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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 increasingly impersonal and threatened by technology and financial pressures. Indeed recent studies have demonstrated that physician empathy increases patient satisfaction and improves clinical outcomes.

The Neurobiology of Empathy

Novel research tools, such as functional MRI scanning, which permit real-time investigation of the brain under experimental conditions, have revealed new insights into the functional neuroanatomy of empathy. The discovery of sensorimotor neurons in the cortex has suggested a mechanism whereby behaviors can trigger an unconscious reciprocal response in an observer. These mirror neurons fire when the subject performs a particular task or when the subject simply observes another individual performing the same task. Most of us have had the experience of reflexively smiling when a stranger walking down the street smiles at us. Our motor response often precedes a conscious reflection of what transpired.

This research is preliminary and some of the conclusions speculative. Nevertheless, a model of empathy is emerging in which connections between mirror neurons and other brain structures could facilitate the observed components of empathy. For example, in our example of the stranger-triggered smile, the mirror neuron projections that are downward to the facial muscles and limbic system could provoke the feeling of happiness concomitant with the motor expression of a smile. These responses are rapid and unconscious. Secondary projections to the more newly evolved cortex provoke awareness of the feeling, thoughts about the social context of the transaction, and decisions about further actions. These are slower, more conscious elements of a complex response.

Empathy as a Clinical Tool

In medical practice, 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 expression of understanding of their sadness.

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 insights into what motivates them ...

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