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“I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.”

Maya Angelou

Empathy is a key therapeutic component of clinician–patient interactions and leads to improved patient experience, health outcomes, and decreased clinician burnout. The absence of expressed empathy in clinicians is associated with longer visits and increased risk of malpractice claims. Exactly what empathy is, however, is debated. There are many, sometimes contradictory, definitions in the literature. This may arise from the provenance of this concept, which stems the late nineteenth century, when it described the feeling that a building or artwork can evoke in a person. Only later did the term enter into the field of medicine. More recently, the concept has received renewed attention from a wide spectrum of health practitioners, educators, and the public, which regard empathy as a means to restore compassion and humanism to the clinician–patient relationship (I and Thou), a relationship that has become increasingly impersonal (I and It) because of technology and financial pressures.

While academics debate whether empathy is a cognitive or affective state, an attitude or a behavior, patients increasingly expect it and clinicians increasingly recognize its importance in their interactions. We define empathy as the capacity to understand another person’s emotional state, the ability to communicate this understanding, and the desire to be of service to that person. Research suggests that empathy skills can be taught. This chapter will describe how to develop and improve these skills; we will begin by exploring the roots of empathy.

What Is Required to Express Empathy?

Clinical empathy requires certain attitudes, knowledge, and skills. The most important attitude is the recognition that to be a patient is an emotional experience. When clinical work becomes routine or hectic, clinicians can forget this truth and neglect to attend to the patient’s emotions, focusing instead on the biomedical tasks at hand. Empathic clinicians try to imagine what it might be like to be the patient; they make it one of their duties to consider the patient’s emotional reaction to illness and respond to it. These clinicians care about their patients, not just for them.

The knowledge domain of empathy includes understanding that many patients offer clues to their emotions, that is, they put their emotion, or at least a hint of it, “on the table”; the clinician merely needs to recognize these clues. Some patients, however, may not express their emotions, but this does not mean that they do not have an emotion to discover and respond to. Because clinicians often have a strong “curative need,” that is, the desire to fix problems in their patients (or avoid them if they seem unfixable), it is also important for them to know that patients do not want them to fix everything that they tell them. Many personal and emotional problems ...

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