Clinician views on optimism and empathy in primary care consultations

Background Practitioner expressions of optimism and empathy may improve treatment engagement, adherence and patient satisfaction but are not delivered consistently amidst the challenges of everyday clinical practice.

Aims To explore primary care practitioner (PCP) views about optimistic and empathic communication in consultations; and to identify behavioural, attitudinal and/or contextual issues likely to encourage or deter PCPs from practising such communication.

Design & setting Qualitative interview study with 20 PCPs (General Practitioners, Practice Nurses, Primary Care Physiotherapists).

Method Semi-structured telephone interviews with 20 PCPs. Data was analysed thematically.

Results A conceptual mismatch between optimism and patient expectations became apparent; when asked how PCPs communicate about the likely effects of a treatment answers were focussed around managing patient expectations. When prompted, it became clear PCPs were open to communicating optimistically with patients, but emphasised the need for realism. Concerns arose that patients may not be receptive to optimistic messages, especially when holding negative expectations. PCPs felt that expressing empathy is fundamental to all clinical consultations, noting that it can be challenging. Some PCPs worried that increasing expressions of empathy might increase their risk of clinician burnout and felt guilty about (appropriately) communicating empathy whilst maintaining some emotional distance.

Conclusion PCPs agreed expressing realistic optimism during consultations could aid communication and would constitute a novel change to practice. PCPs strive for clinical empathy but can struggle to manage emotional self-protection. Specific training to help PCPs express realistic optimism and empathy, and better utilise efficient non-verbal skills could help these issues.