Where Is The Care in Health Care? Needed: The Art of Persuasion

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Where Is The Care in Health Care? Needed: The Art of Persuasion

September 24, 2008 Persuasion 2

Dr. John Dye sent me a link to an interesting study in the Archives of Internal Medicine, titled Missed Opportunities for Interval Empathy in Lung Cancer Communication. The study suggests that surgeons and cancer specialists miss most opportunities to provide empathic responses to patient concerns. I think this is significant to explore, at least briefly, the role and power of empathy in our study of the art of persuasion.

The details of the study are as follows.  Researchers listened to 20 audio recordings made at a Veterans Affairs hospital, and identified 384 empathic opportunities between oncologists and men with lung cancer. An example would be a patient saying they felt overwhelmed, or sharing their intent to fight their difficult disease. And out of those 384 chances to provide patients with acknowledgement, encouragement, support or just a little human kindness, 39 of those opportunities were acted on. That’s 10% of the possible chances, which amounts to ‘cold comfort’ for struggling patients.

I suppose this isn’t really news. Not if you’ve been in a hospital, witnessed a few doctor patient interactions. My mother recently broke her hip, and I’ve spent the better part of about 2 weeks over the last month at her bedside getting a first hand look at what passes for health ‘care’ these days. I see understaffed and overworked healthcare professionals in a chain of command where the left hand doesn’t know what the right hand is doing, where everyone is afraid of missing something and therefore jumps to conclusions, where procedures replace common sense at every turn, and where the humanity implied in the word ‘care’ is the last thing considered rather than the first.

Meanwhile, the obvious meaning of care is not lost on the authors of the study, who write, “When patients get the empathy that stems from effective communication, they’re more satisfied and more likely to comply with treatment.”

Nor is it lost on Paul Schyve, chair of the AMA Ethical Force Program’s Oversight Body, “Communication breakdowns are the most common root cause of heath care errors that harm patients.”

What happened?  What’s happening?  How is it possible that the most obvious therapeutic modality, the human connection, has been replaced with such distance, calculation and regulation?

It’s the classic case of fear overwhelming reason.  Medicine, particularly in hospitals and nursing homes, is a life-and-death business.  It provokes fear at every turn by its very nature.  Demanding patients, demanding family members, and the demands of the effort required to manage multiple people with multiple problems in the presence of multiple opportunities for real harm and damage have taken their toll.

The sheer volume of what is required of these professionals distracts so many of them so completely from their humanity that it creates a vaccuum into which opportunistic organisms have replaced the opportunity for empathy.  It’s a sad situation.  My mom says her nursing home feels like a prison sometimes, and complains that she’s being tossed around like a sack of potatoes (her words.)  She has lost the ability to attend to the most basic things for herself, and is left to the not-so-tender mercies of the nursing and affiliated staff. I’ve met the people trying to meet her needs.  They are good people in a bad situation.  They are doing their best.  But it’s the luck of the draw, and the understanding of empathy is uneven.  Those who were good with people before have the better chance of offering some of that good now.  Those who lacked communication skill before this job find themselves resorting to their worst in the presence of all the pain and fear.

And me?  I’m on the sidelines at the moment.  As long as one of my family members can be at my Mom’s side, she’ll get most of her needs addressed.  But the floor she’s on has many rooms, and each room has an occupant who lives at the knife’s edge of hope and hopelessness.  And I can only hope for the opportunity to present my Psyc 604-Healthy Communication class to more people.   Because too many of these professionals are missing out on ounces of prevention and relying on pounds of unnecessary cure.  As is so often true in life, the solutions in low quality high stress high complexity situations are found in the simple things.

I’m interested in hearing your comments about doctors, other healthcare professionals and the healthcare system.  Me, I’m at the airport, heading home to sleep in the healthy environment that is my own bed, to celebrate my 59th birthday in the loving presence of my wife and friends.  I have my health.  I am incredibly fortunate to be able to think that and know it’s truth.

Be well,


P.S.  My free offer, a chance to listen to my $49 audio program on dealing with difficult people at no cost to you, is still available at LearnToPersuade.com.


2 Responses

  1. J.D. Meier says:

    Happy Birthday! The wisdom and experience you share shows you’re a fine wine — getting better with age.

    Somehow you write about the stuff I happen to be thinking about. Recently, I was remembering task-focused vs. people-focused. I was thinking about empathy — and how some people have a strength for it — and how it can be a strength or it can be their weakness — and drain them.

    I remembered a vague conversation from moons ago about how my Uncle had too much empathy to be some sort of cop (I forget the details). At the time, it didn’t make sense to me. Now it does. It can be tough — very draining — and even lead to bad decisions — if you have too much empathy in some situations.

    When my Dad sees soaps on TV, he just sees actors, flaws, and can’t suspend disbelief. When my Mom sees soaps, she *feels* their situation — she laughs, she cries, she’s with them. It’s quite the drain … or it’s quite the emotional roller-coaster ride. It’s not sympathy; it’s empathy.

    Long story short — it makes more sense to me now that certain professionals that have high demanding jobs, may rank low on the empathy scale (but be very task focused and be very effective in the domain knowledge). In those cases, it might make sense to have intermediaries that bridge and show the empathy. I didn’t realize how effective this pattern is until I looked back to my days in developer support. The engineers focused on problem resolution. The customer liaisons focused on customer empathy.

    When an intermediary’s not possible or feasible, then I think another approach is to teach people how to wear hats — and to put their empathy hat on when it makes sense, and to put another hat on when it gets in the way.

  2. Thanks J.D., for the comment.

    Interesting take on it. And yes, at least learn to change hats relational to context! Of course that requires behavioral flexibility, or ‘requisite variety,’ something sorely lacking in many competent professionals. You know, good at the technical stuff, but soft on the soft stuff.

    That’s one of the changes I like to bring about in my work with organizations. I think learning people skills, persuasion skills, listening skills, empathy skills, changes just about everything for the good.

    Thank you for the birthday wishes. My best to you

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