How clinicians respond to patients’ emotions may impact length of visit, study shows
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In-person clinic visits were shorter when clinicians explicitly responded to patients’ emotional expressions, according to an observational analysis published in Annals of Family Medicine.
“Physicians have traditionally been taught that expressing empathy saves time in patient encounters, but many physicians still feel that doing so may take more time,” Mary Catherine Beach, MD, MPH, a professor of medicine at Johns Hopkins University, told Healio Primary Care. “I was curious to figure out what accounts for that disconnect, and to learn how our responses to patient emotions might impact the length of the visit.”
![An infographic with a quote that reads “Paying attention to patient emotions and explicitly addressing [these] emotions can save time." The source of the quote is: Mary Catherine Beach, MD, MPH.](/~/media/slack-news/fm_im/misc/infographics/2021/december/pc1221beach_graphic_01_web.jpg?w=800)
Beach and colleagues audio-recorded and timed primary care visits conducted by 41 clinicians for 342 patients who had been in HIV care for at least 6 months. The researchers characterized clinician responses to patient emotions and determined whether the clinician was explicit or nonexplicit in addressing emotions and whether the clinician gave the patient space.
“Providing space for patients essentially just means responding in such a way as to facilitate the patient talking more about their emotional experiences,” Beach said. “For example, giving someone advice about how to manage an emotional situation (which may or may not be helpful depending on the specific context) is not an example of providing space because it does not facilitate the patient talking about the situation. But asking questions or backchanneling does facilitate the patient talking about the situation.”
Beach and colleagues reported that the mean visit length was 30.4 minutes. Among the 1,028 emotional expressions that were identified, most clinicians responded by providing space (81%) and were nonexplicit in their response (56%). The longer a patient’s visit, the less likely a clinician would provide space (OR = 0.96; 95% CI, 0.95-0.98) and the more likely the clinician was explicit (OR = 1.02; 95% CI, 1-1.03). A patient’s emotions were more likely to be repeated when clinicians provided space (OR = 2.33; 95% CI, 1.66-3.27). Conversely, the patients’ responses were less likely to be repeated when clinicians were explicit (OR = 0.61; 95% CI, 0.47-0.8).
“Paying attention to patient emotions and explicitly addressing [these] emotions can save time,” Beach said.
She added that it is important for clinicians to consider “how best to use the time that we have rather than necessarily spending more time with each patient.”
“Our study suggests that it takes more time to provide space for patients to talk about their emotions,” she continued. “If there is a benefit to doing so (and we suspect there well may be), then it might be time worth spending. However, we did find that it seems to take less time to be explicit in response to patient emotional expressions.”
In a related editorial, Kenneth W. Lin, MD, MPH, a physician at Georgetown University Medical Center, said that clinicians need to decide for themselves which is more important: shorter appointments with more patients or longer appointments with fewer patients.
“Readers can judge if saving about 2 minutes per visit is worth what was potentially lost in these encounters,” he wrote.
References
Beach MC, et al. Ann Fam Med. 2021;doi:doi.org/10.1370/afm.2740.
Lin KW. Ann Fam Med. 2021;doi.org/10.1370/afm.2752.
Perspective
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Health care providers are often caught between being accurate and being efficient while attending to patients. Providing empathy to their emotions during clinical encounters is often construed as time-consuming. However, other than managing medical conditions, it is necessary for clinicians to attend to patients as humans too.
This unique study by Beach and colleagues examined the effects of various clinician responses to a patient’s emotions, with a focus on the length of a clinical encounter. It is an eye-opener and reinforces that addressing and acknowledging patients’ feelings and concerns are crucial. I believe that missing such opportunities can distort physician-patient relationships and diminish patients’ confidence in their providers. Clinician responses in the form of explicit empathy are associated with a decrease in the repetition of emotional expressions and hence shorter visit time.
A surprising finding in this study was that providing space for the patients to express (clinician’s non-explicit empathy) is associated with repetition of patient’s expressions and lengthier visit time. Teaching such communication skills during medical education is essential for future physicians to achieve higher patient satisfaction during clinical practice.
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