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Neurologists Need to Better Empathize With MS Patients

Neurologists Need to Better Empathize With MS Patients

Neurologists need to improve their skills in dealing with patient emotions, according to a new study. Anxiety and depression are common in people with MS; however, neurologists may be less concerned with the emotional aspects of the disease than its physical manifestations.

The study

Researchers in Italy conducted a study to measure patient expressions of emotion during outpatient consultations and neurologist responses to those expressions. Patient and neurologist characteristics likely to affect both outcomes were also explored. Levels of anxiety and depression were measured in 88 patients with MS (or suspected MS) before an initial consultation with a neurologist. Consultations with 10 neurologists at four MS Italian centers were recorded and later analyzed for patient expressions of emotional cues or explicitly expressed concerns, spontaneous or elicited, and doctor response.

During the 88 consultants, patients expressed 492 cues and 45 concerns (median 4 cues and 1 concern per consultation). The most common cues were verbal hints to hidden concerns (41%), followed by neutral expressions referring to stressful life events/situations (26%). Patient anxiety was directly associated with emotional expressions, while older age of patients and neurologists, and second opinion consultants, were inversely associated with patient emotional expression.

Most of the time neurologists reacted to patient expressions of emotions by reducing the opportunity to explore the emotion (by changing the subject, ignoring the content of the cue, or giving medical advice) for 58% of cues and 76% of concerns. Doctors were more than twice as likely to give these ‘space reduction’ type responses when speaking with anxious patients.

Emotional cues and concerns

‘Concerns’ are clear, unambiguous verbalizations of unpleasant current or recent emotions, with or without an indication of their importance. ‘Cues’ are hints (verbal or nonverbal) which suggest an underlying unpleasant emotion. Cues/concerns can be expressed spontaneously by the patient or elicited by the healthcare provider. When a patient expresses cues/concerns spontaneously, the aim is often to bring up topics that have been neglected, or not adequately explored.

Cues can be divided into seven sub-categories:

  1. Words or phrases in which the patient uses vague or unspecified words to describe his/her emotions.
  2. Verbal hints to hidden concerns (emphasizing, unusual words, unusual description of symptoms, profanities, exclamations, metaphors, ambiguous words, double negatives, expressions of uncertainties and hope).
  3. Words or phrases which emphasize (verbally or non-verbally) physiological or cognitive correlates (regarding sleep, appetite, physical energy, excitement or motor slowing down, sexual desire, concentration) of unpleasant emotional states. Physiological correlates may be described by words such as weak, dizzy, tense, restless, or by reports of crying, whereas cognitive correlates may be described by words such as poor concentration or poor memory.
  4. Neutral expressions that mention issues of potential emotional importance which stand out from the narrative background and refer to stressful life events and conditions. This applies to non-verbal emphasis of the sentence, abrupt introduction of new content, pauses before or after the expression, or to a patient-elicited repetition of a previous neutral expression in subsequent turns.
  5. A repetition, with very similar words, of an expression said in a previous turn by the patient.
  6. Non-verbal clear expressions of negative or unpleasant emotions (crying), or hints to hidden emotions (sighing, silence after provider question, trembling voice, frowning, etc.).
  7. A clear and unambiguous expression of a concern, e.g., a previous mental state, a previous worry or fear, referring to a past episode, of more than four weeks ago or without a clear time frame.

Patient-doctor communication and patient-centered care

Communication between patient and physician improves when the physician recognizes and responds empathically to patient concerns. When communication is effective and the patient’s physical and emotional needs are addressed, patient outcomes are improved.

Patient: “I’m so lacking in energy. I can’t get up, I feel so low…”

Doctor: “That’s strange. Cortisone usually picks you up. You shouldn’t be feeling so low.”

Unfortunately, 75% of patient expressions of concern in this study were met by responses that limited further discussion or disclosure, particularly for anxious patients. Neurologists often switched the topic, devalued emotions, ignored the emotion, or gave generic reassurance.

Patient: “I often wonder why this had to happen to me. It’s horrible.”

Doctor: “Yes, but, it’s not the end of the world. It may seem serious, but I have many MS patients who lead normal lives.”

Giving information and advice (analyzed as reduction of space) is at the heart of the medical consultation. Nevertheless, authors state that helping patients to verbalize their feelings facilitates emotion regulation, predicts competent coping, generates greater patient satisfaction with interpersonal care, and increases collaboration.

Results from this study suggest that MS neurologists need to be empowered with better communication and shared decision-making skills. An integrated approach that combines evidence-based medicine with shared decision-making, arising from empathic listening, is essential for quality health care and should be taught at all levels of medical training.1

Lisa Emrich | Follow me on Facebook |Follow me on Twitter | Follow me on Pinterest

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

  1. Del Piccolo L, Pietrolongo E, Radice D, et al. Patient Expression of Emotions and Neurologist Responses in First Multiple Sclerosis Consultations. PLoS One. June 2015; 10(6):e0127734.


  • Azjackie
    3 years ago

    I would like when Neurologists go to their medical seminars to find time for a meeting relating to how their patients feel.

    I’ve not had the opportunity to have a Neurologist tell me kind words. Due to insurance changes I’ve seen 5 now and they act like they do not care. Appointments are rushed and words spoken rather hurtful, let’s keep you out of a wheelchair (while another patient is wheeling by), you have lesions all over your brain, and one watched me fall without rendering help. I travel 90+ miles to see them and usually resort to the car to cry before my 90+ mile trip home.

    If they just knew how we feel, our struggles…

  • eramosb
    3 years ago

    8 years ago, when I was diagnosed, I was very scared and, most probably, it showed. Then, as I was walking out of the examination room, my neurologist made this comment: “I can’t guarantee it but, based on your history, I think you will be fine. Don’t worry. We’ll help you when you have other relapses.” This comment made a huge difference for me. Despite starting with a caveat, the comment actually addressed the most pressing question in my mind: “is life as I know it over for me?” And I’ve stayed with this doctor. I haven’t had any noticeable symptoms in these 8 years and nobody knows for sure what the future holds, but, to this day, that one comment is what I remember the most. Showing empathy makes a difference.

  • Carol
    3 years ago

    That is a great comment, rather uplifting. I think my neurologist can be okay sometimes. When I went to him after my first MRI, probably my second or third appoointment, I didn’t know what to think. My husband had come to a few appointments with me. Neurologist was really concerned that my husband wasn’t there. Finally, he told me to pull my chair a little closer so I could see the MRI. All I saw was white things all over my brain and neck. He told me those were lesions and that I had MS. I screamed and cried, I don’t know what he said to me after he told me, but I was flooded with so many emotions. I cried all the way home on the bus. I then placed am emergency call to my Aunt to ask if we had MS in the family and did my mother know. Unfortunately, yes, it is in the family, her daughter was in a wheelchair and there were a couple of other cousins that had MS. And yes my mother knew about it and never said anything to anybody about it. Damn _itch took that secret to the grave.

  • Lisa
    4 years ago

    I have a particularly good neurologist and have enjoyed working with him since right after my diagnosis in 1999. The first neurologist I saw was not a good fit for for me. Lots of explanations about how this wasn’t that big a deal while I was crumbling in front of him. I have just found out that my current neurologist is leaving our particular system to do more teaching. This makes me very happy for him. I think he will be an awesome teacher. Perhaps he can pass along some of that patient/doctor relationship skill at which he excels. I am pretty sad and not looking forward to finding someone new.

  • Theresa
    4 years ago

    I feel lucky to have a great neurologist with whom I have a wonderful Dr./patient relationship. He actually had a hard time convincing me that I was depressed. I fought that diagnosis (& the RX that would eventually come with it) for embarrassment of the shameful stigma society has for depression. I realize now that I was in denial for that reason & because I was IN DENIAL about my MS as well, to some degree. If I was depressed about having MS then I was admitting to myself that the MS was a factor in my life. For a long time it wasn’t…for years it was “dormant”, “mild”…now it’s an issue. I’m dealing with it -with the help of my very compassionate, caring & understanding neurologist.

  • bjshockley
    4 years ago

    I had this problem with my supposed MS specialist. My appointments with him became useless. I no longer told him anything. If I acted emotional he told me I was crazy. I tried to get a different doctor and no other doctor in the HMO would take me because they wouldn’t step on his toes. Basically I went years without care because of him. I celebrated when he left our healthcare facilities.

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