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The concept of empathy dates from the early years of this century, when discussions of the topic were restricted to psychotherapists' analyses of their interactions with patients. More recently, the concept has received renewed attention from a wide spectrum of health practitioners and educators. They believe that empathy can positively affect communication with patients and thus lead to improved therapeutic outcomes. Many of the lay public regard empathy as an avenue to the restoration of compassion and humanism to the doctor–patient relationship, which has been threatened by and has become increasingly impersonal due to technology and financial pressures.

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The power of empathy lies in its ability to help us cross, if only for a moment, the divide between clinicians and patients created by their very different circumstances. To briefly bridge that divide and to become simply two humans sharing an experience can help in accomplishing professional diagnostic and therapeutic tasks. We have all experienced the gratitude of patients, isolated by depression or family loss, for our expressed understanding of their sadness.

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Succeeding at the greater challenge of putting aside our disagreement with a patient requesting chronic narcotics or perhaps our negative judgment of a patient unable to quit smoking can have proportionally greater rewards. Being willing to imagine what it must be like for these more challenging patients can provide us with insight into what motivates them or what might help them. That's diagnostic information. Communicating that insight may encourage patients to change their behavior. That's therapeutic. Our disclosure also allows us to check the accuracy of what we think we know about the patient's state. We relinquish nothing of ourselves or our role in that moment, we simply expand our perspective.

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Empathy can be defined as an intellectual identification with, or vicarious experiencing of, the feelings, thoughts, or attitudes of another. Some have described empathy as a momentary identification with another person in which our human capacity to feel what another feels erodes the boundaries of self. If we in fact temporarily lose awareness of self, the process might better be termed "sympathy for" or "feeling with" someone else. Remaining aware that we are experiencing empathy prevents total dissolution of ego boundaries and permits a more salutary stance. Empathy skills are behaviors that demonstrate empathy. They may be the clinician's most powerful therapeutic tool.

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Research suggests that empathy skills can be taught. This chapter will describe how to develop and improve these skills. Research has recently shed light on the frequency of empathic opportunities in clinical practice, on how physicians respond to or neglect these opportunities, and the implications of such choices. Empathic opportunities occur in more than half of surgical and primary care visits, although on average there are more opportunities per visit in primary care (2.6) than in surgical care (1.9). Patients initiate most of the opportunities. Contrary to common belief, surgeons respond empathically at least as frequently as primary care physicians, ...

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