Journal of General Internal Medicine

, Volume 24, Issue 1, pp 122–125 | Cite as

Expanding Clinical Empathy: An Activist Perspective

  • Rebecca GardenEmail author



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.


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.


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.


communication skills doctor-patient relationships medical education—attitudes and psychosocial patient-centered care medical humanities 



Thanks to Eli Braun for his research assistance.

Conflict of Interest

None disclosed.


  1. 1.
    Halpern J. What is clinical empathy? J Gen Intern Med. 2003;18:670–4.PubMedCrossRefGoogle Scholar
  2. 2.
    Marcus ER. Empathy, humanism, and the professionalization process of medical education. Acad Med. 1999;74:1211–5.PubMedCrossRefGoogle Scholar
  3. 3.
    Brainard AH, Brislen HC. Viewpoint: learning professionalism: a view from the trenches. Acad Med. 2007;82:1010–4.PubMedGoogle Scholar
  4. 4.
    Lowenstein J. Can you teach compassion? The midnight meal and other essays about doctors, patients, and medicine. New Haven: Yale University Press; 1997.Google Scholar
  5. 5.
    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.PubMedCrossRefGoogle Scholar
  6. 6.
    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.PubMedCrossRefGoogle Scholar
  7. 7.
    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.CrossRefGoogle Scholar
  8. 8.
    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.PubMedCrossRefGoogle Scholar
  9. 9.
    Halpern J. From detached concern to empathy: humanizing medical practice. New York: Oxford University Press; 2001.Google Scholar
  10. 10.
    Garden R. The problem of empathy: medicine and the humanities. New Literary History. 38(3):551–568.Google Scholar
  11. 11.
    Association of American Medical Colleges Medical School Objectives Project. Report 1, Learning objectives for medical student education, guidelines for medical schools. Available at: Accessed May 31, 2007.
  12. 12.
    Hafferty FW, Franks R. The hidden curriculum, ethics teaching, and the structure of medical education. Acad Med. 1994;69:861–71.PubMedCrossRefGoogle Scholar
  13. 13.
    Coulehan J, Williams PC. Vanquishing virtue: the impact of medical education. Acad Med. 2001;76:598–605.PubMedCrossRefGoogle Scholar
  14. 14.
    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.PubMedCrossRefGoogle Scholar
  15. 15.
    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.PubMedCrossRefGoogle Scholar
  16. 16.
    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.PubMedCrossRefGoogle Scholar
  17. 17.
    Spiro H. What is empathy and can it be taught? Ann Intern Med. 1992;116:843–6.PubMedGoogle Scholar
  18. 18.
    Gaba DM, Howard SK. Patient safety: fatigue among clinicians and the safety of patients. N Engl J Med. 2002;347:1249–55.PubMedCrossRefGoogle Scholar
  19. 19.
    Bellini LM, Baime M, Shea JA. Variation of mood and empathy during internship. JAMA. 2002;287:3143–6.PubMedCrossRefGoogle Scholar
  20. 20.
    DasGupta S, Charon R. Personal illness narratives: using reflective writing to teach empathy. Acad Med. 2004;79:351–6.PubMedCrossRefGoogle Scholar
  21. 21.
    Spickard A Jr, Gabbe SG, Christensen JF. Mid-career burnout in generalist and specialist physicians. JAMA. 2002;288:1447–50.PubMedCrossRefGoogle Scholar
  22. 22.
    Dugdale DC, Epstein R, Pantilat SZ. Time and the patient-physician relationship. J Gen Intern Med. 1999;14:S34–40.PubMedCrossRefGoogle Scholar
  23. 23.
    Kim SS, Kaplowitz S, Johnston MV. The effects of physician empathy on patient satisfaction and compliance. Eval Health Prof. 2004;27:237–51.PubMedCrossRefGoogle Scholar
  24. 24.
    Redelmeier DA, Molin JP, Tibshirani RJ. A randomised trial of compassionate care for the homeless in an emergency department. Lancet. 1995;345:1131–4.PubMedCrossRefGoogle Scholar
  25. 25.
    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.PubMedGoogle Scholar
  26. 26.
    Stepien KA, Baernstein A. Educating for empathy, A review. J Gen Intern Med. 2006;21:524–30.PubMedCrossRefGoogle Scholar
  27. 27.
    Morse JM, Anderson G, Bottorff JL, et al.. Exploring empathy: a conceptual fit for nursing practice? Image J Nurs Sch. 1992;24:273–80.PubMedCrossRefGoogle Scholar
  28. 28.
    Benbassat J, Baumal R. What is empathy, and how can it be promoted during clinical clerkships? Acad Med. 2004;79:832–9.PubMedCrossRefGoogle Scholar
  29. 29.
    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.Google Scholar
  30. 30.
    Lazare A. Outpatient Psychiatry: Diagnosis and Treatment. Baltimore: Williams & Wilkins; 1989:153–7.Google Scholar
  31. 31.
    Suchman AL, Markakis K, Beckman HB, Frankel R. A model of empathic communication in the medical interview. JAMA. 1997;277:678–82.PubMedCrossRefGoogle Scholar
  32. 32.
    Mercer SW, Reynolds WJ. Empathy and quality of care. Br J Gen Pract. 2002;52:S9–12.PubMedGoogle Scholar
  33. 33.
    Adler HM. Toward a biopsychosocial understanding of the patient-physician relationship: an emerging dialogue. J Gen Intern Med. 2007;22:280–5.PubMedCrossRefGoogle Scholar
  34. 34.
    Lipkin M, Putnam SM, Lazare A. The medical interview: clinical care, education, and research. New York: Springer; 1995.Google Scholar
  35. 35.
    Beach MC, Inui T. Relationship-centered care research network. Relationship-centered care. A constructive reframing. J Gen Intern Med. 2006;21:S3–8.PubMedCrossRefGoogle Scholar
  36. 36.
    Lipkin M. Integrity, compassion, respect. J Gen Intern Med. 1986;1:65–7. Jan-Feb.PubMedCrossRefGoogle Scholar
  37. 37.
    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.PubMedCrossRefGoogle Scholar
  38. 38.
    Churchill LR. Why literature and medicine? Lit Med. 1982;1rev. ed.35–6.Google Scholar
  39. 39.
    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.PubMedCrossRefGoogle Scholar
  40. 40.
    Reifler DR. “I actually don’t mind the bone saw”: narratives of gross anatomy. Lit Med. 1996;15:183–99.PubMedGoogle Scholar
  41. 41.
    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.CrossRefGoogle Scholar
  42. 42.
    Charon R. Narrative Medicine: Honoring the Stories of Illness. Oxford: Oxford UP; 2006.Google Scholar
  43. 43.
    Montgomery Hunter K. Doctors’ Stories: The Narrative Structure of Medical Knowledge. Princeton: Princeton UP; 1991.Google Scholar
  44. 44.
    Kirkpatrick JN, Nash K, Duffy TP. Well rounded. Arch Intern Med. 2005;165:613–6. at 615.PubMedCrossRefGoogle Scholar
  45. 45.
    Marshall PA, O’Keefe JP. Medical students’ first-person narratives of a patient’s story of AIDS. Soc Sci Med. 1995;40:67–76.PubMedCrossRefGoogle Scholar
  46. 46.
    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.CrossRefGoogle Scholar
  47. 47.
    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.PubMedCrossRefGoogle Scholar
  48. 48.
    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.PubMedGoogle Scholar
  49. 49.
    Bauby JD. The diving-bell and the butterfly. New York: Vintage; 1994.Google Scholar
  50. 50.
    Grealy L. Autobiography of a face. New York: Harper Perennial; 2003.Google Scholar
  51. 51.
    Fries K. Body, remember: a memoir. Madison: University of Wisconsin Press; 2003.Google Scholar
  52. 52.
    Kaysen S. Girl, interrupted. New York: Vintage; 1994.Google Scholar
  53. 53.
    Mairs N. Waist-high in the world: a life among the nondisabled. Boston: Beacon Press; 1996.Google Scholar
  54. 54.
    Ndebele NS, Rasebotsa N, Samuelson M, eds. Nobody ever said AIDS: poems and stories from southern Africa. Capetown: Kwela Books; 2004.Google Scholar
  55. 55.
    I am indebted to an anonymous reviewer for this concept.Google Scholar
  56. 56.
    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.PubMedCrossRefGoogle Scholar
  57. 57.
    Larson EB, Yao X. Clinical empathy as emotional labor in the patient-physician relationship. JAMA. 2005;293:1100–6.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  1. 1.Center for Bioethics and HumanitiesSUNY Upstate Medical UniversitySyracuseUSA

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