Johns' ability to build relationships reverberates years later

The boy sat quietly in the doctor's office with his parents. His mother had a legal pad with a long list of questions. The doctor looked at the 15-year-old and started to talk: "You have a tumor in your mouth. That means a growth. It has to come out." He took his time explaining the surgery. Then he asked the boy: "Any questions?"

The mother went down her list, her voice catching in her throat. The doctor nodded and addressed each concern. Once again he addressed the boy: "Is there anything else you'd like to ask?"

Nearly a decade ago, the family had come to the specialist for his medical skill and his surgical technique. What they remember is the healing power of his talk.

"We knew he was a busy man. The waiting room was packed. But when we were in front of him, he was completely there for us," recalls the mother, my friend. "We were hanging on this man. Our hopes and fears resided in him. He carried that burden. We felt confident from then on."

Both patient and doctor have done well. The boy completely recovered and is in college.

The physician, Michael M.E. Johns, a specialist in head and neck tumors at Johns Hopkins School of Medicine, went on to become the school's dean. Last year he moved to Atlanta as chief executive officer of all health services at Emory, including the schools of medicine and nursing. He is editor of the Archives of Otolaryngology and a fellow of the American Association for the Advancement of Science.

But nowhere on his resume does it say "board certified in compassion." There is no medical journal entitled the "Archives of Empathy." And nowhere on a hospital bill is there a charge for what might be called verbal medicine.

Yet there is increasing evidence that talking to patients is a key element in the healing process. It is also essential to patient satisfaction-even when a treatment fails or recovery is not complete.

A new study, for example, shows that the way doctors talk to their patients during routine visits has a direct impact on whether they get sued for malpractice. As reported in a recent Journal of the American Medical Association, researchers analyzed the behavior of 124 physicians in Oregon and Colorado. Not surprisingly, the physicians who didn't get sued took more time with their patients and carefully explained the details of treatment, used humor in their conversations and elicited patients' opinions about their care.

"A warm relationship with the physician may make the patient feel that he or she is a real person in the physician's eyes, rather than a disease," conclude the researchers in the JAMA study.

Johns learned the lesson of empathy early in his career when his brother was diagnosed with leukemia and needed a bone marrow transplant. Johns became his brother's donor. "That helped me realize there are two sides to this and they had to intersect," he says. "I also realized that if patients ask questions and understand what is happening to them, they recover better. If patients are afraid-and if they don't understand something, they're more likely to be afraid-there's always a chance that the outcomes will be less," he says.

MD "empathologists" put themselves in their patients' shoes. This is often difficult for those trained to view illness with a detached, clinical eye. Johns remembers when his son, aged 9, was about to have an appendectomy-a minor procedure to a physician but not to the patient. The boy grabbed his father's hand and said: "Am I going to die, Daddy?"

"No one had talked to him," Johns recalls. "If you listen to patients' questions, you can help them manage their fears."

In recent years, empathy has made something of a comeback. Courses on the doctor-patient relationship have found their way into the curriculum of some medical schools.

But now as CEO of a major academic medical center, Johns believes the healing power of talk is once again on the endangered specialty list as the medical marketplace becomes more focused on the bottom line. In an era of managed care, the buzzword for restraining escalating costs and weeding out ineffective and unnecessary treatments is "efficiency."

And one way to increase efficiency is for physicians to see more patients in a day. But to many medical leaders, that means shorter office visits and less chance to listen for the telling details, hear the fear in a patient's voice or offer hope with thoughtful words. With the commercialization of medicine, "will anyone have the time" to dispense empathy? asks Johns. "If we look at the way managed care is going, we're talking about efficiency." The challenge, he says, is to make "talking [to patients] part of that efficiency."

Perhaps it's time to give empathy a monetary value. Maybe an "empathy tip" for hospitals and doctors-at the patients' discretion, but paid for by the health plan. In the long run, everybody would come out ahead. Patients would be more satisfied. Doctors and hospitals could boost their income with tips. Managed care plans, after initial outlays for tips, would save money in lower malpractice costs and perhaps lower hospitalization rates because plan members would heal better.

Good communication skills are not only good medicine-they are good for the bottom line.

Taken from the "Second Opinion" column by Abigail Trafford © Universal Press Syndicate. Reprinted with permission. All rights reserved. This article first appeared in The Washington Post.