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Page/Link:Page URL:HTML link:The Free Library. Retrieved Oct 23 2019 from'A problem that is well understood is a problem that is halfsolved.' (cited in Hojat, 2007, p. Xix).Empathy is an ambiguous concept with a history that is marked byuncertainty in its conceptualization and measurement. The notion ofempathy has been described as 'elusive' (Basch, 1983) and'slippery' (Eisenberg & Strayer, 1987). Some suggest thatempathy means so much that it really 'means nothing' (Pigman,1995); thus, it has been concluded that empathy 'does not mean anything at all' (Reik, 1948).
Because of these anomalies, it has beenproposed that the word empathy should be 'eliminated' orreplaced by a less ambiguous term (Levy, 1997). Because of theaforementioned confusion, empathy has been viewed as a concept that isdifficult to define and hard to measure (Kestenbaum, Farber & Srouf,1989).I have described elsewhere that 'an undefined concept cannever be measured, and a well define concept is half measured.' (Hojat, 2007, p. Thus, the definition and measurement of a conceptare intertwined: One depends on another. Despite a lack of consensus onthe definition of empathy, there are many descriptions orcharacterization of the term in the literature (see for example Chapter1 in Hojat, 2007). Based on those characterizations of empathy, Iproposed the following definition of empathy in the context of patientcare:'Empathy is a predominantly cognitive (rather than emotional)attribute that involves an understanding (rather than feeling) ofexperiences, concerns and perspectives of the patient, combined with acapacity to communicate this understanding.' (Hojat, 2007, p.
The three key terms in this definition are italicized for tworeasons: 1. To underscore their importance in the construct of empathyin the context of patient care, and 2.
To distinguish between empathyand sympathy. An intention to help and alleviate pain and suffering isanother feature of empathy in health and human services cultures.Sympathy, as opposed to empathy, is predominantly an affective oremotional attribute that involves intense feelings of a patient'spain and suffering. Despite the differences in conceptualization, thetwo notions are not entirely independent (Hojat, Mangione, Nasca, Cohen,Gonnella, et al., 2001).The two concepts of empathy and sympathy are usually tossed intoone terminological basket.
The interchangeable use of these concepts maybe inconsequential in social psychology, but it is important to separatethe two in the context of patient care. The reason for making such adistinction is that the two concepts lead to different and sometimesopposite outcomes in patient care. In the context of social psychology,both empathy and sympathy can lead to a similar outcome (e.g., prosocialbehavior), although for different behavioral motivations. It has also been reported that higher cognitive empathy wasassociated with more positive well-being among therapists (Linley &Joseph, 2007) and among internal medicine residents (Shanafelt, West,Zhao, Novotny, Kolars, et al., 2005). In contrast, lower empathy wasassociated with professional burnout in medical students (Thomas,Dyrbye, Huntington, Lawson, Novotny, et al., 2007).
Also, lower empathyamong medical residents was associated with self-perceived medicalerrors (West, Huschka, Novotny, Sloan, Kolars, et al., 2008). Patientsat Mayo Clinic identified empathy as one of the important ingredients inthe ideal physician (Bendapudi, Berry, Frey, & Parish, 2006).Because of the effect of empathy on patient outcomes and physicianwell-being, enhancement of empathic understanding is considered one ofthe major tasks of medical education (Marcus, 1999).In addition to the controversies surrounding the conceptualizationof empathy, measurement of the concept in the context of health care hasalso been questioned. A few instruments have been developed formeasuring empathy in the general population (for a description of theseinstruments see, Chapter 5 in Hojat, 2007). Based on the contents ofthese instruments, it is difficult to confirm their face validity foruse with health care professionals. Moreover, it is not clear if theseinstruments intend to measure empathy, or sympathy, or both. None ofthese instruments is specific enough to capture the essence of empathyin the context of patient care.A few years ago, our research team at Jefferson Medical Collegerecognized the need for an instrument to measure empathy in the contextof patient care.
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In response to this need, we developed the JeffersonScale of Physician Empathy (JSPE), which specifically targeted medicalstudents, physicians, and other health professionals (for a briefhistory of the JSPE's development and its measurement properties,see Chapter 7 in Hojat, 2007). Extensive data in support of thepsychometrics (validity, reliability) of the JSPE have been reported forsamples of physicians (Hojat, Gonnella, Mangione, Nasca, Veloski, etal., 2002a, Hojat, Gonnella, Nasca, Mangoine, Veloski, et al., 2002b;Hojat, Gonnella, Nasca, Mangione, Vergare, et al., 2002c), medicalstudents (Hojat, Mangoine, Nasca, Cohen, Gonnella, et al., 2002; Hojat,Mangoine, Nasca, & Gonnella, 2005) nursing students (Ward, Schaal,Sullivan, Bowen, Erdmann, et al., in press), and nurses (Fields, Hojat,Gonnella, Mangione, Kane, et al., 2004; Hojat, Fields, & Gonnella,2003).
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The JSPE has already been translated into 25 languages and isbeing used by researchers in the United States and abroad (for moreinformation about the JSPE, visit the following website:www.tju.edu/jmc/crmehc/medu/jspe.cfm).Changes are occurring in the health care system in the UnitedStates and abroad that have rippling effects on the education of healthprofessionals, the delivery of health care services, administrationroles in academic medical centers, and managerial function in healthcare institutions and assisted-living organizations. Therefore, it isimportant and timely to pay serious attention to promoting and improvingempathy in the health care environment, and in all sectors of humanservices.SELECTED APPROACHES TO ENHANCE EMPATHY IN THE CLINICAL ENVIRONMENTEmpathy is amenable to positive (Stepien & Baersntein, 2006),and negative changes (Hojat, Mangione, Nasca, Rattner, Erdmann, et al.,2004; Mangione, Kane, Caruso, Gonnella, Nasca, et al., 2002), and can betaught (Spiro, 1992). A number of approaches to enhance empathy havebeen developed by social and developmental psychologists, counselors,and nursing and medical educators (for a review see, Hojat, 2007). Inthe following section, I briefly described 10 approaches that are morespecific to health professions education, practice, and management.Consistent with our definition of empathy, the common goal of all ofthese approaches is to enhance the understanding of health careprofessionals and administrators about patients' concerns andexperiences. In addition, improving skills to convey this understandingto the patient is another goal of most of these approaches.Improving Interpersonal Skills:Interpersonal skills development is considered as an essentialprerequisite to demonstrate empathic behavior (Book, 1991).
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