Updated: Jul 25, 2021
Author: Hadeel Alhadi
Empathy is an important, yet an often misunderstood and neglected pillar in the physician-patient relationship. It involves understanding the emotional experience and needs of the patient, which may help ease their stress, and hence, establish a relationship based on trust and compassion. It only seems natural that clinical empathy is a key trait for physicians, but can a physician have too much empathy?
To answer this question, a distinction must be made between two emotional scales: (1) empathic concern (EC) and (2) personal distress (PD) . Empathic concern evaluates feelings of compassion, concern, and warmth for others . In comparison, personal distress evaluates emotional reactions that are self-oriented rather than other-oriented, including feelings of discomfort and apprehension towards other people’s negative experiences .
“It is important…to protect both the physician and patient since burnout leads to increased medical errors, reduced empathy, and affects the overall quality of care.”
Using these two scales as types of empathy, researchers at Florida International University studied the relationship between empathy and burnout among new medical students . Over 3 years of study, the researchers used the Maslach Burnout Inventory and Davis’ Interpersonal Reactivity Index to study how EC and PD impact three components of burnout: (1) emotional exhaustion, (2) depersonalization, and (3) personal accomplishment. The study found that students with high EC empathy scored low on the burnout scale, while students with high PD empathy had higher scores on the burnout scale .
It is a common concern amongst physicians that empathy may pose a risk to their wellbeing . A study conducted by the University of Milan aimed to address these concerns by measuring the relationship between empathy levels and moral distress, job satisfaction, and intention to quit their job . The researchers used questionnaires to collect data and multiple linear and logistic regressions to analyze the results . The results indicated that empathy is not a risk factor in developing moral distress or physicians’ intentions to quit their job; in fact, empathy was found to increase job satisfaction .
It is safe to say that the relationship between empathy and burnout is not that simple; the literature contains much conflicting evidence. One of the biggest questions that researchers investigate is the reason behind the decline of medical students’ and physicians’ empathy levels as they progress in their medical careers . A neuroscientific study by Neumann et al. suggests that empathy decline is a coping mechanism for “extreme emotional arousal” . According to their findings, the down regulation of empathy pathways in the brains of medical professionals, particularly physicians, is a sign of extreme distress . The study crowns empathy as an underlying cause of compassion fatigue, and emotional exhaustion .
It is important to care for physicians’ and medical students’ mental health by managing how their level of empathy impacts them . This is necessary to protect both the physician and patient since burnout leads to increased medical errors, reduced empathy, and affects the overall quality of care. Therefore, physicians and medical students must have access to mental health support and training on emotion-regulation and burnout prevention . For instance, the American Medical Association (AMA) provides online training modules that teach healthcare workers team-based care and communication skills . The very existence of these training modules marks a major advancement in recognizing the organizational and environmental factors that contribute to burnout.
Ibrahim Alayche, Mouayad Ali, Rhea Verma
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Image 1: by Jacqueline Day @jacday_alabaster from Unsplash
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