Perspective Chapter: Having Heart – The Different Facets of Empathy

Abstract

This chapter discusses the history of the various definitions of empathy and states two widely accepted current definitions for affective and cognitive empathy. The neural basis of different or overlapping cortical regions used by affective or cognitive empathy as well as sympathy/compassion are summarized, with the ventromedial prefrontal cortex as a probable common denominator for these emotions. Longitudinal studies of allopathic and osteopathic medical students confirm that women have higher affective and cognitive empathy scores than men, via the use of the Balanced Emotional Empathy Scale (BEES) and the Jefferson Scale of Empathy (JSE), respectively. During undergraduate medical education, BEES and JSE scores drop after the completion of the first basic science year and after the first year of clinical rotations. Students with higher empathy scores tend to enter primary care residencies, whereas students with lower scores are more likely to enter technical or procedure-oriented specialties. The ability to partially blunt an affective empathic response to an emotionally charged patient situation helps to ensure the health care provider can devote all their attention to the patient vs. the provider being caught up in their own emotions. Affective blunting may also be helpful in preventing burnout, especially among women health care workers.

Empathic Divergence: Partially Blunting an Affective Empathic Response While Maintaining Cognitive Empathy is an Important Skill for Medical Students to Acquire

“…off the male and female population norms, suggesting they have hardened their heart to the extent that patients may view them as uncaring or distant. 14,21 These results infer more emphasis needs to be placed in the didactic years and clinical rotations on teaching and showing students how to build a cognitive empathic bond of trust with patients while blunting deleterious affective responses.…”

“…above the population norm, it is possible they may be more prone to job burnout than those who have lesser scores. 14,21 This is especially true for women who prefer to enter the people-oriented, primary care specialties. Female medical students have been shown to have BEES scores larger than male scores, 27,28 and this increased amount of affective empathy puts women at a greater risk of depression, anxiety, emotional exhaustion, and burnout than their male counterparts.…”

“…19,20 As medical students learn to become physicians, how are the cognitive empathic communication skills they need to develop related to the need for the students to also realize they need to partially blunt an excessive affective empathic response to patients. 14,21 Blunting an affective empathic response is necessary for health care professionals; because a pronounced affective empathic response by a student or physician to an emotionally charged situation can overwhelm their ability to give their full attention to the patient. 22 This detrimental response diminishes the therapeutic ability of the student or physician to adequately care for the patient because they are focused on their own vicarious emotions.…”