November 8, 2017/Bioethics

Wherefore Art Thou, Empathy?

What is it, and where did it go?

15-RHE-XXXX-Calabrese-and-Fernandez-Consult-QD-Image

By Leonard Calabrese, DO

Advertisement

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

I think before we can find out where empathy goes, we must define what it is. We define empathy as a predominantly cognitive attribute which involves an understanding of experiences, concerns and perspective of the patient, combined with a capacity to communicate this understanding, and an intention to help. In other words, it is a quality that requires us to listen carefully and understand our patient’s pain and suffering as well as an ability to let them know we have done so!

Several instruments can be used to measure empathy; the Jefferson Empathy Scale (JES) is the most widely used tool in healthcare. Such measurements have repeatedly correlated with numerous variables that clearly are important for patient care and a successful career in medicine.

We can define the what and measure the how much of empathy, but it turns out that over the course of medical training, many of us can’t answer the question of where… where did my ability to care about patients go as my ability to care for them grew?

Mohammadreza Hojat, PhD, who developed the JES, named the phenomenon of losing empathy during medical training aptly in his 2009 article, “The Devil in the Third Year: A Longitudinal Study of Erosion of Empathy in Medical School.” He used this description to indicate that, for a variety of reasons, trainees may become jaded and hardened to the suffering of others.

While there is not universal agreement on this, it appears that most caregivers, especially women, start with high levels of empathy as they enter medical school. Then, somewhere in around the third year (coincident with them entering the hospital arena for training) a significant portion of them (perhaps two-thirds) begin to lose their empathy. It continues to fall through internship and residency. Qualitative analysis of subjects suggest fatigue, environmental factors and the “hidden curricula” of seniors and mentors who are burning out all may have negative effects.

I think finding that lost empathy lies in studying the one-third of trainees who do not see a decline in empathy. Moving ahead we need to learn more about this precious group and attempt to translate this to empathy saving interventions for the majority.

Dr. Calabrese is Director of the R.J. Fasenmyer Center for Clinical Immunology.

Advertisement

Related Articles

Francoise Bethoux, MD
October 3, 2023/Bioethics
When the Question is ‘Can You Fix Me, Doc?’

In rehabilitation medicine, the answer might require nuance

Elliott Richards MD
September 26, 2023/Bioethics
Difficult Fertility News Calls for Respecting Individual Experience

Mental health colleagues can provide much-needed perspective

Laura Shoemaker DO
September 14, 2023/Bioethics/Best Practices
Honoring Values for Patients With Serious Illness

Palliative care specialists know hard conversations can also be valuable ones

Seth Rotz, MD
September 6, 2023/Bioethics
Difficult Disclosures in Pediatric Oncology

Variables affect nuances of the conversation

Hands in protective gloves hold blue-stained electrophoresis gel.
June 16, 2023/Bioethics
The Cost of ‘Free’: Advising Patients About Sponsored Genetic Testing

Authors discuss ethical challenges associated with sponsored genetic testing

22-NUR-3084987-NN-Nursing-Ethics-Fellowship-CQD_650x450
November 29, 2022/Bioethics
New Faculty Fellowship Prepares Nurses to Navigate Moral Challenges

Program focuses on nurturing ethics leaders in daily practice

GettyImages-151531118
December 28, 2021/Bioethics
When a Surrogate Decision-Maker Wants Medically Futile Treatment

Medical, ethical and legal considerations

Ad