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Who cares for empathy?

Empathy is seen by some researchers as a cognitive attribute (i.e. ‘understanding’ another person's concerns) and by others as an affective attribute (i.e. ‘feeling’ another person's suffering) or both. We propose that clinical empathy should be viewed as a continuum of three obligatory sequential stages: ‘comprehension’ of the patient's predicament (a cognitive process based on listening); followed by ‘compassion’ (an emotional or affective process) and then, ‘commitment’ to do the best for this patient (a practical stage of obtaining and applying the best patient-suited evidence and providing ongoing support). Thus, for empathy to be effective, the physician's compassion needs to be not only felt by the patient but also followed by action.

Clinical empathy is universally lauded. This interpersonal skill is an acknowledged essential component of professional competence.1 Patients desire it.2 Physicians who are empathic are more satisfied and have less burnout.3 Sincere empathy is recognized as a major constituent in the practice styles of excellent ‘healing’ clinicians.4 However, despite all these attributes, empathy in medicine may be hard to find.

While patients' anecdotal experiences lamenting heartless 'technical' medical practice may not be objective, and many additional reasons are cited by patients for the escalating popularity of 'complementary and alternative medicine' providers,5 research reveals a similar pattern. In a well-known study, physicians were found to cut short and redirect their patients' narratives after approximately 20 seconds.6 Observations of patient–physician encounters in varied settings show that patients often offer clues instead of verbalizing emotions and concerns directly. However, the great majority of clues and expressions of affect (four out of five) were allowed to pass unacknowledged by physicians.7 Empathic opportunities abound, but physicians disregard most of them and when they do respond, they are extremely brief and quickly shift to biomedical issues.8 Patient-centered …