Empathy – How Much is Too Much?




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The physician-patient relationship is the cornerstone to quality medical care. A key component to this relationship is physician empathy — the ability to understand the patient’s experiences and feelings and view the world from the patient’s perspective. Empathy is so important in this day and age that medical and other health care professional schools are instituting empathy training programs and establishing empathy-related learning objectives. But, a recent study reveals that physicians might benefit from decreasing their empathy response and improve clinical outcomes.

Empathy certainly plays a positive role in interpersonal relationships. In health care, empathy is associated with many positive attributes, including dutifulness, prosocial behavior, moral reasoning, reduced malpractice litigation, improved history taking and physical examination, patient satisfaction, physician satisfaction, improved therapeutic relationships, and overall improved clinical outcomes. Some researchers claim that empathy is always beneficial in medical care and allows physicians to complete clinical tasks more accurately. However, others argue that keeping an emotional distance from patients maintains clinical neutrality. This is especially true in clinical specialties in which practitioners routinely inflict pain or discomfort on their patients, such as surgery.

A study recently published in the journal NeuroImage asserts that emotional regulation skills are critical for physicians, since too much empathy impedes the delivery of quality medical care. They maintain that the repeat exposure to the suffering of others is associated with negative outcomes, including personal distress, compassion fatigue and burnout, all of which lead to poor quality health care and an increased risk of medical errors. If physicians down-regulate their empathy response, it may weaken the negative effects of perceiving the pain of others and free up cognitive resources that are needed for completing clinical tasks.

Empathy is a natural human response with a biological basis and proves that humans are fundamentally altruistic beings that care for others. But, barriers to empathy in health care exist: gender, culture, or clinical specialty. Also, some physicians feel there is not enough time to engage in truly compassionate care, that empathy for patients is too exhausting, or that they do not have the proper skills to engage in empathy.

So far, the data on whether or not empathy is truly advantageous in health care is inconclusive. While a complete lack of empathy is a barrier to quality medical care, so is too much empathy. Physicians and other health care professionals need to maintain an appropriate emotional distance from patients, if only to maintain their own emotional well-being. This so-called “compassionate detachment” does not mean that physicians care less for their patients or do not understand their patients’ perspectives; it means that physicians keep their emotions under control in order to maintain clinical objectivity and personal and professional stability. Some empathy is good, but a lot is not always better.

References

Brunero, S., Lamont, S., & Coates, M. (2010). A review of empathy education in nursing Nursing Inquiry, 17 (1), 65-74 DOI: 10.1111/j.1440-1800.2009.00482.x

Cheng, Y., Lin, C., Liu, H., Hsu, Y., Lim, K., Hung, D., & Decety, J. (2007). Expertise Modulates the Perception of Pain in Others Current Biology, 17 (19), 1708-1713 DOI: 10.1016/j.cub.2007.09.020

Decety, J., Yang, C., & Cheng, Y. (2010). Physicians down-regulate their pain empathy response: An event-related brain potential study NeuroImage DOI: 10.1016/j.neuroimage.2010.01.025

Hojat M, Gonnella JS, Nasca TJ, Mangione S, Vergare M, Magee M. Physician empathy: definition, components, measurement, and relationship to gender and specialty. Am J Psychiatry. Sep 2002;159(9):1563-1569.

Mason, P., & Bartal, I. (2010). How the social brain experiences empathy: Summary of a gathering Social Neuroscience, 1-5 DOI: 10.1080/17470911003589085

Neumann, M., Bensing, J., Mercer, S., Ernstmann, N., Ommen, O., & Pfaff, H. (2009). Analyzing the “nature” and “specific effectiveness” of clinical empathy: A theoretical overview and contribution towards a theory-based research agenda Patient Education and Counseling, 74 (3), 339-346 DOI: 10.1016/j.pec.2008.11.013

Singer T (2007). The neuronal basis of empathy and fairness. Novartis Foundation symposium, 278 PMID: 17214308

  • http://www.shockmd.com Dr Shock MD PhD

    Don’t agree, to my opinion empathy is not easily learned, it’s a quality not everyone simply has or can be educated. Mostly what is meant by empathy is sympathy. This last aspect of the doctor patient relationship can be energy consuming.
    Both have to be teached learned and used with patient care, emotional distance is mostly an excuse not to get involved instead of it being tiresome.
    As far as empathy and sympathy are concerned it is unclear whether they represent distinct phenomena or whether they reflect parallel processes that covary across situations.
    Empathy is an effortful process by which we try to comprehend another’s experience, while sympathy would be a direct perceptual awareness of another person’s experience akin to the phenomenon of sympathetic resonance. Sympathy does not necessarily require feeling any kind of congruent emotions on part of the observer, a detached recognition or representation that the other is in need or suffers might be sufficient.
    Interesting subject of which appropriate emotional distance is mostly not the problem, most doctors already possess that capacity.
    Thanks Dr shock

  • Barbara Stott

    Empathy is not the same thing as emotional attachment.

    You can understand a persons thoughts and feelings completely without sharing them or even liking them.

    You don’t have to be a sadist to understand how a sadist thinks, and you don’t need to be a gay man to uderstand how and why a gay man enjoys gay sex.

    A psychiatrist can never have too much empathy.

    Even if you feel that the patient is just like you, you can have empathy and still be emotionally detatched.

    It is the attachment that is draining.

    But can you chose to be emotionally detatched? And should you?

    Doesn’t that depend on which branch of psychiatry you are practicing? And dosen’t that depend on the patient?

    If the patient has empathy too, will pshchotherapy ever work, if the doctor isn’t emotionally attached?

    Barbara Stott

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    I’ve wondered this too. I work as a mediator and have always battled with offering to much empathy. I know at times my empathy has gotten in the way of helping resolve problems.

    The line of empathy vs enabling can be thin. Too much empathy can at times enable people to remain firm and not be willing to be reasonable.

  • ERic Vander

    Empathy is a great topic. I think my views have changed througout the years. I know one time I myself wasnt all that empathetic but I am now. I think as far as a Dr. Patient role the emapthy is so important because it creates that connection. For the paient its so important too. The Diet Solution

  • Kimber Angle

    Very interesting article. As a patient, I want my doctor to be empathetic and friendly but I don’t want to have too much empathy as it doesn’t seem real. It really does need to be a case by case basis, which would be really difficult for the physicians.

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Jennifer Gibson, PharmD

Jennifer Gibson, PharmD, is a practicing clinical pharmacist and medical writer/editor with experience in researching and preparing scientific publications, developing public relations materials, creating educational resources and presentations, and editing technical manuscripts. She is the owner of Excalibur Scientific, LLC.
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