Year : 2019 | Volume
: 9 | Issue : 2 | Page : 104--107
Importance of empathy among medical doctors to ensure high-quality healthcare level
Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Sungai Besi, Kuala Lumpur 57000
Patients hunt for genuine empathy from their medical doctor. Empathy is an affective mode of understanding. Empathy involves being enthused by another's experiences. However, a leading group medical doctors defines empathy as 'the act of correctly acknowledging the emotional state of another without experiencing that state oneself'. Beyond the field of medicine, empathy is an approach to understanding that precisely involves emotional resonance. However, mentioned definition of empathy primarily gives emphasis to an intellectual component rather than emotional form. Medical educationist and medical professional bodies increasingly recognise the importance of empathy because there are a lot report published regarding poor empathy level among medical doctors. This article will try to discuss emphasising on educational intervention which improves empathy level and its influence on healthcare.
|How to cite this article:|
Haque M. Importance of empathy among medical doctors to ensure high-quality healthcare level.Adv Hum Biol 2019;9:104-107
|How to cite this URL:|
Haque M. Importance of empathy among medical doctors to ensure high-quality healthcare level. Adv Hum Biol [serial online] 2019 [cited 2019 Dec 15 ];9:104-107
Available from: http://www.aihbonline.com/text.asp?2019/9/2/104/257814
The Society for General Internal Medicine defines empathy as 'the act of correctly acknowledging the emotional state of another without experiencing that state oneself'.
A few quotes
‘When we honestly ask ourselves which person in our lives mean the most to us, we often find that it is those who, instead of giving advice, solutions or cures, have chosen rather share our pain and touch our wounds with a warm and tender hand. The friend who can be silent with us in a moment of despair or confusion, who can stay with us in an hour of grief and bereavement, who can tolerate not knowing, not curing, not healing and face with us the reality of our powerlessness, that is a friend who cares’.
‘Nothing is more important than empathy for another human being's suffering. Nothing – Not career, not wealth, not intelligence, certainly not status. We must feel for one another if we're going to survive with dignity’.
Sympathy and empathy frequently foggy with one another. These two words distinctly have separate meaning. Sympathy has been defined as 'an emotional response stemming from the apprehension of another's emotional state or condition that is not the same as the other's state or condition but consists of feelings of sorrow or concern for the other'. 'Empathy is the capability to share and appreciate the emotions of others imitates emotional understanding'. The implementation and utilisation of empathy are widespread in human life and especially crucial for patient care, where the efficient treatment outcome of patients hinges on operative patient–physician communications.,,,,, The word empathy denotes the skill to put yourself in the other shoes which is a fundamental skill of extraordinary power and to perceive and interpret what another person is feeling or maybe even thinking., Therefore, empathy is the ability to 'stand in the shoes of another', to consider a situation from someone else's point of view and thereby gain a greater understanding of their perspective which highly required medical science.
Clinical and healthcare professionals' empathy
Empathy, in relation to healthcare professionals, has been defined as an intellectual quality that permits an understanding of the experience, concerns and perspectives of a patient, as well as the skill to communicate that understanding.,,,, Furthermore, medical empathy has been described as an exclusive quality for all healthcare professionals, especially a physician as soon as understand patient's concept, impression, state of mind, and provides improved patient care. Empathy has been identified as the nucleus of the success of the health-giving activity.,,,, Empathy is also well-thought-out to be the major as an essential component for all health professionals.,,, Therefore, a group of scientists proposes that empathy is 'most powerful tool' for healthcare practitioners to maximise health system outcome as it is an essential component of medical 'professionalism'.
Empathy is one strong communication expertise, as it incorporates a linking and an understanding that comprises the mind, body and soul, and when used properly during a medical interview that is often misconceived and underutilised., 'The medical interview is the practicing physician's most versatile diagnostic and therapeutic tool. However, interviewing is also one of the most difficult clinical skills to master. The demands made by the physician are both intellectual and emotional'. Advantages of better-quality empathetic communication are noticeable for both clinician and patient as empathy cares patients' values, ideas and feelings beyond deductive logic, physical examinations and treatment., Subsequently, this highly effective and influential communication tool builds patient belief, reduces anxiety, improves patient satisfaction, increases adherence to treatment and fewer malpractice complaints, as well as increases physician health, well-being and professional satisfaction and improves health outcomes.,,
Clinical empathy is a firm supporter to develop a good rapport with the patient. Furthermore, a good rapport with the patient has been reported to have positively correlated with high levels of patient contentment and healthcare consequences., In-depth understanding clinical scenario and technical expertise are essential necessity of medical education and to be a high-quality medical doctor; conversely, interpersonal skills and empathy are progressively more documented as core clinical skills. Multiple research reported that clinical empathy level declines while getting more senior and older.,,,, Although ample research studies had demonstrated that more empathetic physicians achieves more professional success because of better treatment related outcomes., A systematic review among medical students and residents reported that empathy started to decline during medical schooling time and in the house-officership period. Thereafter, waning of professionalism leads to poor healthcare quality. It has been reported that both distress and well-being are related to medical student empathy. Furthermore, multivariate analysis measuring distress and well-being concurrently revealed that, both burnout (negative correlation) and well-being (positive correlation) independently correlated with student empathy scores. Another study revealed that scores suggestive of higher medical student burnout were related to poorer medical student empathy scores and inferior professionalism climate scores witnessed in medical students, interns and lecturers. This study utilised the Maslach Burnout inventory, the Jefferson scale of Physician Empathy - Student Version and the professionalism climate instrument. One more study concluded that improved understanding regaining how situational perspective influences the neuro-cognitive mechanisms to reinforce emotional sensitivity and empathy in medicine could contribute to inhibit serious health hazards and improves health professionals' rapport with patient and reputation. As empathy is a highly flexible and accommodative process that permits for the interplay of prosocial behavior in many different social contexts, afterwards, contextual alteration of empathy characterises an adaptive advantage, making the behavior more sensitive to different environment conditions.
A few quotes
'Medicine is an art whose magic and creative ability have long been recognised as residing in the interpersonal aspects of patient-physician relationship'.
'The patient will never care how much you know, until they know how much you care'.
'To attend those who suffer, a physician must possess not only the scientific knowledge and technical abilities, but also an understanding of human nature. The patient is not just a group of symptoms, damaged organs and altered emotions. The patient is a human being, at the same time worried and hopeful, who is searching for relief, help and trust. The importance of an intimate relationship between patient and physician can never be overstated because in most cases, an accurate diagnosis, as well as an effective treatment, relies directly on the quality of this relationship'.
'Every patient wants their doctor to be academically prepared – To know the medicine that they need to know,… but equally important, they want their doctors to have personal attributes that contribute to their professionalism – What a patient might call their bedside manner', that is the view of Dr. Darrell G. Kirch, AAMC President and CEO.,
A brief history
Doctor–patient effective communication concept is some 2500 years old. Hippocrates suggested that doctors may influence patients' health.,, Astoundingly, the hippocratic model is reflected in the hippocratic oath, which emphasises on the trustworthiness of the profession, compassion and human generosity in the practice of medicine., The proficient clinician has a bedside manner that is humanitarian, concerned, empathetic and helpful.
Empathy intervention, medical students and doctor
Quite a few research studies recommend that the eating away of empathy begins in medical school, with the shrillest deterioration in the year III, when most students begin their clinical clerkship and interacting with patients in the hospital., However, one recent educational interventional study found that Jefferson Scale of Empathy score improved rather than declined. In addition, there was a statistically significant (P < 0.001) increase in Groningen Reflection Ability Scale (GRAS) scores. The GRAS was developed to measure the personal reflection ability of medical students. One systematic review studied the full texts of 18 articles (15 quantitative and 3 qualitative studies) and concluded that educational mediations were effective in preserving and promoting empathy in undergraduate medical students. Another systematic review comprising of 64 studies initiate valuable understanding regarding empathy intervention research literature and suggested that targeted interventions had potential to nurture physician empathy. Several original research studies furthermore reported that empathy level could be improved through empathy education.,,
'Humanists, ethicists, and social scientists agree that empathy is critical – And very often lacking – In medical care'. Furthermore, evidence recommends that doctors with advanced empathy levels – denotes that they are responsive of their patients' emotional requirements and answer applicable to patients' distresses – experience a lesser amount of stress, cynicism and burnout than those with less empathy. Subsequently, medical educators, the authority of schools and overall society are highly concerned about the empathy in doctor–patient relationships.,,, Multiple research studies recommended that careful educational intervention restores high empathy level among medical students and physician to protect good rapport among doctors and patients.,
Empathy and professionalism should need to be protected and enhanced to safeguard healthcare globally. Enhanced level empathy will ensure safety measure for physician from burnout. Thereafter, medical schools need to act positively to nurture empathy in both students and physicians.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
|1||Markakis K, Frankel R, Beckman H, Suchman A. Teaching Empathy: It can be Done. Working Paper. San Francisco, CA, USA: The Annual Meeting of the Society of General Internal Medicine; 1999.|
|2||Nouwen HJ. Out of Solitude: Three Meditations on the Christian Life. Revised Edition. Indian, USA: Ave Maria Press, Notre Dame; 2004.|
|3||Hepburn A. Quotes. AZ Quotes. Available from: http://www.azquotes.com/quote/1160191. [Last accessed on 2018 Mar 24].|
|4||Eisenberg N, Michalik N, Spinrad TL, Hofer C, Kupfer A, Valiente C, et al. The relations of effortful control and impulsivity to children's sympathy: A longitudinal study. Cogn Dev 2007;22:544-67.|
|5||The Conversation. Understanding Others' Feelings: What is Empathy and Why Do We Need It; 2017. Available from: https://www.theconversation.com/understanding-others-feelings-what-is-empathy-and-why-do-we-need-it-68494. [Last accessed on 2018 Mar 24].|
|6||Elam CL. Use of “emotional intelligence” as one measure of medical school applicants' noncognitive characteristics. Acad Med 2000;75:445-6.|
|7||Elam C, Stratton TD, Andrykowski MA. Measuring the emotional intelligence of medical school matriculants. Acad Med 2001;76:507-8.|
|8||Swasey ML. Physician and Patient Communication: A Grounded Theory Analysis of Physician and Patient Web-Logs. Master's Thesis for Arts in Professional Communication. Southern Utah University, USA; 2013. Available from: https://www.suu.edu/hss/comm/masters/capstone/thesis/swaseythesis.pdf. [Last accessed on 2018 Mar 25].|
|9||Eliassen AH. Power relations and health care communication in older adulthood: Educating recipients and providers. Gerontologist 2016;56:990-6.|
|10||Lichstein PR. The medical interview. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd ed., Ch. 3. Boston: Butterworths; 1990. Available from: https://www.ncbi.nlm.nih.gov/books/NBK349/. [Last accessed on 2018 Mar 25].|
|11||Stebbins CA. Enhancing Empathy in Medical Students Using FLEX Care™ Communication Training. Ph.D. Thesis. Iowa State University, Ames, IA 50011. USA; 2005. Available from: https://www.lib.dr.iastate.edu/cgi/viewcontent.cgi?article=2813&context=rtd. [Last accessed on 2018 Mar 25].|
|12||Ahrweiler F, Neumann M, Goldblatt H, Hahn EG, Scheffer C. Determinants of physician empathy during medical education: Hypothetical conclusions from an exploratory qualitative survey of practicing physicians. BMC Med Educ 2014;14:122.|
|13||Williams B, Brown T, McKenna L, Boyle MJ, Palermo C, Nestel D, et al. Empathy levels among health professional students: A cross-sectional study at two universities in Australia. Adv Med Educ Pract 2014;5:107-13.|
|14||Kataoka HU, Koide N, Ochi K, Hojat M, Gonnella JS. Measurement of empathy among Japanese medical students: Psychometrics and score differences by gender and level of medical education. Acad Med 2009;84:1192-7.|
|15||Sinclair S, Beamer K, Hack TF, McClement S, Raffin Bouchal S, Chochinov HM, et al. Sympathy, empathy, and compassion: A grounded theory study of palliative care patients' understandings, experiences, and preferences. Palliat Med 2017;31:437-47.|
|16||Halpern J. What is clinical empathy? J Gen Intern Med 2003;18:670-4.|
|17||Hojat M, Louis DZ, Maio V, Gonnella JS. Empathy and health care quality. Am J Med Qual 2013;28:6-7.|
|18||Hojat M, Gonnella JS, Nasca TJ, Mangione S, Vergare M, Magee M, et al. Physician empathy: Definition, components, measurement, and relationship to gender and specialty. Am J Psychiatry 2002;159:1563-9.|
|19||Hojat M, Gonnella JS. Eleven years of data on the Jefferson scale of empathy-medical student version (JSE-S): Proxy norm data and tentative cutoff scores. Med Princ Pract 2015;24:344-50.|
|20||Alcorta-Garza A, González-Guerrero JF, Tavitas-Herrera SE, Rodríguez-Lara FJ, Hojat M. Validación de la escala de empatía médica de Jefferson en estudiantes de medicina mexicanos. Educ Méd 2005;28:57-63.|
|21||Ted William Grubb. The Relationship between Therapist Empathy in Therapy and Nontherapy Settings and some Contributing Components to Empathic Understanding. Master's Thesis. University of Massachusetts Amherst, Amherst, MA 01003. USA; 1977. Available from: https://www.scholarworks.umass.edu/cgi/viewcontent.cgi?article=2711& context=theses. [Last accessed on 2018 Mar 25].|
|22||McGrane B. An Exploration of Sustaining Empathy in the Therapeutic Relationship. Master's Thesis. Dublin Business School, School of Arts, 13/14 Aungier Street. Dublin 2. Ireland; 2012. Available from: https://www.esource.dbs.ie/bitstream/handle/10788/481/ma_mcgrane_b.pdf?sequence=1&isAllowed=y. [Last accessed on 2018 Mar 25].|
|23||Spiro H. Commentary: The practice of empathy. Acad Med 2009;84:1177-9.|
|24||Colliver JA, Conlee MJ, Verhulst SJ, Dorsey JK. Reports of the decline of empathy during medical education are greatly exaggerated: A reexamination of the research. Acad Med 2010;85:588-93.|
|25||Wampold BE. How important are the common factors in psychotherapy? An update. World Psychiatry 2015;14:270-7.|
|26||Larson EB, Yao X. Clinical empathy as emotional labor in the patient-physician relationship. JAMA 2005;293:1100-6.|
|27||Weiner SJ, Auster S. From empathy to caring: Defining the ideal approach to a healing relationship. Yale J Biol Med 2007;80:123-30.|
|28||Sinclair S, McClement S, Raffin-Bouchal S, Hack TF, Hagen NA, McConnell S, et al. Compassion in health care: An empirical model. J Pain Symptom Manage 2016;51:193-203.|
|29||Hegazi I, Wilson I. Maintaining empathy in medical school: It is possible. Med Teach 2013;35:1002-8.|
|30||Hardee JT. An overview of empathy. Perm J 2003;7:51-4.|
|31||Stone J. The Importance of Empathy in Healthcare. Medical GPS; 2016. Available from: http://www.blog.medicalgps.com/the-importance-of-empathy-in-healthcare. [Last accessed on 2018 Mar 25].|
|32||Decety J, Fotopoulou A. Why empathy has a beneficial impact on others in medicine: Unifying theories. Front Behav Neurosci 2014;8:457.|
|33||Riess H, Kelley JM, Bailey RW, Dunn EJ, Phillips M. Empathy training for resident physicians: A randomized controlled trial of a neuroscience-informed curriculum. J Gen Intern Med 2012;27:1280-6.|
|34||Gleichgerrcht E, Decety J. Empathy in clinical practice: How individual dispositions, gender, and experience moderate empathic concern, burnout, and emotional distress in physicians. PLoS One 2013;8:e61526.|
|35||Hannah A, Lim BT, Ayers KM. Emotional intelligence and clinical interview performance of dental students. J Dent Educ 2009;73:1107-17.|
|36||Stewart MA. Effective physician-patient communication and health outcomes: A review. CMAJ 1995;152:1423-33.|
|37||Epstein RM, Hundert EM. Defining and assessing professional competence. JAMA 2002;287:226-35.|
|38||Sherman JJ, Cramer A. Measurement of changes in empathy during dental school. J Dent Educ 2005;69:338-45.|
|39||Hojat M, Mangione S, Nasca TJ, Rattner S, Erdmann JB, Gonnella JS, et al. An empirical study of decline in empathy in medical school. Med Educ 2004;38:934-41.|
|40||Nunes P, Williams S, Sa B, Stevenson K. A study of empathy decline in students from five health disciplines during their first year of training. Int J Med Educ 2011;2:12-7.|
|41||Ward J, Cody J, Schaal M, Hojat M. The empathy enigma: An empirical study of decline in empathy among undergraduate nursing students. J Prof Nurs 2012;28:34-40.|
|42||Neumann M, Edelhäuser F, Tauschel D, Fischer MR, Wirtz M, Woopen C, et al. Empathy decline and its reasons: A systematic review of studies with medical students and residents. Acad Med 2011;86:996-1009.|
|43||Hojat M, Louis DZ, Markham FW, Wender R, Rabinowitz C, Gonnella JS, et al. Physicians' empathy and clinical outcomes for diabetic patients. Acad Med 2011;86:359-64.|
|44||Del Canale S, Louis DZ, Maio V, Wang X, Rossi G, Hojat M, et al. The relationship between physician empathy and disease complications: An empirical study of primary care physicians and their diabetic patients in Parma, Italy. Acad Med 2012;87:1243-9.|
|45||Thomas MR, Dyrbye LN, Huntington JL, Lawson KL, Novotny PJ, Sloan JA, et al. How do distress and well-being relate to medical student empathy? A multicenter study. J Gen Intern Med 2007;22:177-83.|
|46||Brazeau CM, Schroeder R, Rovi S, Boyd L. Relationships between medical student burnout, empathy, and professionalism climate. Acad Med 2010;85:S33-6.|
|47||Cheng Y, Chen C, Decety J. How situational context impacts empathic responses and brain activation patterns. Front Behav Neurosci 2017;11:165.|
|48||Melloni M, Lopez V, Ibanez A. Empathy and contextual social cognition. Cogn Affect Behav Neurosci 2014;14:407-25.|
|49||Hall JA, Roter DL, Rand CS. Communication of affect between patient and physician. J Health Soc Behav 1981;22:18-30.|
|50||Tongue JR, Epps HR, Forese LL. Communication skills for patient-centered care: Research-based, easily learned techniques for medical interviews that benefit orthopedic surgeons and their patients. J Bone Joint Surg Am 2005;87:652-8.|
|51||Hellín T. The physician-patient relationship: Recent developments and changes. Haemophilia 2002;8:450-4.|
|52||Suttie J. Should We Train Doctors for Empathy; 2014. Available from: https://www.greatergood.berkeley.edu/article/item/should_we_train_doctors_for_empathy. [Last accessed on 2018 Mar 28].|
|53||Bazalgett P. The Empathy Instinct: How to Create a More Civil Society. London: John Murray Publishers; 2017.|
|54||Fabre J. Hip, hip, Hippocrates: Extracts from the hippocratic doctor. BMJ 1997;315:1669-70.|
|55||Kaplan SH, Greenfield S, Ware JE Jr. Assessing the effects of physician-patient interactions on the outcomes of chronic disease. Med Care 1989;27:S110-27.|
|56||Reiser SJ. What modern physicians can learn from hippocrates? Ethics Law Oncol 2003;98:1555-8.|
|57||Rothstein MA. The hippocratic bargain and health information technology. J Law Med Ethics 2010;38:7-13.|
|58||Jotterand F. The Hippocratic Oath and contemporary medicine: Dialectic between past ideals and present reality? J Med Philos 2005;30:107-28.|
|59||Silverman BD. Physician behavior and bedside manners: The influence of William Osler and the Johns Hopkins school of medicine. Proc (Bayl Univ Med Cent) 2012;25:58-61.|
|60||Batt-Rawden SA, Chisolm MS, Anton B, Flickinger TE. Teaching empathy to medical students: An updated, systematic review. Acad Med 2013;88:1171-7.|
|61||Hojat M, Vergare MJ, Maxwell K, Brainard G, Herrine SK, Isenberg GA, et al. The devil is in the third year: A longitudinal study of erosion of empathy in medical school. Acad Med 2009;84:1182-91.|
|62||Duke P, Grosseman S, Novack DH, Rosenzweig S. Preserving third year medical students' empathy and enhancing self-reflection using small group “virtual hangout” technology. Med Teach 2015;37:566-71.|
|63||Aukes LC, Geertsma J, Cohen-Schotanus J, Zwierstra RP, Slaets JP. The development of a scale to measure personal reflection in medical practice and education. Med Teach 2007;29:177-82.|
|64||Rosenthal S, Howard B, Schlussel YR, Herrigel D, Smolarz BG, Gable B, et al. Humanism at heart: Preserving empathy in third-year medical students. Acad Med 2011;86:350-8.|
|65||Kelm Z, Womer J, Walter JK, Feudtner C. Interventions to cultivate physician empathy: A systematic review. BMC Med Educ 2014;14:219.|
|66||Williams B, Brown T, McKenna L, Palermo C, Morgan P, Nestel D, et al. Student empathy levels across 12 medical and health professions: An interventional study. J Compassionate Health Care 2015;2:4.|
|67||Winefield HR, Chur-Hansen A. Evaluating the outcome of communication skill teaching for entry-level medical students: Does knowledge of empathy increase? Med Educ 2000;34:90-4.|
|68||Everhart RS. Teaching tools to improve the development of empathy in service-learning students. J High Educ Outreach Engagem 2016;20:129-54.|
|69||Sulzer SH, Feinstein NW, Wendland CL. Assessing empathy development in medical education: A systematic review. Med Educ 2016;50:300-10.|
|70||Garden R. Expanding clinical empathy: An activist perspective. J Gen Intern Med 2009;24:122-5.|
|71||Bates V. Yesterday's doctors: The human aspects of medical education in Britain, 1957-93. Med Hist 2017;61:48-65.|
|72||Harris J. Altruism: Should it be included as an attribute of medical professionalism? Health Prof Educ 2018;4:3-8.|
|73||Quince T, Thiemann P, Benson J, Hyde S. Undergraduate medical students' empathy: Current perspectives. Adv Med Educ Pract 2016;7:443-55.|