Physicians Build Less Empathy for Obese Patients

A new study suggests that primary care physicians (PCPs) built much less of an emotional rapport with their overweight and obese patients than with those of normal weight.

Researchers at Johns Hopkins University (JHU; Baltimore, MD, USA) used audio-recorded outpatient encounters from 39 urban PCPs and 208 of their patients to examine the frequency of their communication behaviors using the Roter Interaction Analysis System (RAIS). The independent variable was measured patient body mass index (BMI), while dependent variables were communication behaviors by the PCP within the biomedical, psychosocial/lifestyle, and rapport building domains.

The results showed that patient weight played no role in the quantity of physicians' medical questions, medical advice, counseling, or treatment regimen discussions. But when it came to demonstrating empathy, concern, and understanding, the PCPs were significantly more likely to express those behaviors in interactions with patients of normal weight than with overweight and obese patients, regardless of the medical topic being discussed. The study was published early online on March 20, 2013, in the journal Obesity.

“If patients see their primary care doctors as allies, I think they will be more successful in complying with our advice,” said lead author Kimberly Gudzune, MD, MPH. “I hear from patients all the time about how they resent feeling judged negatively because of their weight. Yes, doctors need to be medical advisors, but they also have the opportunity to be advocates to support their patients through changes in their lives.”

“If you aren't establishing a rapport with your patients, they may be less likely to adhere to your recommendations to change their lifestyles and lose weight,” continued Dr. Gudzune. “Some studies have linked those bonding behaviors with patient satisfaction and adherence, while other studies have found that patients were more likely to change their dietary habits, increase exercise, and attempt to lose weight when their physicians expressed more empathy. Without that rapport, you could be cheating the patients who need that engagement the most.”

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