Social determinants of health are nonmedical factors that can affect a person's overall health and health outcomes. Where a person is born and the social conditions they are born into can affect their risk factors for premature death and their life expectancy. In this position paper, the American College of Physicians acknowledges the role of social determinants in health, examines the complexities associated with them, and offers recommendations on better integration of social determinants into the health care system while highlighting the need to address systemic issues hindering health equity.

Background The Accreditation Council for Graduate Medical Education (ACGME) Outcome Project requires that residency program directors objectively document that their residents achieve competence in 6 general dimensions of practice.

This study was designed to examine the relationships between scores of two measures of empathy. One was specifically developed for measuring empathy in patient care situations; the other was developed for the general population. It was hypothesized that the overlap between scores of the two measures would be greater for their constructs that are more relevant to patient care. Study participants were 93 first-year internal medicine residents at Thomas Jefferson University Hospital in Philadelphia. The Jefferson Scale of Physician Empathy (JSPE, specifically developed for administration to health professionals), and the Interpersonal Reactivity Index (IRI, developed for the general population) were administered. A statistically significant correlation of a moderate magnitude between the total scores of the JSPE and IRI (r = 0.45, p < 0.01) was found. The research hypothesis was confirmed by observing higher correlations between those scales of the IRI that were relevant to patient care (e.g. empathic concern, perspective taking) and related factors of the JSPE (compassionate care, perspective taking) than other scales of the IRI that seemed less relevant to patient care (e.g. personal distress and fantasy). These findings provide further support for the validity of the JSPE. It is concluded that physician empathy as measured by the JSPE and its underlying factors are distinct personal attributes that have a limited overlap with fantasy and no overlap with personal distress defined as dimensions of an empathy measure that was developed for the general population.

The operational measurement of physician empathy, as well as the question of whether empathy could change at different levels of medical education, is of interest to medical educators. To address this issue, 98 internal medicine residents from all 3 years of training were studied. The Jefferson Scale of Physician Empathy was administered, and residents' empathy scores correlated with ratings on humanistic attributes made by postgraduate program directors. No statistically significant differences in scores were found among residents of different training levels. Empathy scores remained also stable during internship (test-retest reliability = 0.72). Correlation between empathy and ratings on humanism was 0.17. Thus, the findings suggest that empathy is a relatively stable trait that is not easily amenable to change in residency training programs. The issue of whether targeted educational activities for the purpose of cultivating empathy can improve empathy scores awaits empirical scrutiny.

In view of many changes taking place in today's health care marketplace, the theme of empathy in health provider-patient relations needs to be revisited. It has been proposed that patients benefit when all members of the health care team provide empathic care. Despite the role of empathy in patient outcomes, empirical research on empathy among health professionals is scarce partly because of a lack of a psychometrically sound tool to measure it. In this study, we briefly describe the development and validation of the Jefferson Scale of Physician Empathy (JSPE), an instrument that was specifically developed to measure empathy among health professionals (20 Likert-type items). The purpose of this study was to compare nurses and physicians on their responses to the JSPE. Study participants were 56 female registered nurses and 42 female physicians in the Internal Medicine postgraduate medical education program at Thomas Jefferson University Hospital. The reliability coefficients (Chronbach's coefficient alpha) were 0.87 for the nurses and 0.89 for physicians. Results of t test showed no significant difference between nurses and physicians on total scores of the JSPE; however, multivariate analyses of variance indicated statistically significant differences between the two groups on 5 of 20 items of the JSPE. Findings suggest that the JSPE is a reliable research tool that can be used to assess empathy among health professionals including nurses.