Skip to main content
SpringerLink
Log in

Expanding Clinical Empathy: An Activist Perspective

  • Perspectives
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

ABTRACT

BACKGROUND

Discussions of empathy in health care offer important ways of enabling communication and interpersonal connection that are therapeutic for the patient and satisfying for the physician. While the best of these discussions offer valuable insights into the patient-physician relationship, many of them lack an action component for alleviating the patient’s suffering and emphasize the physician’s experience of empathy rather than the patient’s experience of illness.

METHODS

By examining educational methods, such as reflective writing exercises and the study of literary texts, and by analyzing theoretical approaches to empathy and suggestions for clinical practice, this article considers how to mindfully keep the focus on what the patient is going through.

CONCLUSION

Clinical empathy can be improved by strategies that address (1) the patient’s authority in providing first-person accounts of illness and disability, (2) expanding the concept of empathy to include an action component geared toward relieving patients’ suffering, and (3) the potential value of extending empathy to include the social context of illness.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Halpern J. What is clinical empathy? J Gen Intern Med. 2003;18:670–4.

    Article  PubMed  Google Scholar 

  2. Marcus ER. Empathy, humanism, and the professionalization process of medical education. Acad Med. 1999;74:1211–5.

    Article  PubMed  CAS  Google Scholar 

  3. Brainard AH, Brislen HC. Viewpoint: learning professionalism: a view from the trenches. Acad Med. 2007;82:1010–4.

    PubMed  Google Scholar 

  4. Lowenstein J. Can you teach compassion? The midnight meal and other essays about doctors, patients, and medicine. New Haven: Yale University Press; 1997.

    Google Scholar 

  5. Varkey P, Chutka DS, Lesnick TG. The aging game: improving medical students’ attitudes toward caring for the elderly. J Am Med Dir Assoc. 2006;7:224–229.

    Article  PubMed  Google Scholar 

  6. Henderson P, Johnson MH. Assisting medical students to conduct empathic conversations with patients from a sexual medicine clinic. Sex Transm Infect. 2002;78:246–249.

    Article  PubMed  CAS  Google Scholar 

  7. Wear D, Varley JD. Rituals of verification: the role of simulation in developing and evaluating empathic communication. Pat Education and Counseling. 2008;71:153–6.

    Article  Google Scholar 

  8. Hanna M, Fins JJ. Power and communication: why simulation training ought to be complemented by experiential and humanist learning. Acad Med. 2006;81:265–270.

    Article  PubMed  Google Scholar 

  9. Halpern J. From detached concern to empathy: humanizing medical practice. New York: Oxford University Press; 2001.

    Google Scholar 

  10. Garden R. The problem of empathy: medicine and the humanities. New Literary History. 38(3):551–568.

  11. Association of American Medical Colleges Medical School Objectives Project. Report 1, Learning objectives for medical student education, guidelines for medical schools. Available at: http://www.aamc.org/meded/msop/msop1.pdf. Accessed May 31, 2007.

  12. Hafferty FW, Franks R. The hidden curriculum, ethics teaching, and the structure of medical education. Acad Med. 1994;69:861–71.

    Article  PubMed  CAS  Google Scholar 

  13. Coulehan J, Williams PC. Vanquishing virtue: the impact of medical education. Acad Med. 2001;76:598–605.

    Article  PubMed  CAS  Google Scholar 

  14. Elder R, Price J, Williams G. Differences in ethical attitudes between registered nurses and medical students. Nurs Ethics. 2003;10:149–61. discussion 161–4.

    Article  PubMed  Google Scholar 

  15. Hojat M, Gonnella JS, Mangione S, et al.. Empathy in medical students as related to academic performance, clinical competence and gender. Med Educ. 2002;36:522–7.

    Article  PubMed  CAS  Google Scholar 

  16. Newton BW, Barber L, Clardy J, Cleveland E, O’Sullivan P. Is there hardening of the heart during medical school? Acad Med. 2008;83:244–249.

    Article  PubMed  Google Scholar 

  17. Spiro H. What is empathy and can it be taught? Ann Intern Med. 1992;116:843–6.

    PubMed  CAS  Google Scholar 

  18. Gaba DM, Howard SK. Patient safety: fatigue among clinicians and the safety of patients. N Engl J Med. 2002;347:1249–55.

    Article  PubMed  Google Scholar 

  19. Bellini LM, Baime M, Shea JA. Variation of mood and empathy during internship. JAMA. 2002;287:3143–6.

    Article  PubMed  Google Scholar 

  20. DasGupta S, Charon R. Personal illness narratives: using reflective writing to teach empathy. Acad Med. 2004;79:351–6.

    Article  PubMed  Google Scholar 

  21. Spickard A Jr, Gabbe SG, Christensen JF. Mid-career burnout in generalist and specialist physicians. JAMA. 2002;288:1447–50.

    Article  PubMed  Google Scholar 

  22. Dugdale DC, Epstein R, Pantilat SZ. Time and the patient-physician relationship. J Gen Intern Med. 1999;14:S34–40.

    Article  PubMed  Google Scholar 

  23. Kim SS, Kaplowitz S, Johnston MV. The effects of physician empathy on patient satisfaction and compliance. Eval Health Prof. 2004;27:237–51.

    Article  PubMed  CAS  Google Scholar 

  24. Redelmeier DA, Molin JP, Tibshirani RJ. A randomised trial of compassionate care for the homeless in an emergency department. Lancet. 1995;345:1131–4.

    Article  PubMed  CAS  Google Scholar 

  25. Coulehan JL, Platt FW, Egener B, et al.. “Let me see if I have this right…”: words that help build empathy. Ann Intern Med. 2001;135:221–7.

    PubMed  CAS  Google Scholar 

  26. Stepien KA, Baernstein A. Educating for empathy, A review. J Gen Intern Med. 2006;21:524–30.

    Article  PubMed  Google Scholar 

  27. Morse JM, Anderson G, Bottorff JL, et al.. Exploring empathy: a conceptual fit for nursing practice? Image J Nurs Sch. 1992;24:273–80.

    Article  PubMed  CAS  Google Scholar 

  28. Benbassat J, Baumal R. What is empathy, and how can it be promoted during clinical clerkships? Acad Med. 2004;79:832–9.

    Article  PubMed  Google Scholar 

  29. Cohen-Cole SA, Bird J. Function 2: building rapport and responding to patient’s emotions (relationship skills). In: Cohen-Cole SA, ed. The Medical Interview: The Three-Function Approach. St. Louis: Mosby Year Book; 1995:21–7.

    Google Scholar 

  30. Lazare A. Outpatient Psychiatry: Diagnosis and Treatment. Baltimore: Williams & Wilkins; 1989:153–7.

    Google Scholar 

  31. Suchman AL, Markakis K, Beckman HB, Frankel R. A model of empathic communication in the medical interview. JAMA. 1997;277:678–82.

    Article  PubMed  CAS  Google Scholar 

  32. Mercer SW, Reynolds WJ. Empathy and quality of care. Br J Gen Pract. 2002;52:S9–12.

    PubMed  Google Scholar 

  33. Adler HM. Toward a biopsychosocial understanding of the patient-physician relationship: an emerging dialogue. J Gen Intern Med. 2007;22:280–5.

    Article  PubMed  Google Scholar 

  34. Lipkin M, Putnam SM, Lazare A. The medical interview: clinical care, education, and research. New York: Springer; 1995.

    Google Scholar 

  35. Beach MC, Inui T. Relationship-centered care research network. Relationship-centered care. A constructive reframing. J Gen Intern Med. 2006;21:S3–8.

    Article  PubMed  Google Scholar 

  36. Lipkin M. Integrity, compassion, respect. J Gen Intern Med. 1986;1:65–7. Jan-Feb.

    Article  PubMed  CAS  Google Scholar 

  37. Burack JH, Irby DM, Carline JD, Root RK, Larson EB. Teaching compassion and respect. Attending physicians’ responses to problematic behaviors. J Gen Intern Med. 1999;14:49–55.

    Article  PubMed  CAS  Google Scholar 

  38. Churchill LR. Why literature and medicine? Lit Med. 1982;1rev. ed.35–6.

    Google Scholar 

  39. Lancaster T, Hart R, Gardner S. Literature and medicine: evaluating a special study module using the nominal group technique. Med Educ. 2002;36:1071–6.

    Article  PubMed  Google Scholar 

  40. Reifler DR. “I actually don’t mind the bone saw”: narratives of gross anatomy. Lit Med. 1996;15:183–99.

    PubMed  CAS  Google Scholar 

  41. Shapiro J, Morrison E, Boker J. Teaching empathy to first year medical students: evaluation of an elective literature and medicine course. Educ Health (Abingdon). 2004;17:73–84.

    Article  Google Scholar 

  42. Charon R. Narrative Medicine: Honoring the Stories of Illness. Oxford: Oxford UP; 2006.

    Google Scholar 

  43. Montgomery Hunter K. Doctors’ Stories: The Narrative Structure of Medical Knowledge. Princeton: Princeton UP; 1991.

    Google Scholar 

  44. Kirkpatrick JN, Nash K, Duffy TP. Well rounded. Arch Intern Med. 2005;165:613–6. at 615.

    Article  PubMed  Google Scholar 

  45. Marshall PA, O’Keefe JP. Medical students’ first-person narratives of a patient’s story of AIDS. Soc Sci Med. 1995;40:67–76.

    Article  PubMed  CAS  Google Scholar 

  46. Maguire P, Fairbairn S, Fletcher C. Consultation skills of young doctors: I–Benefits of feedback training in interviewing as students persist. Br Med J (Clin Res Ed). 1986;292:1573–6.

    Article  CAS  Google Scholar 

  47. Klein S, Tracy D, Kitchener HC, Walker LG. The effects of the participation of patients with cancer in teaching communication skills to medical undergraduates: a randomised study with follow-up after 2 years. Eur J Cancer. 2000;36:273–81.

    Article  PubMed  CAS  Google Scholar 

  48. Tervalon M, Murray-García J. Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education. J Health Care Poor Underserved. 1998;9:117–25.

    PubMed  CAS  Google Scholar 

  49. Bauby JD. The diving-bell and the butterfly. New York: Vintage; 1994.

    Google Scholar 

  50. Grealy L. Autobiography of a face. New York: Harper Perennial; 2003.

    Google Scholar 

  51. Fries K. Body, remember: a memoir. Madison: University of Wisconsin Press; 2003.

    Google Scholar 

  52. Kaysen S. Girl, interrupted. New York: Vintage; 1994.

    Google Scholar 

  53. Mairs N. Waist-high in the world: a life among the nondisabled. Boston: Beacon Press; 1996.

    Google Scholar 

  54. Ndebele NS, Rasebotsa N, Samuelson M, eds. Nobody ever said AIDS: poems and stories from southern Africa. Capetown: Kwela Books; 2004.

  55. I am indebted to an anonymous reviewer for this concept.

  56. Reisman AB, Hansen H, Rastegar A. The craft of writing: a physician-writer’s workshop for resident physicians. J Gen Intern Med. 2006;21:1109–11.

    Article  PubMed  Google Scholar 

  57. Larson EB, Yao X. Clinical empathy as emotional labor in the patient-physician relationship. JAMA. 2005;293:1100–6.

    Article  PubMed  CAS  Google Scholar 

Download references

ACKNOWLEDGMENTS

Thanks to Eli Braun for his research assistance.

Conflict of Interest

None disclosed.

Author information

Authors and Affiliations

  1. Center for Bioethics and Humanities, SUNY Upstate Medical University, 725 Irving Ave. #406, Syracuse, NY, 13210, USA

    Rebecca Garden PhD

Authors
  1. Rebecca Garden PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rebecca Garden PhD.

Additional information

Clinical Empathy: Uncovering Assumptions and Acting for the Patient in Social Context

Rights and permissions

Reprints and permissions

About this article

Cite this article

Garden, R. Expanding Clinical Empathy: An Activist Perspective. J GEN INTERN MED 24, 122–125 (2009). https://doi.org/10.1007/s11606-008-0849-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11606-008-0849-9

KEY WORDS

Search

Navigation