Empirical research on empathy in medicine—A critical review
Introduction
Empathy is generally considered important and positive to help patients in a good way, and empirical research on medical students’ and physicians’ empathy is growing. For example, many studies have shown that empathy may be stunted or reduced during medical training (see Section 3.5.1), and these tendencies have given rise to considerable concern.
Generally, empathy in medicine may be described as appropriate understanding of the patient [1]. However, there is no general agreement concerning how to define, teach, or study empathy. Some conceptual issues that have been hotly debated are whether empathy is emotional or cognitive, subjective or objective, and whether empathy includes communicating the understanding generated or acting appropriately based upon this understanding. Some researchers have argued that empathy is a multidimensional construct and have used more inclusive methods, while others have chosen to study selected dimensions. Empirical studies of empathy have been reviewed in various publications (see e.g. [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13]). However, after reading publications in which empirical research on medical students’ or physicians’ empathy has been presented or discussed, my impression was that important methodological assumptions, ideals, and trends did not receive adequate attention. Furthermore, none of the previous reviews were systematic reviews including both qualitative and quantitative methods used to study empathy in medicine. Thus, this critical review was undertaken. The focus in this article is on the methods used to study empathy in medicine – in particular methodological limitations and challenges – and the reported results in the reviewed publications are only presented where relevant to illustrate methodological aspects. Thus, the publications reviewed include many positive contributions and interesting results not presented here.
Section snippets
Methods
A systematic literature search in Ovid MEDLINE(R), PsycINFO, EMBASE, and CINAHL was performed from May to August 2008. Publications presenting empirical research on medical students’ or physicians’ empathy were searched for (through subject headings related to empathy [AND] medical students or physicians [AND] empirical research; see Box 1. Languages included: English, German, Spanish, and the Scandinavian languages). In addition, other publications were identified through “unsystematic”
What methods were used?
In the majority of the selected publications (171 of 206) predominantly quantitative methods were used. Among the 171 predominantly quantitative studies, 38 various quantitative measures were identified (see Table 1 and Section 3.4). However, 51 of the predominantly quantitative studies selected did not describe how empathy was evaluated or indicated that empathy was measured in an implicit or imprecise way [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28]
Discussion
This review indicates that empirical research on empathy in medicine is abundant with quantitative measures and studies, and single-method approaches. The quantitative studies of empathy are often based solely on self-reports far away from medical practice and the patient, or uncritically focused on observable aspects, and in general remote from physician's and patient's concrete feelings, experiences and interpretations in practice. Some of the observer-based measures seem to presuppose that
Conflict of interest statement
The author has no conflict of interest (e.g. financial, personal or other relationships with other people or organizations that could inappropriately influence, or be perceived to influence, his work).
Acknowledgments
This paper is part of a Ph.D. project funded by the Research Council of Norway and supervised by Professor Jan Helge Solbakk and Professor Arne Johan Vetlesen.
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