Patient Doctor Relationship Series: Empathy

Responsiveness to the emotional state of another plays a fundamental role in the patient doctor relationship (PDR) as well as in other human interaction. Sympathy and empathy are not the only responses in the PDR. Other responses can be consolation, kindness, politeness,compassion, and pity.

Empathy and sympathy: at first glance, the 2 concepts fit perfectly with medical practice. Clearly, these are emotions competent clinicians must know how to display; they are a part of good bedside manner.

This is the first post in a series about the Patient Doctor Relationship.The next post will be on Saturday, July 19th.
Next post on this subject: Consolation reduces stress

My point is that good bedside manners is something each doctor can and has to learn as well as sympathy when called for. Empathy is a quality not every human or doctor possesses. Moreover, experience and age enhance the use of empathy. Not to say that lack of experience or being young excludes the possibility for showing empathy, there are still natural talents out there.

What is empathy?
The most clarifying definition of empathy is based on viewing it as a process. This process of empathy consists of the following stages.

  • The patient expresses feelings by way of verbal and non-verbal communication. Patients are not always aware of these expressions.
  • The doctor also notices these emotions in himself more or less voluntary, more or less conscious. He or she coming aware of these feelings usually comes after the fact (affective empathy).
  • Realizing these feelings as being from the patient is the cognitive empathy. Together with everything the doctor knows about the patient as a patient and as a person, he or she is coming to know the inner feelings of the patient(cognitive empathy).
  • The doctor can now express these feelings for the patient or act on them for the patient(expressed empathy).
  • The patient receives this empathy (received empathy).

The best and shortest explanation of empathy is in the German word for it: Einfühling

Empathy usually is part of a process such as the patient doctor relationship, psychotherapy, counseling or caring by a nurse.

The difference between empathy and sympathy?
As far as empathy and sympathy are concerned it is unclear whether they represent distinct phenomena or whether they reflect parallel processes that covary across situations.
Empathy is an effortful process by which we try to comprehend another’s experience, while sympathy would be a direct perceptual awareness of another person’s experience akin to the phenomenon of sympathetic resonance. Sympathy does not necessarily require feeling any kind of congruent emotions on part of the observer, a detached recognition or representation that the other is in need or suffers might be sufficient.

The difference between emotional contagion and empathy
In a recent article in the New York Times: At Bedside, Stay Stoic or Display Emotions?, to my opinion some examples of emotional contagion are displayed:

Dr. Benita Burke, skipped lunch to spend extra time with her cancer patients. They dubbed this time “mental health rounds,” during which they could address issues that were not strictly medical. Many times, Dr. Burke would wind up in tears or giving an embrace.

Emotional contagion – This is when someone identifies with the strong emotions of others and tends to become subjective to the same emotions themselves. Emotional contagion however does not require that one is aware of the fact that one experiences the emotions because other people experience them, rather one experiences them primarily as one’s own emotion.

With empathy there is no confusion between the feelings and needs belonging to the patient and to the doctor. Empathy is neutral, aimed at understanding the other and not about feeling for the other, empathy is unselfish, free from prejudice.

Empathy to me is a valuable tool in the patient doctor relationship, but not a simple one. It costs a lot of energy, emotional energy. It usually needs at least a working alliance with a patient or other therapeutic forms of a relationship. A lot of questions remain about empathy. Is empathy a trait or a state or a combination of both? Can you teach empathy?

What do you think about empathy? Let me know in the comments.
Jahoda, G. (2005). Theodor Lipps and the shift from sympathy to empathy. Journal of the History of the Behavioral Sciences, 41(2), 151-163. DOI: 10.1002/jhbs.20080