherapy."

Example #2: Reflecting emotions:

Patient: "I've been feeling run down and discouraged. I guess I'm a little overwhelmed."

Physician: "You have been feeling discouraged and overwhelmed ..."

Example #3: Reflecting behavior:

Patient begins to cry.

Physician: "I see that you are crying..."

Affirmation & respect. Patients and families take a risk when they share their emotions; affirm and support the patient. Examples: Thank you for sharing your feelings and thoughts; or, I'm glad that you are talking with me about your feeling; or, I can do a better job as your doctor when I know how you are feeling.

Empathic curiosity. Be curious and request more information: I'd like to know more about this...; or Please tell me more about the sadness you are feeling ....

Summarize/paraphrase. Restate the patient's story in your own words. In contrast to reflection, paraphrase and summary involves interpretation and condensation of the patient's narrative. An effective comment is brief yet captures essential meaning and emotion. We have been talking for awhile about how things are going for you. Let me see if I can summarize what you have said, then you can let me know if I'm on track ....

Make a plan. Sometimes a patient simply wants to talk about their feelings; other times, action may be important. Possible action steps include making changes in how you and the patient communicate, helping the patient identify sources of social support, and changing the plan of care. Find out what the patient is expecting-How can I help? or, What, if anything, would make a difference for you?

8. Offer Follow-up

I would like to check in with you next week and see how things are going. In the mean time, please let me know if you need to talk before then, OK?


{ ADDIN ENBbu }Egener, B. (1997). Empathy. Behavioral Medicine in Primary Care: A Practical Guide. M. D. Feldman and J. F. Christensen. Stamford, Connecticut, Appleton & Lange: 8-14.

Cole, S & Bird, J. (2000). The Medical Interview: The Three Function Approach. Second Edition. St. Louis, Missouri, Mosby.

Fast Facts and Concepts was originally developed as an end-of-life teaching tool by Eric Warm, MD, U. Cincinnati, Department of Medicine. See: Warm, E. Improving EOL care--internal medicine curriculum project. J Pall Med 1999; 2: 339-340.

Copyright Notice: Users are free to download and distribute Fast Facts for educational purposes only. Citation for referencing: Weissman DE. Fast Facts and Concepts #29: Responding to Patient Emotions, December, 2000. End-of-Life Physician Education Resource Center www.eperc.mcw.edu.

Disclaimer: Fast Facts provide educational information, this information is not medical advice. Health care providers should exercise their own independent clinical judgment. Some Fast Fact information cites the use of a product in dosage, for an indication, or in a manner other than that recommended in the product labeling. Accordingly, the official prescribing information should be consulted before any such product is used.

Creation Date: 12/2000

Format: Handouts

Purpose: Instructional Aid, Self-Study Guide

Training: Fellows, 1st/2nd Year Medical Students, 3rd/4th Year Medical Students, PGY1 (Interns), PGY2-6, Physicians in Practice
Specialty: Anesthesiology, Emergency Medicine, Family Medicine, General Internal Medicine, Geriatrics, Hematology/Oncology, Neurology, OB/GYN, Ophthalmology, Pulmonary/Critical Care, Pediatrics, Psychiatry, Surgery
Non-Physician: Clergy/Chaplains, General Public, Graduate Students, Lawyers, Patients/Families, Nurses, Social Workers

ACGME Competencies: Interpersonal and Communication Skills, Patient Care

Keyword(s): Communications skills, Death pronouncement, Discussing hospice care, Family conference, Giving bad news, Negotiating treatment goals, Personal reflection, Prognosis

The Fast Facts series is distributed for educational use only and does not constitute medical advice. For the most current version of Fast Facts visit the EPERC web site at www.eperc.mcw.edu. This mirror version is provided subject to copyright restrictions for educational use within the Inter-Instutional Collaborating Network on End-of-Life Care (IICN).