Understanding Physician Empathy, How It Impacts Patient Care

October 17, 2018 - As the healthcare industry continues its focus on better patient experiences and higher satisfaction, physicians work to improve their patient-provider communication skills. Paramount to these skills is physician empathy, a somewhat elusive factor that few medical professionals understand.

In a general sense, empathy is defined as “the ability to understand and share the feelings of another.”

It seems natural that empathy be a key aspect of provider communication. Being able to feel a patient’s emotions will help a provider deliver more compassionate care and make the patient feel more comfortable during treatment.

But allowing raw emotions to overcome the provider is not always ideal, especially as providers aim to be objective in delivering quality care.

This raises questions about the role empathy plays in the clinical setting. How does the definition of empathy change in the medical space? Is it truly necessary to patient care? And if so, how do we teach providers physician empathy?

What is physician empathy?

The definition of empathy in the clinical sense may diverge slightly from its general definition, experts agree. Specifically, physician empathy becomes more nuanced in the clinical setting.

Many medical professionals break empathy down into different categories. Cognitive empathy, for example, refers to a physician’s ability to recognize a patient’s emotions, reflect those emotions back to the patient, and consider the emotions when making care decisions.

Affective empathy is more related to the tradition definition of empathy. Affective empathy is when providers internalize the emotions a patient feels and truly feels those emotions themselves.

Some experts argue that cognitive empathy is better suited for the medical profession. After all, providers want to do their jobs objectively, free of the emotional toll some cases may take. Known as detached empathy, cognitive empathy allows providers to recognize patient needs without being impacted by those emotions.

However, the medical industry may consider shifting its perception of physician empathy, according to a group of researchers from the University of Chicago. Empathy is nuanced and requires both cognitive and affective empathy.

“We found that changes in empathy during medical training are not necessarily negative—the narrative appears to be much more complicated than we initially thought and illustrates how problematic it is to rely on a single, subjective measure to evaluate a complex psychological construct,” the researchers wrote in a 2017 article published in Medical Education.

Other experts agree. In a 2002 essay published in the Journal of General Internal Medicine, researchers asserted physicians need affective empathy to guide their cognitive empathy.

“There is a long-standing tension in the physician's role,” the researchers wrote. “On the one hand, doctors strive for detachment to reliably care for all patients regardless of their personal feelings. Yet patients want genuine empathy from doctors, and doctors want to provide it.”

Cognitive empathy is not enough to create a positive patient experience, the authors continued.

“The function of empathy is not merely to label emotional states, but to recognize what it feels like to experience something,” they said. “That is why empathy is needed even when it is quite obvious what emotion label applies to a patient.”

Of course, there are numerous challenges to having genuine affective empathy, experts have acknowledged. Providers might not think they have enough time to connect with patients, and a culture of detachment may make physicians apprehensive to become more empathic.

But many experts are beginning to believe clinicians can build genuine connections in a minute or two. And feeling affective empathy does not need to take away from quality care, the JGIM authors noted.

“Empathy does not require that physicians vicariously experience and introspect about patients' emotions,” they explained. “The physician's attention should not be unduly diverted to introspection. The whole point of empathy is to focus attention on the patient. A listener who was busy having his or her own parallel emotions and introspecting about them would have the wrong focus.”

Does empathy improve patient care?

Aside from improving patient satisfaction, physician empathy can have an impact on patient care outcomes.

Studies indicate that patients who perceive their providers as more empathic tend to get better faster and experience less aggressive symptoms.

A 2011 study published in Patient Education and Counseling showed that patients receiving care for the common cold and who gave their providers perfect empathy scores felt less severe symptoms and felt the symptoms mitigate in a shorter period of time.

A separate study published in the Annals of Family Medicine yielded similar results, showing that patients reported better outcomes when they perceived more physician empathy.

The researchers in neither of the studies suggested that the patients’ better health was a direct result of more physician empathy. Instead, positive outcomes could be tied to a higher level of overall care that comes complete with more empathy. Providers displaying more empathy could be more likely to engage in shared decision-making or to hear specific patient needs that result in better quality care.

Additionally, patients reporting perceived empathy may have initially had less severe symptoms.

Nonetheless, empathy is an important indicator of quality care and better patient-provider relationships, the literature shows, making it a stalwart in the patient-provider relationship.

Can you teach physician empathy?

Although industry attitudes toward physician empathy may be cynical, research largely suggests that does not need to be the case. Physician empathy is an entirely teachable skill.

A 2014 literature review published in BMC Medical Education revealed that interventions to improve physician empathy are largely effective. Although most of the literature analyzing those interventions is flawed, those studies that were deemed high-quality revealed improvements in physician empathy following intervention.

Sixty-six percent of the studies on empathy education reported an increase in physician empathy. What’s more, all of the “top tier” studies indicated effective empathy interventions. These results are more trustworthy, the researchers said.

However, there is still a path forward in designing empathy interventions, the researchers continued. For example, more targeted interventions for physicians who are already into their careers, as opposed to those targeted at medical students, could be effective.

“Interventions aimed at enhancing empathy among residents, fellows and physicians may be more important to ensure that patients consistently receive empathic care from their physicians,” the researchers said. “Little is known about the long-term efficacy of empathy interventions.”

Additionally, the JGIM authors assert that providers can deliver strong physician empathy so long as their medical education contains information on how to relate to and build relationships with their patients.

“One path to educating empathic physicians is by encouraging trainees to maintain their natural curiosity about their patients' lives,” the authors noted. “Doctors learn to suppress curiosity in order to take rapid, standardized histories.”

There is still very limited information regarding physician empathy and how to teach it to medical professionals. However, as value-based care further drives a need for higher patient satisfaction and better experiences of care, experts may wish to learn more about empathy’s role in the clinical setting.