A model of empathic communication in the medical interview

A. L. Suchman, K. Markakis, H. B. Beckman, Richard Frankel

Research output: Contribution to journalArticle

470 Citations (Scopus)

Abstract

Objective.-To formulate an empirically derived model of empathic communication in medical interviews by describing the specific behaviors and patterns of interaction associated with verbal expressions of emotion. Design.-A descriptive, qualitative study of verbal exchanges using 11 transcripts and 12 videotapes of primary care office visits to a total of 21 physicians. Setting.-An urban health maintenence organization (HMO), an urban university-based general medicine clinic, and an urban community hospital general medicine clinic. Analytic Method.-Individual review of transcripts by each research team member to identify instances of expressed or implied emotional themes and to observe the physicians' responses. Individual ratings were compared in group discussions to achieve consensus about the classifications. Similar consensus-based classification was used for review of videotapes. Results.-We observed that patients seldom verbalize their emotions directly and spontaneously, tending to offer clues instead. If invited to elaborate, patients may then express the emotional concern directly, and the physician may respond with an accurate and explicit acknowledgment. In most of the interviews, the physicians allowed both clues and direct expressions of affect to pass without acknowledgment, returning instead to the preceding topic, usually the diagnostic exploration of symptoms. With emotional expression so terminated, some patients attempted to raise the topic again, sometimes repeatedly and with escalating intensity. We noted a parallel dynamic for encounters in which patients sought praise. We summarized the full interactional sequence in a simple descriptive model. Conclusions.-This empirically derived model of empathic communication has practical implications for clinicians and students who want to improve their communication and relationship skills. Based on our observations, the basic empathic skills seem to be recognizing when emotions may be present but not directly expressed, inviting exploration of these unexpressed feelings, and effectively acknowledging these feelings so the patient feels understood. The frequent lack of acknowledgment by physicians of both direct and indirect expressions of affect poses a threat to the patient-physician relationship and warrants further study.

Original languageEnglish (US)
Pages (from-to)678-682
Number of pages5
JournalJournal of the American Medical Association
Volume277
Issue number8
StatePublished - 1997
Externally publishedYes

Fingerprint

Emotions
Communication
Interviews
Physicians
Videotape Recording
Consensus
Community Medicine
Hospital Medicine
Urban Health
Office Visits
Physician-Patient Relations
Urban Hospitals
Community Hospital
Primary Health Care
Medicine
Students
Research

ASJC Scopus subject areas

  • Medicine(all)

Cite this

A model of empathic communication in the medical interview. / Suchman, A. L.; Markakis, K.; Beckman, H. B.; Frankel, Richard.

In: Journal of the American Medical Association, Vol. 277, No. 8, 1997, p. 678-682.

Research output: Contribution to journalArticle

Suchman, AL, Markakis, K, Beckman, HB & Frankel, R 1997, 'A model of empathic communication in the medical interview', Journal of the American Medical Association, vol. 277, no. 8, pp. 678-682.
Suchman, A. L. ; Markakis, K. ; Beckman, H. B. ; Frankel, Richard. / A model of empathic communication in the medical interview. In: Journal of the American Medical Association. 1997 ; Vol. 277, No. 8. pp. 678-682.
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