To try to better understand patients’ experiences and find ways to improve empathy among physicians, they have developed the Jefferson Scale of Physician Empathy. The scale asks students and physicians to rate their agreement or disagreement on a number of issues. For example, one item says: “Empathy is a therapeutic skill without which success in treatment is limited.” Another one goes on: “It is difficult for me to view things from my patients’ perspectives.” The scale is the first to be developed to specifically measure empathy among medical students, physicians and other health professionals in patient care situations.
Empathy, historically, has been difficult to measure, says Mohammadreza Hojat, Ph.D., research professor of psychiatry and human behavior at Jefferson Medical College of Thomas Jefferson University, who helped develop the scale.
While knowledge and clinical skills are important, the personal qualities of the physician count for much as well, he says, particularly in evaluating overall physician performance. “Professionalism in medicine includes compassionate care, and physicians should be trained to provide such care,” Dr. Hojat says. “One component is empathy. It should be measured to find out which physicians may need more of it, and how to improve it among medical students and physicians.”
Dr. Hojat and his colleagues have already published several studies in which the scale was used in samples of medical students, residents, practicing physicians, nurse practitioners and registered nurses. They summarized their research findings in May in the inaugural issue of Seminars in Integrative Medicine. The group found, among other things, a drop in empathy among third-year medical students at the end of the academic year when compared to the beginning.
Co-author Sal Mangione, M.D., clinical associate professor of medicine at Jefferson Medical College, suggests a number of reasons, none of which may explain fully why such a drop was seen.
“There is a general awareness that something makes us jaded – maybe from a combination of a need to shield ourselves from pain and suffering to the nature and intensity of medical training, which is sometimes dehumanizing,” says Dr. Mangione.
Still, losing some sense of empathy may not necessarily be a bad thing. It may allow students and physicians to better cope with some situations they may encounter, notes co-author Joseph S. Gonnella, M.D., emeritus dean and distinguished professor of medicine at Jefferson Medical College.
Dr. Mangione isn’t sure that teaching empathy – if indeed empathy can be “taught” – is necessarily neglected in medical schools. He says that the medical system itself is what has gone awry. It’s difficult today to be a physician with sufficient autonomy, given the restrictions placed by insurance companies.
“Physicians aren’t dealing with patients, but rather, with a system that is between the patient and the doctor,” he says. “There’s less of a direct relationship now. Doctors spend less time with patients than they have in the past.” As a result, “some people may perceive us as not caring.”
Many medical school programs around the country are trying to develop ways to teach empathy, he says. The most successful ways seem to involve student role-playing to get a better feel for what the patient is experiencing. “It’s clear that empathy is an extremely important issue to address in medical education,” notes co-author Thomas J. Nasca, M.D., Dean of Jefferson Medical College and senior vice president at Thomas Jefferson University. “Further, with effective measurement tools, we will eventually be able to evaluate this important humanistic attribute with a goal of enhancement of physician effectiveness.”
But just how much empathy is enough? “We’re trying, in our research, to find out the essential level [of empathy] that needs to be maintained for many physicians,” says Dr. Gonnella. “We think the scale we’ve developed will be a useful tool in helping provide us with some insights.”
According to Dr. Hojat, interpersonal skills and empathy play a role in the patient’s outcome. “Physicians who can understand the illness from the patient’s point of view can render better care,” he says. “A basic human need is fulfilled when an empathic relationship is formed between a physician and his or her patient. When the patient feels the physician can understand him, that in itself seems to have a therapeutic effect.”
The scale could be used in several ways. It might help, for example, in evaluating an educational program for its value in training physicians. And if, as some believe, students become cynical as time goes on, particularly after they’ve begun clinical training, the scale could help empirically test this as well.
Dr. Hojat and his colleagues have some suggestions for developing greater empathy. “One of the factors that can contribute to more empathy is to have physicians read literature, to be aware of human suffering,” he says.
Physician education might also focus on improving interpersonal skills. “We need a formal, targeted educational program to improve empathy in medical students,” he says. “This attribute could be improved if targeted education was given appropriately.”
The scale has been popular. The group has received a large number of requests for permission to use the scale, and it has been translated into Spanish, Italian and Hebrew.
Mike Magee, M.D., senior medical advisor and director of the Division of Medical Humanities Initiative at Pfizer, Inc., New York, was also a co-author.
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