"Isn't there anything more you can do?": When empathic statements work, and when they don't.

The query, "Isn't there anything more you can do?" represents a classic informational question with an emotional subtext. In our previous work we have emphasized the value of noticing the emotional cue implicit in this question, and responding with an empathic statement. Yet responding explicitly to patients' emotions is not the best initial communication strategy for all patients. In this paper we discuss four different opening communication strategies--verbalize empathy, exchange information, contain chaos, respect searching--for patients who ask, "Isn't there anything more you can do?"