Making space for emotions – a continuing challenge for neurologists

Studies have shown that having the chance to express emotions during healthcare appointments helps people to cope with their condition and with life,1 and enhances collaboration with their healthcare professionals.2 But how often are people given this chance in practice?

Researchers at four different multiple sclerosis (MS) centres in Italy recorded 88 conversations involving people who were having their first appointment with a neurologist (with permission from all involved). They listened for moments when a sensitive response would be helpful. In particular, they noted when the person directly mentioned an emotional concern or provided an emotional cue – such as a hint about a hidden worry or a mention of something they’d found stressful. In most cases, they found that neurologists reacted to emotional cues and concerns by reducing the opportunity for dialogue. For over half of cues and three-quarters of concerns, they gave medical advice or general reassurance, changed the subject, devalued the emotion or took no notice of what had been expressed.

Responding sensitively to expressions of emotion is an essential part of involving people in shared decisions about their treatment. The researchers therefore concluded that neurologists need to be empowered with better skills in communication and shared decision-making, which should be taught at all levels of medical training.3 This is in line with the recommendation made in Brain health: time matters in multiple sclerosis of implementing a shared decision-making process that embodies dialogue between people with MS and healthcare professionals.


1. Little P, Everitt H, Williamson I et al. Observational study of effect of patient centredness and positive approach on outcomes of general practice consultations. BMJ 2001;323:908–11.

2. Davenport S, Goldberg D, Millar T. How psychiatric disorders are missed during medical consultations. Lancet 1987;22:439–41

3. Del Piccolo L, Pietrolongo E, Radice D et al. Patient expression of emotions and neurologist responses in first multiple sclerosis consultations. PLoS ONE 2015;10:e0127734.

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