Empathy and quality of care.
Abstract
Empathy is a complex multi-dimensional concept that has moral cognitive emotive and behavioural components Clinical empathy involves an ability to: (a) understand the patient's situation, perspective, and feelings (and their attached meanings); (b) to communicate that understanding and check its accuracy; and (c) to act on that understanding with the patient in a helpful (therapeutic) way. Research on the effect of empathy on health outcomes in primary care is lacking, but studies in mental health and in nursing suggest it plays a key role. Empathy can be improved and successfully taught at medical school especially if it is embedded in the students actual experiences with patients. A variety of assessment and feedback techniques have also been used in general medicine psychiatry and nursing. Further work is required to determine if clinical empathy needs to be, and can be, improved in the primary care setting.
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Selected References
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- Gore J, Ogden J. Developing, validating and consolidating the doctor-patient relationship: the patients' views of a dynamic process. Br J Gen Pract. 1998 Jul;48(432):1391–1394.[PMC free article] [PubMed] [Google Scholar]
- Cromarty I. What do patients think about during their consultations? A qualitative study. Br J Gen Pract. 1996 Sep;46(410):525–528.[PMC free article] [PubMed] [Google Scholar]
- Reynolds WJ, Scott B. Empathy: a crucial component of the helping relationship. J Psychiatr Ment Health Nurs. 1999 Oct;6(5):363–370. [PubMed] [Google Scholar]
- Di Blasi Z, Harkness E, Ernst E, Georgiou A, Kleijnen J. Influence of context effects on health outcomes: a systematic review. Lancet. 2001 Mar 10;357(9258):757–762. [PubMed] [Google Scholar]
- Reynolds WJ, Scott B. Do nurses and other professional helpers normally display much empathy? J Adv Nurs. 2000 Jan;31(1):226–234. [PubMed] [Google Scholar]
- Taylor MB. Compassion: its neglect and importance. Br J Gen Pract. 1997 Aug;47(421):521–523.[PMC free article] [PubMed] [Google Scholar]
- Lewis JR. Patient views on quality care in general practice: literature review. Soc Sci Med. 1994 Sep;39(5):655–670. [PubMed] [Google Scholar]
- Levinson W, Gorawara-Bhat R, Lamb J. A study of patient clues and physician responses in primary care and surgical settings. JAMA. 2000 Aug 23;284(8):1021–1027. [PubMed] [Google Scholar]
- Marvel MK, Epstein RM, Flowers K, Beckman HB. Soliciting the patient's agenda: have we improved? JAMA. 1999 Jan 20;281(3):283–287. [PubMed] [Google Scholar]
- Roter DL, Stewart M, Putnam SM, Lipkin M, Jr, Stiles W, Inui TS. Communication patterns of primary care physicians. JAMA. 1997 Jan 22;277(4):350–356. [PubMed] [Google Scholar]
- Suchman AL, Roter D, Green M, Lipkin M., Jr Physician satisfaction with primary care office visits. Collaborative Study Group of the American Academy on Physician and Patient. Med Care. 1993 Dec;31(12):1083–1092. [PubMed] [Google Scholar]
- Beckman HB, Frankel RM. The effect of physician behavior on the collection of data. Ann Intern Med. 1984 Nov;101(5):692–696. [PubMed] [Google Scholar]
- Mercer SW, Watt GC, Reilly D. Empathy is important for enablement. BMJ. 2001 Apr 7;322(7290):865–865.[PMC free article] [PubMed] [Google Scholar]
- Dixon DM, Sweeney KG, Gray DJ. The physician healer: ancient magic or modern science? Br J Gen Pract. 1999 Apr;49(441):309–312.[PMC free article] [PubMed] [Google Scholar]
- Krupnick JL, Sotsky SM, Simmens S, Moyer J, Elkin I, Watkins J, Pilkonis PA. The role of the therapeutic alliance in psychotherapy and pharmacotherapy outcome: findings in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. J Consult Clin Psychol. 1996 Jun;64(3):532–539. [PubMed] [Google Scholar]
- Burns DD, Nolen-Hoeksema S. Coping styles, homework compliance, and the effectiveness of cognitive-behavioral therapy. J Consult Clin Psychol. 1991 Apr;59(2):305–311. [PubMed] [Google Scholar]
- La Monica EL, Wolf RM, Madea AR, Oberst MT. Empathy and nursing care outcomes. Sch Inq Nurs Pract. 1987 Fall;1(3):197–213. [PubMed] [Google Scholar]
- Coulehan JL, Platt FW, Egener B, Frankel R, Lin CT, Lown B, Salazar WH. "Let me see if i have this right...": words that help build empathy. Ann Intern Med. 2001 Aug 7;135(3):221–227. [PubMed] [Google Scholar]
- Morse JM, Anderson G, Bottorff JL, Yonge O, O'Brien B, Solberg SM, McIlveen KH. Exploring empathy: a conceptual fit for nursing practice? Image J Nurs Sch. 1992 Winter;24(4):273–280. [PubMed] [Google Scholar]
- Nightingale Stephen D, Yarnold Paul R, Greenberg Michael S. Sympathy, empathy, and physician resource utilization. J Gen Intern Med. 1991 Sep-Oct;6:420–423. [PubMed] [Google Scholar]
- Matthews DA, Suchman AL, Branch WT., Jr Making "connexions": enhancing the therapeutic potential of patient-clinician relationships. Ann Intern Med. 1993 Jun 15;118(12):973–977. [PubMed] [Google Scholar]
- ROGERS CR. The necessary and sufficient conditions of therapeutic personality change. J Consult Psychol. 1957 Apr;21(2):95–103. [PubMed] [Google Scholar]
- McKinstry B. Do patients wish to be involved in decision making in the consultation? A cross sectional survey with video vignettes. BMJ. 2000 Oct 7;321(7265):867–871.[PMC free article] [PubMed] [Google Scholar]
- Winefield HR, Chur-Hansen A. Evaluating the outcome of communication skill teaching for entry-level medical students: does knowledge of empathy increase? Med Educ. 2000 Feb;34(2):90–94. [PubMed] [Google Scholar]
- Kramer D, Ber R, Moore M. Increasing empathy among medical students. Med Educ. 1989 Mar;23(2):168–173. [PubMed] [Google Scholar]
- Branch WT, Jr, Kern D, Haidet P, Weissmann P, Gracey CF, Mitchell G, Inui T. The patient-physician relationship. Teaching the human dimensions of care in clinical settings. JAMA. 2001 Sep 5;286(9):1067–1074. [PubMed] [Google Scholar]
- Cope DW, Linn LS, Leake BD, Barrett PA. Modification of residents' behavior by preceptor feedback of patient satisfaction. J Gen Intern Med. 1986 Nov-Dec;1(6):394–398. [PubMed] [Google Scholar]
Abstract
Empathy is a complex multi-dimensional concept that has moral cognitive emotive and behavioural components Clinical empathy involves an ability to: (a) understand the patient's situation, perspective, and feelings (and their attached meanings); (b) to communicate that understanding and check its accuracy; and (c) to act on that understanding with the patient in a helpful (therapeutic) way. Research on the effect of empathy on health outcomes in primary care is lacking, but studies in mental health and in nursing suggest it plays a key role. Empathy can be improved and successfully taught at medical school especially if it is embedded in the students actual experiences with patients. A variety of assessment and feedback techniques have also been used in general medicine psychiatry and nursing. Further work is required to determine if clinical empathy needs to be, and can be, improved in the primary care setting.