Clinical Empathy as Emotional Labor in the Patient-Physician Relationship

Eric B. Larson, MD, MPHXin Yao, PhC

In the article about doctor-patient relationship, the author mainly discussed the mechanisms involved in empathy, “the value of learning about emotional labor and acting methods in creating an empathic treatment relationship” and the possible future development of clinical empathy. In the first part “Clinical Empathy and Its Consequences”, the author talked about the current situation of clinical empathy and stated that empathy affected the therapeutic process affectively. In the second part “Empathic Processes”, the author divided the Empathic Processes into three parts: Intrapersonal and Interpersonal Outcomes, Antecedents and Feedback Loops and Patient and Physician Outcomes and discussed them separately. He also used the theorem from “Davis and colleagues” to prove that “a physician’s communication skills and social style have a direct impact on patient satisfaction and health outcomes”. In the third part, the author introduced us about the “Emotional Labor and Acting Methods”, which is, one may use his or her empathy to make the business or the outcome of the work better, and actually it works in most cases. The author discussed that physicians sometimes also use the same method to make their patient’s outcome better. Moreover, the author argued that there are “surface empathy” and “deep empathy” and “Physicians may try to take the patient’s role while applying communication skills that have been found to be effective in soothing patients and generating positive treatment results. While engaging in both, each acting method can change the dynamics of the situation”. At last, the author stated the point that the empathy “is not an attribute limited to those who perform direct day-to-day care, such as nurses; it also includes, and in many ways more importantly, those who diagnose and treat”. The author supports that a close relationship between doctor and patient is good and we should develop this relationship deeper in the future.

From my perspective, this article could help my paper in “the definition of clinical empathy” and answering “why should we develop clinical empathy” as well as “what does clinical empathy works”.


Empathy Is a Protective Factor of Burnout in Physicians: New Neuro-Phenomenological Hypotheses Regarding Empathy and Sympathy in Care Relationship

Bérangère ThiriouxFrançois Birault, and Nematollah Jaafari

In this passage, the author mainly discussed that “empathy can protect physicians from burnout and can make them do their work better. What I am interested in is one of the author’s point: There is an obvious phenomenological distinction between empathy and sympathy. In his part “Neuro-phenomenology of empathy and sympathy”: empathy happened when doctor actually “feel with: the patient and think in patient’s way while sympathy can only illustrate that the author “knows” what his/her patient feels but could not feel the patient’s feeling, which sometimes made a doctor hard to fully understand his/her patient and cannot make the best decision for the patient or even lead to a physician’s burnout. The author discussed the distinction between sympathy and empathy in both psychological way and medical way. The author also discussed the “Neurophysiology working” of empathy and sympathy, which could be used in my article to distinct the “clinical empathy” and “clinical sympathy” and analyze which one is better and what should we develop more in the future.


What is Clinical Empathy?

Jodi Halpern, MD, PhD

The passage “What is Clinical Empathy” mainly introduced the clinical empathy by discussing the difference of “detached concern” and “empathy”, “specify ways that emotion contribute to empathy” and “whether empathy is practical in therapeutic process”. In the part discussing the difference between “detached concern” and “empathy”, the author gave an interesting point: “When doctor asks a patient about his or her condition directly, patient will usually feel “angry, uncomfortable and disrespected” though this might be the most efficient way to cure the patient”. The author also gave us two examples about how patients dislike to be asked about their conditions directly and why showing empathy to patients first might be a good choice. In the second part “specify ways that emotion contribute to empathy”, the author mainly discussed how empathy works, especially in clinical situation. The author also state that constructing an empathic relation between doctors and patients can produce “trust” and “disclosure” from patients and promote the doctor’s efficiency and preciseness. In this part, the author also provided four ways “that physicians can capitalize on their emotional responses to enhance medical care”, and this whole part will act as an important part to my essay in discussing “how” we should develop clinical empathy as well as “why” should we keep empathy in doctor-patient relationship.


Walking a fine line: is it possible to remain an empathic physician and have a hardened heart?

Bruce W. Newton

In this essay, the author mainly discussed the differentiation of clinical empathy revealed and performed in different gender and how does empathy work in male doctors and female doctors. This is a long essay and the author discussed this topic by several parts. Putting aside the gender differentiation of empathy between different genders. I am interested in the chapters: “Why is physician empathy important”, “What is empathy” and “Should physicians have a hardened empathic heart”. In the chapter “Why is physician empathy important”, the author stated the point that “empathic communication skills promote patient satisfaction, establishes trust, reduces anxiety, increases adherence to treatment regimens, improves health outcomes, as well as decreasing the likelihood of malpractice suits”, which could be used in my essay stating the reason why empathy is important in a doctor-patient relationship. In the part “What is empathy”, the author gave us one of the definition of empathy and the role that empathy usually acts in clinical situation. The author cited Eisenberg’s point as an example, which could also be used in my passage in defining empathy. For me, the most important part of this essay is the chapter “Should physicians have a hardened empathic heart”. This chapter mainly discussed that whether physicians should show their empathy towards patients while fully control themselves and make the most logical decision and not be affected by their emotion of empathy. The answer in the passage is “Yes” and the author suggest that doctors should “pretend” to be empathic, this will be a point that I disagree with but the point “physician should not be controlled by their empathy” is what I agree I and I will also mention the point in my paper.


A systematic review of the associations between empathy measures and patient outcomes in cancer care

Sophie Lelorain, Anne Brédart, Sylvie Dolbeault, Serge Sultan

This is a research report of “whether empathy affects the clinical progress? If yes, is it positive or negative”? In the report, the author’s group used multiple databases as well as contrast method to do the experiment. They chose lots of students and patients to do this experiment and the result was mainly based on the patients’ satisfaction and the result of the therapeutic outcome. The result is clear and obvious: Although “future research should apply different empathy assessment approaches simultaneously, including a perspective-taking task on patients’ expectations and needs at precise moments”, “clinicians’ empathy has beneficial effects according to patient perceptions”. Moreover, the writer, through the result of the experiment, suggested that “This review suggests that clinician’s empathy is associated with higher patient satisfaction, better psychosocial adjustment, lesser psychological distress and need for information, particularly in studies with patient-reported measures and retrospective designs”, which can be refined as “Empathy is very important in clinical situation because it is directly related to the patient’s satisfaction, the effect, and the outcome of the therapeutic process. I would like to use the result and part of the process of this experiment in my paper when discussing “why should we develop clinical empathy” and mention “how empathy will help us”.


How to Optimize Physicians’ Communication Skills in Cancer Care: Results of a Randomized Study Assessing the Usefulness of Posttraining Consolidation Workshops

Darius Razavi, Isabelle Merckaert, Serge Marchal, Yves Libert, Sandrine Conradt, Jacques Boniver, Anne-Marie Etienne, Ovide Fontaine, Pascal Janne, Jean Klastersky, Christine Reynaert, Pierre Scalliet, Jean-Louis Slachmuylder, Nicole Delvaux

This is another research report. It mainly answered a question: “How should we train medical students’ empathy”. The authors chose some random physicians and asked them to attend a program that would train their empathy as well as the ability to communicate with people. After five-month training, sixty-three physicians completed the program and their “Communication skills improved significantly more in the consolidation-workshop group compared with the waiting-list group” and “Patients interacting with physicians who benefited from consolidation workshops reported higher scores concerning their physicians’ understanding of their disease”. The research showed us a successful way to train physicians’ empathy and I might use them in my chapter of “The future development of clinical empathy”.


Why Doctors Should Be More Empathetic–But Not Too Much More (unscholarly)

Omar Sultan Haque, Adam Waytz

This is an article from SSA, and it mainly answered two questions: Does physicians nowadays lack of empathy on the patients? If so, do they hold-up their empathy while it appears or they do not come up with any empathy for them in the first place? The answer of the article is clear: physicians do lack of empathy nowadays and they actually do not feel empathetic for the patients in the first place. The author provided two experiments by Jean Decety and colleagues of the University of Chicago to prove his point. The author summarized the as this: “Whether during a surgery, biopsy, physical exam, or even a simple blood draw, healthcare professionals routinely must inflict pain on others to make them better in the long run”, so physicians might feel tired of empathy with people and thus their empathy were wore down day-by-day. Apart from these two questions, the author also stated that “when empathy is detrimental, it should not be the goal of physicians, then, to be more empathetic. They should aim instead to find the right balance, the golden mean that optimizes care”. I would like use this passage’s main idea: “whether physicians are lack of empathy now and what the reason it happens” to my discussion of “the relationship of doctors and patients”.


Should We Train Doctors for Empathy? (unscholarly)

Jill Suttie

The passage “Should we train doctor for empathy” mainly discussed three popular topic: Why do doctors need empathy, How to build empathy in medicine and how training empathy could solve some burnout and stress of physicians. The author started her essay by giving an example of herself: she prefer doctors who can show empathy for her and she changed her doctor because his lack of empathy. In the chapter “why do doctors need empathy”, the author used the viewpoints and the researches from Darrell Kirch, president and CEO of the Association of American Medical Colleges (AAMC). Darrell Kirch suggested that “Every patient wants their doctor to be academically prepared—to know the medicine that they need to know” and it is obvious that doctors need empathy because empathy is “a tool that can help us see how students might interact with real people in real situations”. In the chapter “how to build empathy in medicine”, the author suggested that the time that students started to feel less empathic with patients is at their third-year time especially “when they start to see patients—suggesting that the erosion of empathy may be more about what’s happening during training rather than the capabilities students possess upon admission”. The author also suggested that one of the reason doctors don’t apply empathy is that, “doctors who don’t feel concern for their patients, he argues, are at an increased, not decreased, risk of job dissatisfaction and burnout” and “when he try to detach themselves emotionally from their patients, the quality of their work suffers”. According to the author, the way to construct empathy in clinic is that, every doctor should face their emotion and should not afraid of it. One of the person that the author mentioned, Decety, believes that “doctors must learn to accept their own empathic feelings toward patients, yet not confuse their feelings with those of their patients, so that they can respond in the best way possible”. I would like to use these two parts in my paper because they both revealed the relationship between doctors and patients at present, which is the case that doctors sometimes lack of empathy towards patients, and the solution for this problem mentioned in the passage may also be helpful for me.


Work Cited

Larson, Eric B., and Xin Yao. “Clinical Empathy as Emotional Labor in the Patient-Physician Relationship.” JAMA, vol. 293, no. 9, 2005., pp. 1100-1106doi:10.1001/jama.293.9.1100.

Thirioux, B., F. Birault, and N. Jaafari. “Empathy is a Protective Factor of Burnout in Physicians: New Neuro-Phenomenological Hypotheses regarding Empathy and Sympathy in Care Relationship.” FRONTIERS IN PSYCHOLOGY, vol. 7, 2016., pp. 763doi:10.3389/fpsyg.2016.00763.

Halpern, Jodi. “What is Clinical Empathy?” Journal of General Internal Medicine, vol. 18, no. 8, 2003., pp. 670-674doi:10.1046/j.1525-1497.2003.21017.x.

Newton, BW. “Walking a Fine Line: Is it Possible to Remain an Empathic Physician and have a Hardened Heart?” FRONTIERS IN HUMAN NEUROSCIENCE, vol. 7, 2013., pp. 233doi:10.3389/fnhum.2013.00233.

Lelorain, Sophie, et al. “A Systematic Review of the Associations between Empathy Measures and Patient Outcomes in Cancer Care.” Psycho‐Oncology, vol. 21, no. 12, 2012., pp. 1255-1264doi:10.1002/pon.2115.

Razavi, Darius, et al. “How to Optimize Physicians’ Communication Skills in Cancer Care: Results of a Randomized Study Assessing the Usefulness of Posttraining Consolidation Workshops.” Journal of Clinical Oncology, vol. 21, no. 16, 2003., pp. 3141-3149doi:10.1200/JCO.2003.08.031.

Why Doctors Should Be More Empathetic–But Not Too Much More

Should We Train Doctors for Empathy?

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