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Thoughts on Empathy

Tuesday, May 30, 2023


A recent publication in the journal Health Services Research A systematic review of research on empathy in health care provides a helpful summary of the past fifty-years of research regarding “empathy.”  This important and timely article included more than 400 peer reviewed studies on the impact of empathy on key health outcomes.  Nembhard et al. conclude:

Empirical research provides evidence of the importance of empathy to health care outcomes and identifies multiple changeable predictors of empathy. Training can improve individuals' empathy; organizational-level interventions for systematic improvement are lacking.

 In the United States, there is confusion about the definition of empathy.  Paul Bloom’s 2016 best seller Against Empathy: The Case for Rational Compassion contributed substantially to this confusion.  Helpfully Nembard et al. begin with a clear definition of empathy consistent with the Rogerian construct:

In health care, empathy is defined contextually as understanding and feeling a patient's emotions and perspective and offering a response (e.g., communication) that reflects understanding and aims to help.

Evaluators and researchers will be familiar with many of the self-report measures of empathy used in the studies included in this meta-analysis.  Not surprisingly the Jefferson Scale of Empathy is the most frequent among the included research.  The subjects in the reviewed studies included patients, clinicians, and trainees.

The research supports the finding that empathy improves patient’s health outcomes and patient’s experience of care.  Additionally, researchers have identified individual and organizational factors that promote, or undermine the presence of empathy.  Finally, the authors conclude that individuals can be trained to increase their use of empathy.

Of note, the first three authors of this manuscript are affiliated with the Health Care Management Department of The Wharton School at the University of Pennsylvania.  While many champions of empathy emerge from humanistic studies, or spiritual traditions, these authors have the credentials to capture the attention of hardened executives.

The authors bemoan the failure of researchers to describe system level interventions that improve the ability of systems to create environments that promote empathy.  They acknowledge that systemic factors are likely important, and complex: 

System dynamics models which account for reinforcing and balancing loops are likely necessary for a more complete picture of empathy dynamics.

While the structural facilitators of empathy have not been described in the research, substantial evidence reports the impact on clinicians and patients. Clinicians who regularly employ empathy in their work with patients may benefit from the feedback loops that result.  Clinicians who provide empathy to patients develop deeper connections with patients and the patients of these clinicians benefit from an improved experience of care, and in some cases, improved outcomes. Essentially, these patients develop deeper connections with their clinicians, who in turn benefit from decreased burnout.

As a mid-career clinician-educator, my anecdotal experience supports the authors’ conclusions. When I began to focus on increasing my use of empathy with patients as an outcome of my training in Motivational Interviewing.  I focused on empathy because I understood it to be a valuable clinical skill that improved patient outcomes.  Over the years I have gone through periods of low satisfaction with my clinical work.  Invariably the remedy to this burnout was a redoubling of empathic efforts with my patients.

Clinician wellness, burnout, and resilience are the buzzwords of today as we grapple with a broken healthcare system and the fallout of the pandemic. This fall I will begin the 11th year of teaching a Motivational Interviewing course for health care providers.  Like my own clinical experience, this teaching experience has shown me that most people can increase their use of empathy with a little bit of practice.  Watching these busy clinicians take time from their schedules to refocus on their own empathic practice is nearly as rewarding as my work with patients.  The course is one more way for me to remind myself that empathy is good for others and good for me. 

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