GPs more empathetic than they think, new research shows

Despite having been a GP for 25 years, Dr Hester Wilson still evaluates her skills every time she sees a patient.
 
‘Because I am a high achiever, I am a little bit obsessive, I am a perfectionist, I always think I can do better,’ Dr Wilson told newsGP.
 
‘It’s not a bad thing to be a perfectionist and always be trying to do better.’
 
A new study by researchers in the Netherlands shows that Dr Wilson is not alone. The researchers found that when it comes to judging how empathetic they were in a consultation, GPs are harder on themselves than their patients.
 
Published in the British Journal of General Practice (BJGP), the study, which took place from December 2016 to February 2017, investigated the correlation between GP perception of delivered empathy and patient-perceived empathy.
 
Researchers found that GPs rate their delivered empathy during consultations consistently and significantly lower than their patients. And GPs’ impressions of the empathy delivered during the consultation do not predict the actual amount of empathy perceived by their patients.
 
The study, Differences between GP perception of delivered empathy and patient-perceived empathy: A cross-sectional study in primary care, obtained questionnaires from 147 consultations by 34 different GPs across 16 primary care practices, analysing all but four of the consultations.

Dr Hester Wilson has found patients are usually loyal and forgiving towards their GP.
 
Dr Paul Grinzi, a GP with special interest in addiction medicine, recently co-presented a workshop designed to help patients develop empathy.
 
He told newsGP there is no clear answer as to whether empathy can be taught.
 
‘Part of our workshop … was looking at how we as medical educators help registrars who were struggling with empathy,’ Dr Grinzi said.
 
‘There is certainly some skill development that can help them.’
 
Dr Grinzi said a key aspect of empathy is being able to understand the experience of the patient.
 
‘Part of our workshop was getting the participants to observe a consultation with the sound off. They observed and analysed their body language, then reported back on what parts of the consultation they felt the doctor was more empathetic and which ones they felt the empathy was lacking,’ he said.
 
‘They were things like mirroring the patients, leaning forward, good eye contact, facial expressions. All those things come to assist with the empathetic approach.’
 
Dr Grinzi said these methods are shortcuts and they do not necessarily make people empathetic.
 
‘They are tools to assist you,’ he said. ‘If you are aware that you need to be empathetic you can then start to focus on those [methods] and they will assist you.’
 
For the BJGP study, consultations were randomly assigned in advance and without GPs’ knowledge, with emergency consultations and home visits excluded for practical reasons.
 
Patients were asked by their GP to participate in the study at the end of the consultation. This prevented them from focusing more on empathy than they usually would during a consultation. If the patient agreed to participate, the researcher informed both the GP and patient whether their consultation had been assigned to the study, and if it had been they were consequently asked to fill in the questionnaire.
 
A maximum of five consultations were included per GP. Patients and GPs filled in the questionnaires separately, directly after the consultation.
 
The authors, who believe this is the first study of its kind, said lack of agreement on the level of empathy shown in consultation means that questioning GPs only on empathy in primary care consultations would not be sufficient to gauge patients’ perceptions.
 
‘The results of this study show that GPs and their patients disagree to some extent on the level of empathy during consultations,’ the researchers said.
 
‘Physicians should be made aware of this disagreement to give them more confidence in their empathic skills.
 
‘Given the therapeutic effects of empathy in the clinical encounter, GPs’ trust in their own empathic skills might result in even better person-centred communication and further enhancement of quality of care.’
 
The researchers also said the discrepancies and the differences found in this study show that studies using self-reporting to rate the health practitioner’s empathy may not accurately reflect actual patient-perceived empathy, and might therefore provide inaccurate results regarding the practitioner’s empathy and, consequently, its effectiveness.
 
They recommend further research using qualitative methods to find explanations for the different answers of GPs and patients.
 
Dr Wilson, who is Chair of the RACGP Specific Interests Addiction Medicine network, said it was a pleasant surprise to read the result of the study. She said patients generally rely upon their general sense of satisfaction when evaluating their GP.
 
‘Our patients are generally very loyal and forgiving for us,’ Dr Wilson said. ‘They value that relationship. And they value the relationship over time.
 
‘Also, we as practitioners over-estimate the need to do things, to be scientific, to find answers, to have the right treatment when, in fact, what our patients need is that human connection, that respectful professional who spends time with them [and] supports them.’

British Journal of General Practice empathy