What Is Empathy, and How Can It Be Promoted during Clinical Clerkships?

Abstract

The ability of medical students to empathize often declines as they progress through the curriculum. This suggests that there is a need to promote empathy toward patients during the clinical clerkships. In this article, the authors attempt to identify the patient interviewing style that facilitates empathy and some practice habits that interfere with it. The authors maintain that (1) empathy is a multistep process whereby the doctor's awareness of the patient's concerns produces a sequence of emotional engagement, compassion, and an urge to help the patient; and (2) the first step in this process--the detection of the patient's concerns--is a teachable skill. The authors suggest that this step is facilitated by (1) conducting a "patient-centered" interview, thereby creating an atmosphere that encourages patients to share their concerns, (2) enquiring further into these concerns, and (3) recording them in the section traditionally reserved for the patient's "chief complaint." Some practice habits may discourage patients from sharing their concerns, such as (1) writing up the history during patient interviewing, (2) focusing too early on the chief complaint, and (3) performing a complete system review. The authors conclude that sustaining empathy and promoting medical professionalism among medical students may necessitate a change in the prevailing interviewing style in all clinical teaching settings, and a relocation of a larger proportion of clinical clerkships from the hospital setting to primary care clinics and chronic care, home care, and hospice facilities, where students can establish a continuing relationship with patients.

Atitudes frente a aspectos relevantes da prática médica: estudo transversal randomizado com alunos de segundo e sexto anos

“…Essa identificação inicial é importante, pois tende a se refletir numa prática assistencial em que o aluno se sensibiliza com a condição do paciente e procura escolher as melhores opções de conduta e tratamento, ou seja, desenvolve a capacidade empáti-ca 22 . Na passagem para a posição de médico, essa sensibilidade pode se modificar -com predomínio de mecanismos psicológi-cos de autoproteção (defesas do ego, como negação, dissociação…”

Identifying Bioethics Learning Needs: A Survey of Canadian Emergency Medicine Residents

“…40 Educational strategies have also been suggested to help learners act more compassionately. 41 In the area of consent and capacity, the needs identified ranged from common and simple (i.e., a patient with a myocardial infarction who is refusing recommended care) to uncommon and complex (i.e., a parent refusing care for their child). There are a number of emergencyspecific educational resources on the subject of consent and refusal of care.…”

Is Empathy Necessary for the Practice of “Good” Medicine

“…The empathy of the medical professional is usually characterized as having an affective component (the capacity to "imagine" [Stepien & Baernstein, 2006, p. 524] and "enter into" [Hojat et al, 2002b[Hojat et al, , p. 1563] the experience and feelings of the patient); a cognitive component (an intellectual ability to understand the patient's perspective and to view the world from that per-spective); and a behavioural component (the ability to "convey understanding of those emotions and perspectives back to the patient" [Stepien & Baernstein, 2006, p. 524]). Some conceptualize these components as evolving from a "multiple-phase process": first one gains insight into the patient's perspective, then one becomes engaged with the patient which elicits a feeling of compassion that moves one to act in a helping manner (Benbassat & Baumal, 2004). Others conceptualize empathy as more akin to events or psychological dispositions, and argue that one or more of the three components is necessary for physician empathy, while the others are undesirable and/or unnecessary.…”

“…The female-brained student has a natural tendency to emotionally resonate with others, attuning them to subtle clues as to the patient's true feelings; the student who is extroverted in social orientation may more easily gain the patient's trust; the student with a disposition toward cognitive flexibility may be best at seeing the world from the perspective of the patient's values, beliefs and desires. Despite natural constraints on individual capacities to learn empathy-related skills, engagement in the humanities (Shapiro et al, 2004;Stepien & Baernstein, 2006) and training in patient-centred interviewing (Benbassat & Baumal, 2004;Stepien & Baernstein, 2006) are reportedly beneficial as means to promote the cognitive, affective and behavioural components of empathy amongst medical students.…”

“…More recently, this condemnation reached a climax when objective studies confirmed that empathy amongst medical students and residents declines as they progress throughout their training (Newton et al, 2000;Spencer, 2004;Hojat et al, 2004). By consequence, an extensive literature has emerged on the questions of how physicians should be empathic (Halpern, 2003;Benbassat & Baumal, 2004;Larson & Yao, 2007), how it should be measured (Hojat et al, 2004;Stepien & Baernstein, 2006), and how best to "educate" empathic physicians (Shapiro et al, 2004;Platt & Keller, 1994;Burack et al, 1999;Winefield & Chur-Hansen, 2000). Evidently, empathy in medicine is very much on the radar today.…”