Physician empathy may mean better patient outcomes

Diabetics have more control of their A1c and LDL levels when their doctors appear more understanding, a study says.

By Tanya Albert Henry — Posted March 30, 2011

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Having empathy for patients isn't something physicians should do just to be nice. A study suggests that it also leads to better outcomes and should be seen as a key component of physician competence.

In what is believed to be the first scientific analysis to link empathy with patient outcomes, researchers found that physicians with high empathy had patients with significantly greater control over their diabetes than patients of physicians with low empathy scores. The findings are in the March issue of Academic Medicine (link).

The 29 physicians who participated in the study completed the Jefferson Scale of Empathy, which assessed how empathetic they were to patients. Researchers then looked at A1c and LDL results for 891 diabetics whom the doctors treated. Among patients who had doctors with high empathy scores, 56% had an A1c test result below 7% and 59% had an LDL test below 100. Among doctors with low empathy scores, 40% of diabetics had an A1c test result below 7% and 44% had an LDL test below 100.

"For those of us in primary care medicine who have devoted much of our working lives to developing empathic relationships with our patients, research findings of improved patient outcomes among the more empathetic physicians is very gratifying indeed," said one of the study's authors, Fred Markham, MD, a family physician and professor in the Dept. of Family and Community at Thomas Jefferson University Jefferson Medical College in Philadelphia.

In a prepared statement, he said, "We have long believed in the importance of empathy, and finding measurably better outcomes lends support to our attempts to nurture empathetic medical students and residents who will pursue careers in every kind of medical and surgical specialty."

If a physician is more empathetic, it can lead to better understanding and trust between the doctor and patient, said lead study author Mohammadreza Hojat, PhD, a research professor of psychiatry and human behavior at Thomas Jefferson University. That can lead to a patient being more open with the physician and the patient becoming more likely to comply with the treatment the doctor outlines.

"And not only is it beneficial to the patient, it can be beneficial to the physician also," Dr. Hojat said. "It can reduce the professional stress and fatigue."

Empathy is part personality and part something that can be taught, he said.

At Thomas Jefferson, first-year emergency physician residents shadow an emergency patient to see what goes on. "This shadowing can increase understanding," Hojat said.

There are nine other approaches to enhance empathy, according to an earlier paper Hojat wrote. They include recording patient encounters, reading literature to better understand pain and suffering, and experiencing a pseudo-admission to the hospital, where doctors pretend they are sick and check into the hospital to experience what it is like from the front desk to the exam room. "Researchers have been able to show increased empathy with training," Hojat said.

Because the March study is the first to use an evidence-based scientific foundation to look at empathy and patient outcomes, the next step is for researchers to replicate this study for other conditions such as asthma, hypertension and cancer, Hojat said. "These findings, if confirmed by larger scale research, suggest that empathy should be viewed as an integral component of a physician's competence."

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