(PHILADELPHIA) A paradigm shift in medical education is needed, one with more emphasis on training future physicians to enhance their empathy skills and to learn to view patients as persons, not just cases, a medical education specialist at Jefferson Medical College says.
"If we want to train physicians with more empathy, then education must shift from emphasizing only the biomedical to also providing a biopsychosocial framework, as well and a more complete picture of patients as persons," says Mohammadreza Hojat, Ph.D., research professor of psychiatry and human behavior at Jefferson Medical College of Thomas Jefferson University in Philadelphia.
According to Dr. Hojat, who has written a book, Empathy in Patient Care: Antecedents, Development, Measurement, and Outcomes, (Springer-Verlag 2007), much emphasis is placed today on the biomedical paradigm of health and illness, which is akin to treating the organ affected by disease rather than curing the patient's illness. "The thinking is, once you treat the organ, the patient is fine," he says. "This is a unidimensional approach to patient care. Health is not simply defined as absence of disease – it encompasses the physical, mental and social well being of a person."
The book is aimed at physicians, medical students, residents, psychologists, clinical social workers and any other health professionals involved in patient care. It serves as a platform, he says, to discuss factors that contribute to empathy development, such as genetic, social and educational factors, and approaches to enhance empathy. Dr. Hojat is convinced that a caregiver's empathic abilities can influence how a patient fares. "It's important to consider the potential role of empathic ability in clinical outcome," he says. "When the patient feels the physician can understand him or her, that in itself seems to have a therapeutic effect."
In 2001, Dr. Hojat and his colleagues developed the Jefferson Scale of Physician Empathy. The scale, which has already been translated into 15 languages and is used by researchers worldwide, is the only psychometrically sound instrument available for specifically measuring empathy among physicians and medical students.
Declining time doctors and patients spend together is another reason the physician-patient relationship is a concern in medical education and practice. "Medical schools are eager to teach professionalism in the practice of medicine," he says. "Empathy is an important element of professionalism because of the increased attention to the physician-patient relationship." Still, despite advances in technology and medicine, "it seems difficult to convince medical students that the art of medicine can be as important as the science."
Many medical schools are incorporating new classes and methods into the curriculum to improve empathy skills among students and residents, hoping to help them better understand what patients experience. Some are including more courses in arts and humanities and literature, for example, while others involve students in role-playing or shadowing a patient. Improving interpersonal skills and the interpretation of non-verbal cues are among other ways to help develop empathy skills. Says Dr. Hojat: "We need to convince medical students and residents that empathic engagement in the context of patient care leads to positive clinical outcomes, and develop a formal, targeted educational program to enhance empathy in patient care."