Skip to main content
Erschienen in: Journal of General Internal Medicine 1/2009

01.01.2009 | Perspectives

Expanding Clinical Empathy: An Activist Perspective

verfasst von: Rebecca Garden, PhD

Erschienen in: Journal of General Internal Medicine | Ausgabe 1/2009

Einloggen, um Zugang zu erhalten

ABTRACT

BACKGROUND

Discussions of empathy in health care offer important ways of enabling communication and interpersonal connection that are therapeutic for the patient and satisfying for the physician. While the best of these discussions offer valuable insights into the patient-physician relationship, many of them lack an action component for alleviating the patient’s suffering and emphasize the physician’s experience of empathy rather than the patient’s experience of illness.

METHODS

By examining educational methods, such as reflective writing exercises and the study of literary texts, and by analyzing theoretical approaches to empathy and suggestions for clinical practice, this article considers how to mindfully keep the focus on what the patient is going through.

CONCLUSION

Clinical empathy can be improved by strategies that address (1) the patient’s authority in providing first-person accounts of illness and disability, (2) expanding the concept of empathy to include an action component geared toward relieving patients’ suffering, and (3) the potential value of extending empathy to include the social context of illness.
Literatur
2.
Zurück zum Zitat Marcus ER. Empathy, humanism, and the professionalization process of medical education. Acad Med. 1999;74:1211–5.PubMedCrossRef Marcus ER. Empathy, humanism, and the professionalization process of medical education. Acad Med. 1999;74:1211–5.PubMedCrossRef
3.
Zurück zum Zitat Brainard AH, Brislen HC. Viewpoint: learning professionalism: a view from the trenches. Acad Med. 2007;82:1010–4.PubMed Brainard AH, Brislen HC. Viewpoint: learning professionalism: a view from the trenches. Acad Med. 2007;82:1010–4.PubMed
4.
Zurück zum Zitat Lowenstein J. Can you teach compassion? The midnight meal and other essays about doctors, patients, and medicine. New Haven: Yale University Press; 1997. Lowenstein J. Can you teach compassion? The midnight meal and other essays about doctors, patients, and medicine. New Haven: Yale University Press; 1997.
5.
Zurück zum Zitat Varkey P, Chutka DS, Lesnick TG. The aging game: improving medical students’ attitudes toward caring for the elderly. J Am Med Dir Assoc. 2006;7:224–229.PubMedCrossRef Varkey P, Chutka DS, Lesnick TG. The aging game: improving medical students’ attitudes toward caring for the elderly. J Am Med Dir Assoc. 2006;7:224–229.PubMedCrossRef
6.
Zurück zum Zitat Henderson P, Johnson MH. Assisting medical students to conduct empathic conversations with patients from a sexual medicine clinic. Sex Transm Infect. 2002;78:246–249.PubMedCrossRef Henderson P, Johnson MH. Assisting medical students to conduct empathic conversations with patients from a sexual medicine clinic. Sex Transm Infect. 2002;78:246–249.PubMedCrossRef
7.
Zurück zum Zitat Wear D, Varley JD. Rituals of verification: the role of simulation in developing and evaluating empathic communication. Pat Education and Counseling. 2008;71:153–6.CrossRef Wear D, Varley JD. Rituals of verification: the role of simulation in developing and evaluating empathic communication. Pat Education and Counseling. 2008;71:153–6.CrossRef
8.
Zurück zum Zitat Hanna M, Fins JJ. Power and communication: why simulation training ought to be complemented by experiential and humanist learning. Acad Med. 2006;81:265–270.PubMedCrossRef Hanna M, Fins JJ. Power and communication: why simulation training ought to be complemented by experiential and humanist learning. Acad Med. 2006;81:265–270.PubMedCrossRef
9.
Zurück zum Zitat Halpern J. From detached concern to empathy: humanizing medical practice. New York: Oxford University Press; 2001. Halpern J. From detached concern to empathy: humanizing medical practice. New York: Oxford University Press; 2001.
10.
Zurück zum Zitat Garden R. The problem of empathy: medicine and the humanities. New Literary History. 38(3):551–568. Garden R. The problem of empathy: medicine and the humanities. New Literary History. 38(3):551–568.
12.
Zurück zum Zitat Hafferty FW, Franks R. The hidden curriculum, ethics teaching, and the structure of medical education. Acad Med. 1994;69:861–71.PubMedCrossRef Hafferty FW, Franks R. The hidden curriculum, ethics teaching, and the structure of medical education. Acad Med. 1994;69:861–71.PubMedCrossRef
13.
Zurück zum Zitat Coulehan J, Williams PC. Vanquishing virtue: the impact of medical education. Acad Med. 2001;76:598–605.PubMedCrossRef Coulehan J, Williams PC. Vanquishing virtue: the impact of medical education. Acad Med. 2001;76:598–605.PubMedCrossRef
14.
Zurück zum Zitat Elder R, Price J, Williams G. Differences in ethical attitudes between registered nurses and medical students. Nurs Ethics. 2003;10:149–61. discussion 161–4.PubMedCrossRef Elder R, Price J, Williams G. Differences in ethical attitudes between registered nurses and medical students. Nurs Ethics. 2003;10:149–61. discussion 161–4.PubMedCrossRef
15.
Zurück zum Zitat Hojat M, Gonnella JS, Mangione S, et al.. Empathy in medical students as related to academic performance, clinical competence and gender. Med Educ. 2002;36:522–7.PubMedCrossRef Hojat M, Gonnella JS, Mangione S, et al.. Empathy in medical students as related to academic performance, clinical competence and gender. Med Educ. 2002;36:522–7.PubMedCrossRef
16.
Zurück zum Zitat Newton BW, Barber L, Clardy J, Cleveland E, O’Sullivan P. Is there hardening of the heart during medical school? Acad Med. 2008;83:244–249.PubMedCrossRef Newton BW, Barber L, Clardy J, Cleveland E, O’Sullivan P. Is there hardening of the heart during medical school? Acad Med. 2008;83:244–249.PubMedCrossRef
17.
Zurück zum Zitat Spiro H. What is empathy and can it be taught? Ann Intern Med. 1992;116:843–6.PubMed Spiro H. What is empathy and can it be taught? Ann Intern Med. 1992;116:843–6.PubMed
18.
Zurück zum Zitat Gaba DM, Howard SK. Patient safety: fatigue among clinicians and the safety of patients. N Engl J Med. 2002;347:1249–55.PubMedCrossRef Gaba DM, Howard SK. Patient safety: fatigue among clinicians and the safety of patients. N Engl J Med. 2002;347:1249–55.PubMedCrossRef
19.
Zurück zum Zitat Bellini LM, Baime M, Shea JA. Variation of mood and empathy during internship. JAMA. 2002;287:3143–6.PubMedCrossRef Bellini LM, Baime M, Shea JA. Variation of mood and empathy during internship. JAMA. 2002;287:3143–6.PubMedCrossRef
20.
Zurück zum Zitat DasGupta S, Charon R. Personal illness narratives: using reflective writing to teach empathy. Acad Med. 2004;79:351–6.PubMedCrossRef DasGupta S, Charon R. Personal illness narratives: using reflective writing to teach empathy. Acad Med. 2004;79:351–6.PubMedCrossRef
21.
Zurück zum Zitat Spickard A Jr, Gabbe SG, Christensen JF. Mid-career burnout in generalist and specialist physicians. JAMA. 2002;288:1447–50.PubMedCrossRef Spickard A Jr, Gabbe SG, Christensen JF. Mid-career burnout in generalist and specialist physicians. JAMA. 2002;288:1447–50.PubMedCrossRef
22.
Zurück zum Zitat Dugdale DC, Epstein R, Pantilat SZ. Time and the patient-physician relationship. J Gen Intern Med. 1999;14:S34–40.PubMedCrossRef Dugdale DC, Epstein R, Pantilat SZ. Time and the patient-physician relationship. J Gen Intern Med. 1999;14:S34–40.PubMedCrossRef
23.
Zurück zum Zitat Kim SS, Kaplowitz S, Johnston MV. The effects of physician empathy on patient satisfaction and compliance. Eval Health Prof. 2004;27:237–51.PubMedCrossRef Kim SS, Kaplowitz S, Johnston MV. The effects of physician empathy on patient satisfaction and compliance. Eval Health Prof. 2004;27:237–51.PubMedCrossRef
24.
Zurück zum Zitat Redelmeier DA, Molin JP, Tibshirani RJ. A randomised trial of compassionate care for the homeless in an emergency department. Lancet. 1995;345:1131–4.PubMedCrossRef Redelmeier DA, Molin JP, Tibshirani RJ. A randomised trial of compassionate care for the homeless in an emergency department. Lancet. 1995;345:1131–4.PubMedCrossRef
25.
Zurück zum Zitat Coulehan JL, Platt FW, Egener B, et al.. “Let me see if I have this right…”: words that help build empathy. Ann Intern Med. 2001;135:221–7.PubMed Coulehan JL, Platt FW, Egener B, et al.. “Let me see if I have this right…”: words that help build empathy. Ann Intern Med. 2001;135:221–7.PubMed
26.
Zurück zum Zitat Stepien KA, Baernstein A. Educating for empathy, A review. J Gen Intern Med. 2006;21:524–30.PubMedCrossRef Stepien KA, Baernstein A. Educating for empathy, A review. J Gen Intern Med. 2006;21:524–30.PubMedCrossRef
27.
Zurück zum Zitat Morse JM, Anderson G, Bottorff JL, et al.. Exploring empathy: a conceptual fit for nursing practice? Image J Nurs Sch. 1992;24:273–80.PubMedCrossRef Morse JM, Anderson G, Bottorff JL, et al.. Exploring empathy: a conceptual fit for nursing practice? Image J Nurs Sch. 1992;24:273–80.PubMedCrossRef
28.
Zurück zum Zitat Benbassat J, Baumal R. What is empathy, and how can it be promoted during clinical clerkships? Acad Med. 2004;79:832–9.PubMedCrossRef Benbassat J, Baumal R. What is empathy, and how can it be promoted during clinical clerkships? Acad Med. 2004;79:832–9.PubMedCrossRef
29.
Zurück zum Zitat Cohen-Cole SA, Bird J. Function 2: building rapport and responding to patient’s emotions (relationship skills). In: Cohen-Cole SA, ed. The Medical Interview: The Three-Function Approach. St. Louis: Mosby Year Book; 1995:21–7. Cohen-Cole SA, Bird J. Function 2: building rapport and responding to patient’s emotions (relationship skills). In: Cohen-Cole SA, ed. The Medical Interview: The Three-Function Approach. St. Louis: Mosby Year Book; 1995:21–7.
30.
Zurück zum Zitat Lazare A. Outpatient Psychiatry: Diagnosis and Treatment. Baltimore: Williams & Wilkins; 1989:153–7. Lazare A. Outpatient Psychiatry: Diagnosis and Treatment. Baltimore: Williams & Wilkins; 1989:153–7.
31.
Zurück zum Zitat Suchman AL, Markakis K, Beckman HB, Frankel R. A model of empathic communication in the medical interview. JAMA. 1997;277:678–82.PubMedCrossRef Suchman AL, Markakis K, Beckman HB, Frankel R. A model of empathic communication in the medical interview. JAMA. 1997;277:678–82.PubMedCrossRef
32.
Zurück zum Zitat Mercer SW, Reynolds WJ. Empathy and quality of care. Br J Gen Pract. 2002;52:S9–12.PubMed Mercer SW, Reynolds WJ. Empathy and quality of care. Br J Gen Pract. 2002;52:S9–12.PubMed
33.
Zurück zum Zitat Adler HM. Toward a biopsychosocial understanding of the patient-physician relationship: an emerging dialogue. J Gen Intern Med. 2007;22:280–5.PubMedCrossRef Adler HM. Toward a biopsychosocial understanding of the patient-physician relationship: an emerging dialogue. J Gen Intern Med. 2007;22:280–5.PubMedCrossRef
34.
Zurück zum Zitat Lipkin M, Putnam SM, Lazare A. The medical interview: clinical care, education, and research. New York: Springer; 1995. Lipkin M, Putnam SM, Lazare A. The medical interview: clinical care, education, and research. New York: Springer; 1995.
35.
Zurück zum Zitat Beach MC, Inui T. Relationship-centered care research network. Relationship-centered care. A constructive reframing. J Gen Intern Med. 2006;21:S3–8.PubMedCrossRef Beach MC, Inui T. Relationship-centered care research network. Relationship-centered care. A constructive reframing. J Gen Intern Med. 2006;21:S3–8.PubMedCrossRef
36.
37.
Zurück zum Zitat Burack JH, Irby DM, Carline JD, Root RK, Larson EB. Teaching compassion and respect. Attending physicians’ responses to problematic behaviors. J Gen Intern Med. 1999;14:49–55.PubMedCrossRef Burack JH, Irby DM, Carline JD, Root RK, Larson EB. Teaching compassion and respect. Attending physicians’ responses to problematic behaviors. J Gen Intern Med. 1999;14:49–55.PubMedCrossRef
38.
Zurück zum Zitat Churchill LR. Why literature and medicine? Lit Med. 1982;1rev. ed.35–6. Churchill LR. Why literature and medicine? Lit Med. 1982;1rev. ed.35–6.
39.
Zurück zum Zitat Lancaster T, Hart R, Gardner S. Literature and medicine: evaluating a special study module using the nominal group technique. Med Educ. 2002;36:1071–6.PubMedCrossRef Lancaster T, Hart R, Gardner S. Literature and medicine: evaluating a special study module using the nominal group technique. Med Educ. 2002;36:1071–6.PubMedCrossRef
40.
Zurück zum Zitat Reifler DR. “I actually don’t mind the bone saw”: narratives of gross anatomy. Lit Med. 1996;15:183–99.PubMed Reifler DR. “I actually don’t mind the bone saw”: narratives of gross anatomy. Lit Med. 1996;15:183–99.PubMed
41.
Zurück zum Zitat Shapiro J, Morrison E, Boker J. Teaching empathy to first year medical students: evaluation of an elective literature and medicine course. Educ Health (Abingdon). 2004;17:73–84.CrossRef Shapiro J, Morrison E, Boker J. Teaching empathy to first year medical students: evaluation of an elective literature and medicine course. Educ Health (Abingdon). 2004;17:73–84.CrossRef
42.
Zurück zum Zitat Charon R. Narrative Medicine: Honoring the Stories of Illness. Oxford: Oxford UP; 2006. Charon R. Narrative Medicine: Honoring the Stories of Illness. Oxford: Oxford UP; 2006.
43.
Zurück zum Zitat Montgomery Hunter K. Doctors’ Stories: The Narrative Structure of Medical Knowledge. Princeton: Princeton UP; 1991. Montgomery Hunter K. Doctors’ Stories: The Narrative Structure of Medical Knowledge. Princeton: Princeton UP; 1991.
44.
45.
Zurück zum Zitat Marshall PA, O’Keefe JP. Medical students’ first-person narratives of a patient’s story of AIDS. Soc Sci Med. 1995;40:67–76.PubMedCrossRef Marshall PA, O’Keefe JP. Medical students’ first-person narratives of a patient’s story of AIDS. Soc Sci Med. 1995;40:67–76.PubMedCrossRef
46.
Zurück zum Zitat Maguire P, Fairbairn S, Fletcher C. Consultation skills of young doctors: I–Benefits of feedback training in interviewing as students persist. Br Med J (Clin Res Ed). 1986;292:1573–6.CrossRef Maguire P, Fairbairn S, Fletcher C. Consultation skills of young doctors: I–Benefits of feedback training in interviewing as students persist. Br Med J (Clin Res Ed). 1986;292:1573–6.CrossRef
47.
Zurück zum Zitat Klein S, Tracy D, Kitchener HC, Walker LG. The effects of the participation of patients with cancer in teaching communication skills to medical undergraduates: a randomised study with follow-up after 2 years. Eur J Cancer. 2000;36:273–81.PubMedCrossRef Klein S, Tracy D, Kitchener HC, Walker LG. The effects of the participation of patients with cancer in teaching communication skills to medical undergraduates: a randomised study with follow-up after 2 years. Eur J Cancer. 2000;36:273–81.PubMedCrossRef
48.
Zurück zum Zitat Tervalon M, Murray-García J. Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education. J Health Care Poor Underserved. 1998;9:117–25.PubMed Tervalon M, Murray-García J. Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education. J Health Care Poor Underserved. 1998;9:117–25.PubMed
49.
Zurück zum Zitat Bauby JD. The diving-bell and the butterfly. New York: Vintage; 1994. Bauby JD. The diving-bell and the butterfly. New York: Vintage; 1994.
50.
Zurück zum Zitat Grealy L. Autobiography of a face. New York: Harper Perennial; 2003. Grealy L. Autobiography of a face. New York: Harper Perennial; 2003.
51.
Zurück zum Zitat Fries K. Body, remember: a memoir. Madison: University of Wisconsin Press; 2003. Fries K. Body, remember: a memoir. Madison: University of Wisconsin Press; 2003.
52.
Zurück zum Zitat Kaysen S. Girl, interrupted. New York: Vintage; 1994. Kaysen S. Girl, interrupted. New York: Vintage; 1994.
53.
Zurück zum Zitat Mairs N. Waist-high in the world: a life among the nondisabled. Boston: Beacon Press; 1996. Mairs N. Waist-high in the world: a life among the nondisabled. Boston: Beacon Press; 1996.
54.
Zurück zum Zitat Ndebele NS, Rasebotsa N, Samuelson M, eds. Nobody ever said AIDS: poems and stories from southern Africa. Capetown: Kwela Books; 2004. Ndebele NS, Rasebotsa N, Samuelson M, eds. Nobody ever said AIDS: poems and stories from southern Africa. Capetown: Kwela Books; 2004.
55.
Zurück zum Zitat I am indebted to an anonymous reviewer for this concept. I am indebted to an anonymous reviewer for this concept.
56.
Zurück zum Zitat Reisman AB, Hansen H, Rastegar A. The craft of writing: a physician-writer’s workshop for resident physicians. J Gen Intern Med. 2006;21:1109–11.PubMedCrossRef Reisman AB, Hansen H, Rastegar A. The craft of writing: a physician-writer’s workshop for resident physicians. J Gen Intern Med. 2006;21:1109–11.PubMedCrossRef
57.
Zurück zum Zitat Larson EB, Yao X. Clinical empathy as emotional labor in the patient-physician relationship. JAMA. 2005;293:1100–6.PubMedCrossRef Larson EB, Yao X. Clinical empathy as emotional labor in the patient-physician relationship. JAMA. 2005;293:1100–6.PubMedCrossRef
Metadaten
Titel
Expanding Clinical Empathy: An Activist Perspective
verfasst von
Rebecca Garden, PhD
Publikationsdatum
01.01.2009
Verlag
Springer-Verlag
Erschienen in
Journal of General Internal Medicine / Ausgabe 1/2009
Print ISSN: 0884-8734
Elektronische ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-008-0849-9

Weitere Artikel der Ausgabe 1/2009

Journal of General Internal Medicine 1/2009 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Costims – das nächste heiße Ding in der Krebstherapie?

28.05.2024 Onkologische Immuntherapie Nachrichten

„Kalte“ Tumoren werden heiß – CD28-kostimulatorische Antikörper sollen dies ermöglichen. Am besten könnten diese in Kombination mit BiTEs und Checkpointhemmern wirken. Erste klinische Studien laufen bereits.

Positiver FIT: Die Ursache liegt nicht immer im Dickdarm

27.05.2024 Blut im Stuhl Nachrichten

Immunchemischer Stuhltest positiv, Koloskopie negativ – in solchen Fällen kann die Blutungsquelle auch weiter proximal sitzen. Ein Forschungsteam hat nachgesehen, wie häufig und in welchen Lokalisationen das der Fall ist.

GLP-1-Agonisten können Fortschreiten diabetischer Retinopathie begünstigen

24.05.2024 Diabetische Retinopathie Nachrichten

Möglicherweise hängt es von der Art der Diabetesmedikamente ab, wie hoch das Risiko der Betroffenen ist, dass sich sehkraftgefährdende Komplikationen verschlimmern.

Mehr Lebenszeit mit Abemaciclib bei fortgeschrittenem Brustkrebs?

24.05.2024 Mammakarzinom Nachrichten

In der MONARCHE-3-Studie lebten Frauen mit fortgeschrittenem Hormonrezeptor-positivem, HER2-negativem Brustkrebs länger, wenn sie zusätzlich zu einem nicht steroidalen Aromatasehemmer mit Abemaciclib behandelt wurden; allerdings verfehlte der numerische Zugewinn die statistische Signifikanz.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.