Parting Thoughts: A Systemic Paradigm of Empathy in Patient Care and Future Directions
- 2k Downloads
Empathy in health professions education and patient care is viewed from a broader and more comprehensive perspective of systems theory.
In a systemic paradigm of empathy in patient care, the contributions of major subsets of the system (e.g., clinician-related, nonclinician-related, social learning, and education) and their related elements to clinical encounters that lead to functional or dysfunctional system outcomes are discussed.
An agenda for future research is outlined which includes: (1) exploration of additional components of empathy in the context of health professions education and patient care; (2) the investigation of additional variables that are beneficial or detrimental to empathy in patient care; (3) consideration of empathy as a criterion for admissions, selection, and employment; (4) the study of empathy as a predictor of career choice, academic and professional success; (5) the development and evaluation of approaches to enhance and sustain empathy in health professions education and patient care; (6) development of approaches to maximize empathy and regulate sympathy; (7) the development of national norm tables and cutoff scores to identify JSE high and low scorers; (8) consideration of patients’ and peers’ perspectives in outcomes of empathy research; and (9) further explorations of neurological underpinnings of empathy.
It is suggested that implementation of remedies for enhancing and sustaining empathy is a mandate that must be acted upon, not only by academic medical centers but by all other educational institutions.
KeywordsSystems theory Empathy paradigm Social learning Clinical outcomes Future research Empathy and admissions Admission interview Letters of recommendation Personal statements Letter of intend Emotional empathy Cognitive empathy Essay Career choice Enhancing empathy Sustaining empathy Empathy maximized Sympathy optimized Sympathy regulated National norm cutoff scores Patients’ perspectives Peer evaluations
- Ackoff, R. L., & Emery, F. E. (1981). On purposeful systems. Seaside, CA: Intersystems.Google Scholar
- Alcorta-Garza, A., Gonzalez-Guerrero, J. F., Tavitas-Herrera, S. E., Rodrigues-Lara, F. J., & Hojat, M. (2005). Validación de la escala de empatia medica de Jefferson en estudiantes de medicina Mexicanos [Validity of the Jefferson Scale of Physician Empathy among Mexican medical students]. Salud Mental [Mental Health], 28, 57–63.Google Scholar
- Balint, M. (1957). The doctor, his patient and the illness. New York: International Universities Press.Google Scholar
- Bateson, G. (1971). A systems approach. International Journal of Psychiatry, 9, 242–244.Google Scholar
- Bellini, L. M., & Shea, J. A. (2005). Mood change and empathy decline persist during three years of internal medicine training. Academic Medicine, 80, 164–167. Bellini, L. M., Baime, M., & Shea, J. A. (2002). Variation of mood and empathy during internship. Journal of the American Medical Association, 287, 3143–3146.Google Scholar
- Carr, L., Iacoboni, M., Dubeau, M. C., Mazziotta, J. C., & Lenzi, G. L. (2003). Neural mechanisms of empathy in humans: A relay from neural systems for imitation to limbic areas. Proceedings of the National Academy of Sciences of the United States of America, 100, 5497–5502. doi: 10.1073/pnas.0935845100.CrossRefPubMedPubMedCentralGoogle Scholar
- Cheng, Y., Lin, C. P., Liu, H. L., Hsu, Y. Y., Lim, K. E., Hung, D., & Decety, J. (2007). Expertise modulates the perception of pain in others. Current Biology, 17, 1708–1713.Google Scholar
- Del Canale, S., Louis, D. Z., Maio, V., Wang, X., Rossi, G., Hojat, M., & Gonnella, J. S. (2012). The relationship between physician empathy and disease complications: An empirical study of primary care physicians and their diabetic patients in Parma, Italy. Academic Medicine, 87, 1243–1249. doi: 10.1097/ACM.0b013e3182628fbf.Google Scholar
- Eisenberg, N., Fabes, R. A., Murphy, B., Karbon, M., Maszk, P., Smith, M., … Suh, K. (1994). The relations of emotionality and regulation to dispositional and situational empathy-related responding. Journal of Personality and Social Psychology, 66, 776–797.Google Scholar
- Elam, C. L., & Johnson, M. M. S. (1992). An analysis of admission committee voting patterns. Academic Medicine, 67(10 Suppl.), S72–S75.Google Scholar
- Gonnella, J. S., Hojat, M., Erdmann, J. B., & Veloski, J. J. (1993b). What have we learned, and where do we go from here? In J. S. Gonnella, M. Hojat, J. B. Erdmann, & J. J. Veloski (Eds.), Assessment measures in medical school, residency, and practice: The connections (pp. 155–173). New York: Springer.Google Scholar
- Hojat, M., Erdmann, J. B., Veloski, J. J., Nasca, T. J., Callahan, C., Julian, E., & Peck, J. (2000). A validity study of the writing sample section of the Medical College Admission Test. Academic Medicine, 75, S25–S27.Google Scholar
- Hojat, M., Erdmann, J. B., & Gonnella, J. S. (2014). Personality assessments and outcomes in medical education and the practice of medicine (AMEE Guide 79). Dundee, UK: Association for Medical Education in Europe (AMEE). First published in 2013 in Medical Teacher, 35, e1267–e1301.Google Scholar
- Hojat, M., & Gonnella, J. S. (2015). Eleven years of data on the Jefferson Scale of Empathy-Medical Student Version (JSE-S): Proxy norm data and tentative cutoff scores. Medical Principles and Practice, 24, 344–350. doi: 10.1159/000381954. Retrieved from: http://www.karger.com/doi/10.1159/000381954.CrossRefPubMedGoogle Scholar
- Hojat, M., Louis, D. Z., Maxwell, K., & Gonnella, J. S. (2011a). The Jefferson Scale of Empathy (JSE): An update. Health Policy Newsletter, 24, 5–6. Retrieved from: http://jdc.jefferson.edu/cgi/viewcontent.cgi?article=1727&context=hpn.Google Scholar
- Hojat, M., Louis, D. Z., Maxwell, K., & Gonnella, J. S. (2011b). The Jefferson Scale of Empathy (JSE): An update. Health Policy Newsletter, 24, 5–6. Retrieved from: http://jdc.jefferson.edu/cgi/viewcontent.cgi?article=1727&context=hpn.Google Scholar
- Hojat, M., Vergare, M., Maxwell, K., Brainard, G., Herrine, S. K., Isenberg, G. A., … Gonnella, J. S. (2009). The devil is in the third year: A longitudinal study of erosion of empathy in medical school. Academic Medicine, 84, 1182–1191.Google Scholar
- Lewin, K. (1936). A dynamic theory of personality. New York: McGraw-Hill.Google Scholar
- Lilienfeld, R. (1978). The rise of systems theory: An ideological analysis. New York: John Wiley & Sons.Google Scholar
- Morse, J. M., Anderson, G., Bottorff, J. L., Yonge, O., O’Brien, B., Solberg, S. M., & McIlveen, K. H. (1992). Exploring empathy: A conceptual fit for nursing practice? Image: Journal of Nursing Scholarship, 24, 273–280.Google Scholar
- Osler, W. (1932). Aequanimitas with other addresses to medical schools, nurses, and practitioners of medicine. Philadelphia, PA: Blakiston.Google Scholar
- Papadakis, M. A., Teherani, A., Banach, M. A., Knettler, T. R., Rattner, S. L., Stern, D. T., … Hodgson, C. S. (2005). Disciplinary action by ethical boards and prior behavior in medical school. New England Journal of Medicine, 353, 2673–2682.Google Scholar
- Pollak, O. (1976). Human behavior and the helping professions. New York: Spectrum Publications.Google Scholar
- Siegel, D. J. (1999). The developing mind: How relationships and the brain interact to shape who we are. New York: Guilford.Google Scholar
- Thomas, L. (1985). The youngest science. Oxford: Oxford University Press.Google Scholar
- Zimbardo, P. (2007). Lucifer effect: Understanding how good people turn evil. New York: Random House.Google Scholar