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Bedside manners: Can empathic communication be taught?

Network - Fall 2012

By Mary Brolley

Walter Baile, M.D., remembers the moment he discovered his passion. 

“A patient with metastatic breast cancer came to my clinic for counseling. She’d recently been told by her physician that her cancer had recurred. When she got this news, she was understandably upset and began to cry.

“She said he told her that if she didn’t stop crying, he’d leave the room,” Baile, professor in the Department of Behavioral Science, recalls with amazement.

As a psychiatrist treating cancer patients, he’d heard many stories from distraught patients about physicians who’d told them in blunt terms that further treatment would be futile.

“Some just told them it was the end of the line, or to get their affairs in order. One doctor told a patient that he wouldn’t touch his case ‘with a 10-foot pole.’” So Baile decided to do something about it. He began to design a training course for physicians and health care professionals to help them communicate more compassionately and effectively with patients.

‘A different set of skills’

Walter Baile, M.D.

Called Interpersonal Communication and Relationship Enhancement — I*CARE for short — the program provides guidelines and video demonstrations for medical professionals on how to empathize with patients and caregivers and communicate with honesty and concern.
In medical school, physicians are taught a set of specialized skills focused on treating the disease, Baile says.

“But, today more than ever, a different set of skills is required. Physicians need to know how to get into the shoes of the patient. Because so many cancers are treatable, patients have many other concerns than dying.”

Some of these are side effects, the impact of the cancer on the family, the ability (or inability) to work and the fear of recurrence.

“When doctors need to deliver bad news, it’s important for patients to feel supported. Physicians must acknowledge the feelings the patient is experiencing, and listening is an important first step,” Baile says.

A fundamental goal of the program is to strengthen relationships between patients and physicians. Establishing trust early by listening and conveying empathy is essential and will sustain the patient and family when things aren’t going well — for example, the disease has recurred or progressed, side effects are worsening or chemotherapy or targeted therapies aren’t working.

A resource for medical staff, volunteers, patients

The I*CARE team has conducted workshops for more than 1,000 oncology care providers at MD Anderson and beyond. It breaks down communication into specific skills applicable to physicians, physician assistants, nurses, patient advocates, chaplains, patient volunteers and others.

Today, the program’s website is a rich resource for clinicians all over the world. A video series called the MD Anderson Library of Clinical Communications Skills covers the fundamental principles of communication and such topics as acknowledging emotions, breaking bad news,transition to palliative care, end-of-life care, disclosing medical errors and additional difficult conversations that occur when someone has a life-threatening illness.

The videos feature experts from universities and medical schools all over the United States and in several other countries. However, while videos and explanations can provide guidelines, hands-on instruction through interactive workshops can lead to more sustainable acquisition of these skills.

So the I*CARE team provides custom workshops for internal and external audiences, such as the one Baile’s team developed for MD Anderson’s Department of Volunteer Services. It trains volunteers and the supervisors who manage them, says Mary Donnelly Jackson, program manager in the department.

Baile worked with Jackson and Jacquié Frelow, volunteer coordinator, to create a workshop for volunteers who interact with patients and families going through emotional crises.

Jackson also uses the I*CARE videos as continuing education tools for volunteers who must complete annual training modules. The videos have helped them sharpen crucial skills in assisting patients in distress without overstepping boundaries.

“Working with Dr. Baile and the I*CARE team has been a great experience,” Jackson says. “The response from volunteers is so positive. They’re so impressed with the quality of the videos that we’re offering them year-round now.”

Baile says it’s been heartening to see the program’s growth and success. “I’ve taught courses in Italy, Germany, Japan and Portugal,” he says. “Except for some cultural differences, health care professionals around the globe face similar communication challenges.

“At one time we withheld the truth about the disease from cancer patients. Now, however, the question has become not ‘whether to tell,’ but ‘how to tell and support the patient and family.’”

I*CARE also has resources for patients, survivors and caregivers. “Talking About the Side Effects of Cancer” (see Resources) offers an expert perspective on why it’s important to report side effects and how best to discuss them with your doctor. 
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© 2015 The University of Texas MD Anderson Cancer Center