The Health Psychologist

Society for Health Psychology

The Push for Physician Empathy in Healthcare

2023 Summer, Conversation corner, The Health Psychologist

Danielle Miller, MS
PhD Candidate, Counseling Psychology, Ball State University
Incoming Behavioral Medicine Fellow, Yale School of Medicine

Person-centered medical care consists of the empowerment of patients to play active roles in their pursuit of wellness (Castro et al., 2016). Treating patients as people rather than an illness or billable code is central to humanistic, dignified medical care (Chochinov, 2023). It also involves collaboration between patients and their medical team throughout treatment (Akinci & Patel, 2014). Although physicians are experts within their respective medical subfields, patients are best equipped to offer their subjective experiences with health and illness. Treatment of various medical diagnoses including cancer, infection, and heart disease is inherently complex – physicians are required to maintain competence in treating patients’ concerns (e.g., Siminoff & Step, 2005). However, along the road to wellness, patients often become conceptualized primarily by their diagnosis, and physicians may become detached and excessively formal (Halpern, 2001; Marcum, 2008). Empathy, a concept existing for many decades and most commonly associated with Carl Rogers’ (1980) work on person-centered psychotherapy, is paramount to supplementing medical care with an ability to feel patients’ suffering.

Given the historical treatment of patients from the biomedical model and the shift toward a more holistic, biopsychosocial model (Engel, 1977), physicians should consider and integrate empathy into their medical practice (Decety & Fotopoulou, 2015). The hope is for readers to gain an understanding about the importance of physician empathy within the physician-patient relationship and healthcare. The medical model of care must adapt to a patient-centered and holistic model of care because cultural identities, access to resources, and health disparities play an integral role in patients’ lived experiences. This necessary shift implies a difference between the traditionally detached physician and the empathic physician.

What is Physician Empathy

Sympathy often gets confused with empathy as an interchangeable term despite their differences (Jeffrey, 2016a). Broadly, sympathy describes feeling for someone’s pain and suffering, while empathy is an affective and cognitive skill in which someone feels with another individual. However, Jeffrey (2016b) highlighted additional benefits of empathy in medical care that make it more optimal to patient communication than sympathy; for instance, empathy is more complex, intentional, other-oriented, imaginative, and integrative of affective and cognitive approaches to understanding someone’s experiences. Empathy facilitates a shift from emotional detachment toward a deeper understanding of patients’ concerns in order to provide a better course of treatment than a detached approach entails (Halpern, 2001). By being able to imagine one’s experiences with illness and think about and feel for their struggles, physicians are increasingly attuned to their patients’ needs and concerns.

Empathy remains a broad concept that needs a clear definition in order to accurately integrate it within a patient-physician relationship. Clark (2007) suggested that empathy involves “the capacity to think and feel oneself into the inner life of another person” (p. 123). Physicians are tasked with diagnosing and treating patients largely based on patients’ self-reported symptoms. Using both their training and patients’ subjective experiences, they must arrive at a diagnosis and course of treatment most appropriate for recovery. Doing so involves more than basic, surface-level listening skills – it requires a heightened level of understanding one’s symptoms through empathy, curiosity, and effective communication skills to facilitate patients’ openness and trust (Bellet & Maloney, 1991; Kurtz et al., 2020).

Popularized by its utilization in psychotherapy, empathy strengthens the working alliance between patient and clinician (Duan & Hill, 1996). Empathic medical care should center around the patient, and it must prioritize the ongoing relationship between patient and their physician. Thus, although its origins were within the psychotherapeutic relationships, empathy among physicians should be embedded in their medical interventions. Patients trust their physicians’ medical expertise and rely on them as they heal from or manage their symptoms; these vulnerable states of being and reliance on a professional for longevity and wellness should be treated with empathic concern. Thus, empathy is crucial in providing quality patient care (Howell, 2016). Its importance has a number of implications on both patients and physicians themselves.

The Importance of Physician Empathy

The positive outcomes of physician empathy are seemingly boundless. One of the clearest reasons to support the study and integration of empathy into practice is based on the developmental of trust between patient and physician (Gabay, 2015). Distrust in the patient-physician relationship may lead to patients feeling closed off from their physicians and less likely to report the full extent of their symptoms (Cook et al., 2004). Conversely, physicians who build trust through empathy are more likely to improve patient compliance and outcomes than detached physicians (Halpern, 2012; Hojat et al., 2011; Roter et al., 1998). The value of trust in the patient-physician relationship is evident. Patients are likely to follow their physicians’ guidance by adhering to medications and treatment recommendations, directly suggesting the importance of physician empathy in healthcare (Renter, 2015).

Moreover, physician empathy suggests a reciprocal relational process that, in turn, benefits both the patient and the physician (Janssen & MacLeod, 2012; Kadji & Schmid Mast, 2021). Although the power differentials are different between physicians and patients, empathic physicians strive for synchrony in body language and vocal tone (Finset & Ørnes, 2017). By cultivating empathic communication, physicians start to access and experience patients’ inner worlds – this allows them to gather more clinical information about symptoms in order to formulate a correct diagnosis and course of treatment (Derksen et al., 2013; Irving and Dickson, 2004). Evidently, empathy has wider-reaching impact on patients than simply fostering a sense of comfort in the examination room; the importance of empathy is clear in the broad patient-physician relationship and in the improved outcomes for patients treated by a warm and compassionate physician.

Impact of Physician Empathy on Patients

Research supports the relationship between physician empathy and patient outcomes (Hojat, 2007). In previous studies, researchers used the Consultation and Relational Empathy scale (CARE; Mercer et al., 2004) and the Jefferson Scale of Empathy (JSE; Hojat et al., 2001) to measure the effects of physician empathy on patient wellbeing. The evidence regarding this relationship is promising. Using the CARE and JSE measures, higher ratings of physician empathy supported better patient outcomes when treating the common cold (Rakel et al., 2009), asthma (Wu et al., 2020), and diabetes (Del Canale et al. 2012). High physician empathy was also positively related to healthy patient outcomes regarding pre-surgical anxiety (Soltner et al., 2011), migraine (Attar & Chandramani, 2012), and recovery from trauma (Steinhausen et al., 2014). In addition to the positive implications of physician empathy on the treatment of various illnesses, empathy leads to advantageous experiences in the provision of medical services. For instance, a survey of 550 patients in Korea found that patients who rated their physicians as high in empathy also reported high patient satisfaction and treatment compliance; this positive relationship was mediated by interpersonal factors including trust and collaboration (Kim et al., 2004). Finally, researchers found promising results by measuring physician empathy in oncology – they found that high physician empathy was positively related with increased patient self-efficacy, satisfaction, and perceived sense of control over recovery from cancer (Zachariae et al., 2003). The advantages of physician empathy in clinical application are clear – patients receiving treatment for a variety of physical health diagnoses will experience better outcomes from an empathic physician than from an emotionally-detached physician.

In addition to concrete health-related impacts on patients, physician empathy also serves as a process of patient empowerment. One of the clearest examples of empathy as a vehicle for empowering patients is shared decision-making (SDM; Adams & Drake, 2006). SDM involves collaboration between patients and physicians regarding treatment options, patient preferences, and patients’ sociocultural contexts (Nicholas, 2016). It also takes various forms – SDM might involve patients who view their physicians as the primary decision-makers, while other patients prefer to play a balanced role in weighing their treatment options (Adams & Drake, 2006, as cited in Nicholas, 2016). Despite the nuances in individualized treatment and patient preferences, SDM centers around a collaborative dynamic in which patients and physicians agree on health-related goals (Pan et al., 2022; Politi et al., 2012). Additionally, patients still have their rights to autonomy and can make decisions that are or are not accordance with their physician’s guidance. Physician empathy has led to optimistic outcomes related to adherence – researchers found that a positive physician-patient relationship that fosters SDM resulted in increased patient adherence to medication (Stavropoulou, 2011; Zolnierek & Dimatteo, 2009). Empathy facilitates a collaborative relationship, one in which patients feel increasingly empowered to ask questions and actively engage with physicians throughout their care (Mercer & Reynolds, 2002).

Impact of Physician Empathy on Physicians

Caring for patients during their most stressful and troubling times is not an easy position to be in. Physicians are commonly tasked with treating patients throughout all stages of life, including end-of-life care that warrants an especially sensitive approach to treatment (Calvo et al., 2014). Further, all physicians take the Hippocratic oath and vow to do no harm to patients (Miles, 2005). Along the way to treating patients across various settings for their respective diagnoses, physicians who integrate empathic practice might find themselves reaping benefits as well. For instance, a trusting relationship between physicians and patients enables patients to disclose more information about themselves and their experiences (Golda et al., 2018; Hoff & Collinson, 2017; Hojat et al., 2002). Openness creates opportunities for physicians to correctly diagnose and treat patients, which promotes patient satisfaction (Morgan et al., 2020; Wang et al., 2022).

Beyond the increased trust and comfort in the working relationship, physician empathy has practical benefits for physicians. From a broad perspective, open communication between physicians and patients reduces the chances of malpractice claims (Huntingdon & Kuhn, 2003). Notably, physicians have fewer malpractice claims when they engage in empathic behaviors (e.g., spending more time with patients during their visits, checking with patients to confirm their understanding of symptoms; Levinson et al., 1997). Moreover, in a sample of emergency medicine physicians who made empathic statements toward patients, researchers found empathy to be correlated with fewer thoughts of suing physicians (Smith et al., 2016). Physician empathy appears to reduce both thoughts and behaviors regarding malpractice claims against physicians. Physician empathy has clear impacts on physicians. Not only does physician empathy promote positive patient outcomes and a strong working relationship, physicians also enjoy the benefits of fewer risks of litigation.

Training Physicians on Empathic Practice and its Impact on Patients

The shift of medical practice toward an increasingly humanistic approach suggests the importance of teaching empathy throughout medical school and beyond. The reasons for the inclusion of empathy as an area of learning include improvements in SDM, treatment adherence, and patient satisfaction (Barry & Edgman-Levitan, 2012; Betancourt, 2003). Medical education can support the teaching of empathy in a few ways. Broadly speaking, nonverbal behavior is critical to attend to – Riess and colleagues (2014) developed a tool to facilitate empathic nonverbal behaviors. Shortened to E.M.P.A.T.H.Y., researchers highlighted nonverbal behaviors that are central to conveying empathy in patient care (Riess et al., 2014). The acronym stands for eye contact, muscles of facial expression, posture, affect, tone of voice, hearing the patient, and the physician (your) response. E.M.P.A.T.H.Y. was first tested as a training tool divided into three modules that focused on implementation of positive nonverbal skills. Physicians who completed the modules were rated higher in empathy by their patients than physicians who did not complete the training (Riess et al., 2014). These suggested nonverbals are important for students, residents, and physicians to be more intentional with, and research supports the relationship between empathic nonverbals and patient outcomes (e.g., Ambady et al., 2002; Pollak et al., 2007).

Decety (2020) suggested the importance of physicians who are “comfortable with themselves and feel safe, so that they can be more open to others and express a caring attitude” (p. 566). Medical education on empathy does not exclusively focus on delivering quality services to patients. Training also prioritizes trainees’ and physicians’ competence with self-reflection and self-awareness (Riess et al., 2012). Physicians can foster their empathy for patients by checking in with themselves, and medical training encourages physician to monitor themselves and their experiences. Self-reflective training starts early in medical school to promote introspection as an ongoing process of learning and growth. Students are encouraged to reflect on their feelings toward patients and to be self-aware of how they interact with patients (Arhweiler et al., 2014). Humanizing clinical practice should be valued by medical educators to instill processes of self-reflection and self-awareness among students who will, one day, graduate into the physician role.

Empathy must be conceptualized as a core competency in medical training and practice (Ogle et al., 2013). It appears to be more detrimental than helpful to patients if their physicians are emotionally detached or distant (Kee et al., 2018). There is inherent value within medical education to frame patients’ humanity through empathy, and physicians should be attuned to the physical and psychological tolls of illness on patients (Kimball, 1973). Fortunately, the medical field has evolved from a strictly biomedical approach toward an increasingly holistic and collaborative model. Education and training continue to shift with these changes, and there is more to be explored with regard to fostering empathy.


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