The word empathy, as we understand it today, is a relatively recent creation of only the past 60 years or so. It came into being as a translation for the German word Einfühlung, a term in the field of physiological aesthetics which means literally “feeling-in.” The field of physiological aesthetics sought physiological explanations for the capacity to appreciate beauty and art, and the term referred to the idea of inhabiting a different body or environment. By “feeling-in” a painted landscape, the viewer can understand what it would be like to exist in that landscape and thus understand the emotional implication of the artistry. In 1908, two psychologists at Cornell and the University of Cambridge created the word empathy as the English translation for Einfühlung, using the Greek “em” for “in” and “pathos” for “feeling.” Needless to say, this is quite a different definition than the one we assign the word today [1].
It wasn’t until 1948 that the word began to take on the meaning we associate with it today, when experimental psychologist Rosalind Dymond Cartwright conducted some of the first tests measuring interpersonal empathy. In the process, she coopted empathy from its previous physiological aesthetics iteration to a term for interpersonal connection. In 1955, the magazine Reader’s Digest brought the word to the public and defined it as the “ability to appreciate the other person’s feelings without yourself becoming so emotionally involved that your judgment is affected” [1][2].
Although a recent creation in the English language, empathy has long been a quality of physicians. Sir William Osler, founder of the modern medical school curriculum, alluded to this concept in his 1889 farewell address at the University of Pennsylvania School of Medicine, Aequanimitas:
Curious, odd compounds are these fellow-creatures, at whose mercy you will be full of fads and eccentricities, of whims and fancies; but the more closely we study their little foibles of one sort and another in the inner life which we see, the more surely is the conviction borne in upon us of the likeness of their weaknesses to our own. The similarity would be intolerable, if a happy egotism did not often render us forgetful of it. Hence the need of an infinite patience and of an ever-tender charity toward these fellow-creatures; have they not to exercise the same toward us?
After a lifetime of practice, Sir William Osler had come to empathize with his patients and understand that they are not so different from the physicians that treat them [3].
But is there a difference between general empathy and physician empathy? One definition of physician empathy in the context of the clinical setting is “the ability of a physician to understand the patient’s situation, perspective, and feelings; to communicate that understanding, and to act on that understanding in a helpful, therapeutic way.” The important difference being while empathy is something that is felt, a physician’s empathy goes further—it is something that is acted upon. This action does not have to be complex; in fact, one of the primary ways in which a physician can demonstrate empathy is to simply acknowledge a patient’s negative emotion of fear, sadness, or worry instead of redirecting or negating it. In doing so, we use the innate empathy that we are born with as another tool of healing [4].
The physician’s demonstration of empathy has been shown to have a significant impact on clinical outcomes. For example, Hojat et al. reported better control of HbA1c in patients who endorsed a high empathy score of their physician as compared to a low one. Similarly, the portion of patients with good LDL-C control was significantly higher for physicians with high empathy scores. In other studies, physicians demonstrating higher empathy have increased patient trust, hope, adherence to treatment plans, and decreased levels of anxiety [5].
It could be argued that there is a correlation between the medical knowledge or skill of the physician and their reported empathy, which explains the improved clinical outcomes. However, Rakel et al. reported that in their patient stratification with the highest reported physician empathy, the duration of the common cold was actually shortened. Furthermore, the patients of these physician had a more effective response to the cold in the form of higher levels of interleukin-8 and neutrophils. This defies our current understanding of the viral immune response; clearly, empathy heals beyond the technical proficiency of the physician [6].
Finally, more than any other factor associated with physician-patient interactions, physician empathy is the most vital to the satisfaction of the patient. Menendez et al. found greater empathy to account for 65% of the variation in patient satisfaction with the physician. Not even long wait times at the office, something which is frequently a source of frustration for patients, was as responsible for the happiness of the patient as empathy demonstrated by the physician [7].
Physician empathy is the ability to not only understand the emotional constitution of the patient, but also to act on it in a way that makes them feel cared for. This is arguably the most important aspect of the patient-physician relationship and will help to heal the patient in ways that technical knowledge cannot.
[1] Ganczarek J, Hünefeldt T, Olivetti Belardinelli M. From “Einfühlung” to empathy: exploring the relationship between aesthetic and interpersonal experience. Cogn Process. 2018;19(2):141–145. doi:10.1007/s10339-018-0861-x
[2] Lanzoni, Susan. “A Short History of Empathy.” The Atlantic, Atlantic Media Company, 15 Oct. 2015, www.theatlantic.com/health/archive/2015/10/a-short-history-of-empathy/409912/.
[3] Osler, William, Sir, 1849-1919. Aequanimitas: With Other Addresses to Medical Students, Nurses and Practitioners of Medicine. Philadelphia: Blakiston, 1943.
[4] Mercer SW, Reynolds WJ. Empathy and quality of care. Br J Gen Pract. 2002;52: S9–S12.
[5] Hojat M, Louis DZ, Markham FW, Wender R, Rabinowitz C, Gonnella JS. Physicians’ empathy and clinical outcomes for diabetic patients. Acad Med. 2011;86(3):359-364. doi: 10.1097/ACM.0b013e3182086fe1
[6] Rakel DP, Hoeft TJ, Barrett BP, Chewning BA, Craig BM, Niu M. Practitioner empathy and the duration of the common cold. Fam Med. 2009;41(7):494–501.
[7] Menendez ME, Chen NC, Mudgal CS, Jupiter JB, Ring D. Physician empathy as a driver of hand surgery patient satisfaction. J Hand Surg Am. 2015;40(9):1860-5.e2. doi: 10.1016/j.jhsa.2015.06.105
Ian Singleton is a member of The University of Arizona College of Medicine – Phoenix, Class of 2021. He graduated from University of California, Santa Barbara with a Bachelor of Science in Microbiology. He enjoys working out and surfing.