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Physicians' Empathy
Can Ease Caregivers' Depression

March 21, 2000 PHILADELPHIA (AP) - David Grande knows how to heal broken bones, prescribe powerful drugs and perform surgery. Empathy, though, was only touched on briefly at his medical school. Yet doctors and student physicians like Grande who lend an empathetic ear to caregivers for the terminally ill can make a difference, according to a study published today.

"Doctors who really listen to patients and caregivers and spend time understanding, that lessens the burdens on caregivers. They feel heard. It's a key element to feeling supported," said lead researcher Ezekiel J. Emanuel of the Department of Clinical Bioethics at the National Institutes of Health.

Without doctors' intervention, caregivers to patients with a lot of physical needs were significantly more likely to be depressed, forced to take out loans to pay for health costs and deal with patients considering euthanasia or physician-assisted suicide.

In the study in today's issue of the Philadelphia-based Annals of Internal Medicine, 42 percent of caregivers with non-empathetic doctors reported depressive symptoms, compared to 27 percent of those with an empathetic doctor, the study showed.

Helping doctors empathize could be taught through a more formalized and structured curriculum during medical school, internships and residency trainings, the study said. Such teachings could make the dying experience more pleasant for everybody, Emanuel said. Caregivers with a good attitude could even make terminally ill patients feel less guilty about the pressures they may put others under.

Better training for doctors may also reduce the chances caregivers will undergo costly medical care for their own depression, he said. Too often, though, doctors aren't trained that way.

"In the later years, there were no role models practicing these things, so it's difficult to expect students to learn it and put those skills in action in their own practice," said Grande, president of the American Medical Student Association in Reston, Va.

Managed-care groups refer patients to community-based organizations that could provide such services without extra costs, said Mohit Ghose, spokesman for the Washington-based American Association of Health Plans, the largest trade group to represent managed care plans.

"But a study like this takes us into that next level of discussion on how to include such benefits in a standard package in taking care of hospice patients," he said.

The study was conducted in six randomly selected cities with 988 terminally ill patients with different illnesses and 893 caregivers. Previous studies showed that terminal illnesses create high economic burdens, but they did not say why. The latest study shows that high caregiving needs, like transportation, homemaking and personal care, are the driving cause behind a caregivers' depression and financial problems.

For the last 26 years, Suzanne Mintz, president of the National Family Caregivers Association in Kensington, Md., has been a caregiver to her husband who suffers from multiple sclerosis. She said the study is a wake-up call to physicians and HMOs.

"Although their legal responsibility is to the patient, the concept of illness and disability is a family affair," Mintz said.






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