Empathy should be the basis of patient care

When dealing with patients and families coping with life threatening illness, one of a physician’s greatest interventions may be that of empathy.  Defined simply, empathy is the responsiveness to the emotional state of another person—we try to understand another’s experience.  It is a process that requires effort and intention.  Sympathy is an awareness of another person’s situation and is an almost “autonomic” type response.  Sympathy is important and is part of what humanizes a caregiver but empathy is integral to a successful doctor-patient relationship.

Many studies of medical students have indicated that empathy is lacking.  A study published in Academic Medicine in 2009 indicated that empathy in fact actually declines during the 3rd (clinical) year.  In this study, 456 students were followed and completed the Jefferson Scale of Physician Empathy (a reliable, validated survey) at different times during their medical school careers.  During the first two years, scores remained consistent—however a significant decline was noted in the third year and persisted until graduation.  There were no gender or eventual specialty related differences—it occurred across the board.  What a paradox—after 2 years of dissection and sitting in lectures, empathy declines when the short white coats are adorned and students become face to face with patients for the first time.

In my opinion, empathy should be the basis of all patient care and the cornerstone of the doctor-patient relationship.  We must find a way to cultivate empathy in medical education.  Medical school admission officers must select applicants that have potential to truly care for the sick.  Medical school deans and other leaders must demand and emphasize inclusion of doctor patient relationship training in the standard curriculum.  We must prepare our students for practice in a world full of challenges and change.  Our patients face increasing stresses outside of illness including job loss, financial ruin, drug and alcohol addiction and family crisis.  These patients put their trust in their physician.  We as providers must provide not only a proper diagnosis but emotional support and genuine human kindness as well.

I can think of many barriers to empathy in medicine and medical education—all good excuses.   I believe that some of the most compelling are the current lack of empathetic role models, negative experiences on the wards, time pressures and academic grade pressures, and an over-reliance on technology and testing.  (Remember 80% of the diagnosis is made with a good history and physical).  Students are driven to be the “best of the best”—that’s who we typically select to fill our medical school classes.  More emphasis needs to be placed on the way we interact with patients, families and each other.  We, as mentors, must model empathy in patient care every day.  It’s just good medicine.

So, next time you go into a room on rounds, take a moment and sit by the bedside.  Talk to the patient and family and truly ask and understand the answer to the question “How are you feeling today?”

Kevin R. Campbell is a cardiac electrophysiologist who blogs at his self-titled site, Dr. Kevin R. Campbell, MD.

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  • http://www.facebook.com/profile.php?id=1070961711 Sue Koehne Wintz

    As a board certified chaplain, I have often led rounds for medical students to teach empathy skills.  Many physicians look to chaplains’ spiritual assessments for an understanding of the spiritual and emotional issues that patients and families are struggling with.  By participating in conversations with physicians and rounds, as a chaplain I’m often able to help facilitate their skills in how to listen to and practice empathy with their patients.  Unfortunately I’ve also seen physicians who come in the room, stand at the bedside without ever looking at the patient or family, say what they came in to say, and leave.  We need to not only teach empathy skills to medical students; we need to find ways to hold physicians accountable for their interactions with patients.  Chaplains can help do that as members of the team.

  • Wendy Shung

    Do you think getting a counseling degree (or at lease, learning counseling skills) would help a doctor be better at delivering, tough news, being empathetic or better at building up trust & open communication between the doctor and patient?

    • Anonymous

      Why not use a team approach, and all have input into the patient status.  Team would be physician, nurse, SW, therapist, doc specialist, possibly the chaplain.  Or maybe talk with all who care for the patient.

  • Anonymous

    This is such an important article and should be a fundamental principle in medical school. I’d like to be optimistic but for some it could be too late and for others it will be a challenge. For those who already embraced this philosophy. Thank you!

  • Anonymous

    Empathy is important, but should not be the “cornerstone” of the doctor-patient relationship. 
    Were that the case, we wouldn’t need to continue performing medical studies. Most medical textbooks would be rendered superfluous. Deductive logic in determining what is causing patient symptoms and physical examinations would be moot.
    This whole empathy/satisfaction push in medicine is having a significant impact on the quality and safety of medicine being practiced in this country. That connection was noted by Kevin last month when the study in Annals of Internal Medicine showed that satisfied patients are significantly more likely to end up … *dead*.
    Empathy is desirable in any communication with another human being. But to say that we should focus only (or even primarily) on empathy in the doctor patient relationship is like saying we should focus only on eye color in choosing a mate, focus only on gas mileage when choosing a car, or focus only on foreign policy when choosing a presidential candidate. It is just poor logic.
    You want a doctor who may be gruff at times and who cures your cancer or do you want someone who holds your hand as you die from the cancer that he wasn’t insightful enough to catch?

    • http://offwhitecoat.wordpress.com/ The Scrivener


      You want a doctor who may be gruff at times and who cures your cancer or do you want someone who holds your hand as you die from the cancer that he wasn’t insightful enough to catch?”

      It’s not really an either-or proposition. The empathy skill-set (communication, perspective-taking, acknowledgement of suffering and rising to the challenge of alleviating that suffering) is not the opposite of the diagnostic skill-set. I think of them as two axes of a graph, rather than opposite ends of a single continuum.

  • Anonymous

    This piece of information is important, not only on medical personnels but to all healthcare personnels, I believe you can ‘t give your best care unless you feel for the person you are caring for

  • Anonymous

    Trust is the “cornerstone” of the medical relationship, and I beleive Empathy is a part of developing trust.  So how is that empathy showed and trust developed?