Understanding empathy: why phenomenology and hermeneutics can help medical education and practice

Abstract

This article offers a critique and reformulation of the concept of empathy as it is currently used in the context of medicine and medical care. My argument is three pronged. First, that the instrumentalised notion of empathy that has been common within medicine erases the term's rich epistemological history as a special form of understanding, even a vehicle of social inquiry, and has instead substituted an account unsustainably structured according to the polarisations of modernity (subject/object, active/passive, knower/known, mind/body, doctor/patient). I suggest that understanding empathy by examining its origins within the phenomenological tradition, as a mode of intersubjective understanding, offers a different and profitable approach. Secondly, I argue that the appropriation of empathy in medicine means that, ironically, empathy can function as a technique of pastoral power, in which virtue, knowledge and authority remain with the doctor (Mayes in Bioeth Inq 6:483-493, doi: 10.1007/s11673-009-9195-9 , 2009). And thirdly, empathy is in danger of being resourced as a substitute for equity and funding within health systems. I conclude however with hope for the productive possibilities for empathy.

Empathy and affect: what can empathied bodies do?

“…Following Reidar Pedersen, Rebecca Garden and others, we argue that an underlying and problematic discursive structure unifies these apparently disparate and oppositional accounts: they are all structured by the polarised dichotomies between subject and object, knower and known, mind and body, active and passive, science and society, culture and nature, (and masculine and feminine) that underpin modernity4 7 Thus, all these accounts reproduce the ideals of objectivity and neutrality in medicine, such that the subjectivity of the doctor , who is supposed to be both objective and neutral, is constantly elided, while the subjectivity of the patient is brought into view 14. Similarly, all these accounts construct empathic knowing as oppositional to, and hence needing to be kept in check by, the technical knowledge of medicine.…”

“…A critical shift that many of these works have made is to cease thinking of empathy as something we have and to being thinking of it as something we do. Thus, several recent psychologically based models of empathy incorporate affective, cognitive and behavioural elements, and draw out—literally— processes for how empathy occurs, mapping the pathways that link these elements 4 19 20. Others have suggested that we understand empathy performatively , as something we enact , in ways very like—or the same as—emotional labour 19.…”

“…Empathy is also considered to confer numerous instrumental benefits in medical practice. It facilitates doctor–patient communication and enhances mutual trust, producing a positive self-reinforcing cycle that can improve shared decision-making, alert physicians to physical and psychosocial factors that affect diagnosis and treatment decisions and help patients to comply with treatment regimens and develop positive health practices3 4 Empathy is good for doctors as well as patients. It can help avoid unpleasant or hostile interactions with patients and it confers significant satisfaction in relation to therapeutical goals 5…”

“…However, the importance of empathy in medicine and healthcare is at present matched by a very extensive scholarly literature on empathy in health and medicine (and beyond), that upon inspection proves to be philosophically vexed, internally contradictory and subject to significant critique over the past decade 4 9–11. Its vexations have been comprehensively examined elsewhere; here, we are most concerned with the question of how empathy can be defined (if at all) and, by corollary, whether empathy is either truly possible or desirable.…”

Empathizing with patients: the role of interaction and narratives in providing better patient care

“…It has been shown that physicians who can empathize with their patients provide better care than those who are unable to empathize (Eikeland et al 2014;Derksen et al 2013;Di Blasi and Kleijnen 2003;Halpern 2001;Hojat et al 2011Hojat et al , 2013Hooker 2015;Pedersen 2008;Roter et al 1998). Empathy greatly enhances the physician-patient interaction, allowing for the physician to better understand the patient's experiences, and therefore better understand how the patient should be treated.…”