Listen-empathise-pause is a formula for success when talking to patients and their families, new research suggests.

While physicians often show empathy in discussion with patients, it may be hidden or negated by medical-speak, an analysis of case conferences from a US paediatric intensive care unit has revealed.

The research looked at 68 case conferences involving 30 physicians, 179 family members and other healthcare professionals, in which high stakes decisions were being made about paediatric care, most commonly involving tracheostomy placement.

In such times, families are under extreme stress and emotions are strong and need the empathy of their treating physician, write Tessie October from the Department of Paediatrics at George Washington University School of Medicine and co-authors wrote in the paper published in JAMA Open Network.

They found the found the physicians responded to emotional cues two thirds of the time with an empathetic statement that fits with the NURSE model (naming, understanding, respecting, supporting and exploring).

Physician responses were especially beneficial when the empathetic response was “unburied”, meaning they paused afterwards, allowing the family to reveal more about their motivations, fears worries or hopes.

However, just over one third of doctors’ empathetic statements were being “buried” effectively shutting down the opportunity for a deeper communication.

“How physicians bury empathy is predictable,” the authors write. “It was most commonly buried within complex medical talk or attached to medical statements with a “but”….We suspect physicians use medical talk or ‘but’ to quickly attempt to address the emotion then return to what is most comfortable.”

The authors also identified that one in four times (26%) a physician missed an opportunity to respond with empathy to an emotion expressed by a family member, by either ignoring or negating the statement, changing the subject or responding with medical information.

In one example given, a family member said “That’s the only option. It’s either [the tracheostomy] or he passes away and I don’t think that’s fair to him” to which the doctor replied: “Do you have family down in [location]?”

The researchers did not find a relationship between the physician’s specialty, gender, or length of time in practice.

Incorporating empathy into communication builds the physician-family relationship, helps physicians make treatment recommendations, and has been linked to patient satisfaction, better health outcomes and reduced physician burnout, write Dr October et al.

Using unburied empathy may be an effective strategy to ensure families feel heard and present an opportunity for the physician to learn values most important to the family.

Meanwhile, the study suggests when physicians bury their empathetic response families may not hear the doctor’s attempt to connect with them.

“Our results offer practical guidance for physicians to consider when communicating with families. Using NURSE statements and stopping to allow time for a response helps to connect with families and share their experience. Limiting talk, using open-ended questions to explore emotions and reducing physician-to-physician interruptions can provide opportunities to learn new information about patients and their families.

“Most importantly, listening to patients and their families allows physicians to avoid missed opportunities to deepen the discussion.”