Empathy, which was first developed in the field of psychotherapy, is a psychological strategy enabling care-givers to offer support to patients grappling with strong emotions, such as anger or sadness. Empathy is a very useful technique. While it has, wrongly, become synonymous with support in doctor-patient relationships, it is, in fact, only an indirect and relatively weak form of support.
To clarify the concept of empathy, it is useful to compare it with sympathy.1 Empathy refers to the understanding or reconstruction of another person’s emotions; sympathy refers to the feelings we have in harmony with another person. When we are sympathetic, we do not necessarily understand what other people are experiencing, but we have feelings of closeness or affection for them. We can begin the empathetic process only if we can adopt our patients’ frames of reference to reconstruct what they understand and imagine what they feel. We only really become empathetic toward patients, however, when we succeed in communicating our understanding to them and in having them confirm it.
Four dimensions of empathy
Suchman et al2 identify 4 dimensions of empathy:
the affective dimension, which describes the capacity to share the feelings of others;
the moral dimension, which describes the motivation to seek the good of others;
the cognitive dimension, which describes the capacity to identify and understand the emotions of others; and
the behavioural dimension, which describes the capacity to convey this understanding of others’ emotions to them in an unequivocal manner.
The latter 2 dimensions are particularly important from a clinical standpoint because they specify 2 distinct skills that physicians must master in order to be empathetic.
Table 1 lists some strategies that, according to DeVito et al,1 help us understand patients’ emotions. The right-hand column indicates the reason for using each strategy.
Table 1.
Strategies for trying to understand patients’ emotions
| RECOMMENDED STRATEGIES | REASONS |
|---|---|
| Be calm and adopt a neutral stance | You will be in a more receptive mode |
| Avoid evaluating your patient’s behaviour | Your evaluation is not part of your patient’s viewpoint |
| Be aware that you always add something to or take something away from a patient’s message | No matter what you have understood, it is never precisely what your patient is thinking. Take such unintentional alterations into account by verifying your understanding with your patient |
| Try to have as much information as possible about your patient | What patients feel is connected with everything they are and with their past. The more you know about them, the better the chances that your construction of their emotions will come close to what they actually feel |
“True” understanding
Tate3 asserts that empathy, in the sense of a “true” understanding of the other (an understanding of a psychological phenomenon as a whole), is an ideal that cannot be attained in medical consultations. During interviews, physicians often simply repeat patients’ words and reflect them back.4,5 It is an exaggeration—even false—to claim you “understand” when, in fact, all you are doing is taking note of the presence of an emotion. Generally though, patients react to reflection by elaborating on their feelings and explaining themselves; they perceive reflection as a request to elaborate. An active process is thus set in motion: physicians’ understanding of their patients’ emotions improves, and, patients, by contemplating their own behaviour, can begin to modify their emotional states.
True understanding is sometimes attained, but only after years of dialogue. Even though such a level of understanding is a rare event in the everyday practice of medicine, the appropriate use of reflection often suffices to help patients clarify and manage the emotions they express. By reflecting what patients say back to them, physicians can help patients clarify associations of which they are not always aware. Their increased awareness can prove very helpful to them in controlling their emotional outbursts. Reflection is an adequate tool for attaining this more limited objective.
Conclusion
Empathy is the capacity to imagine what another person is feeling without feeling it yourself. Although what we imagine can never be exactly what the other person feels, we try to get as close to it as possible. Empathy is also the capacity to reflect the feelings of the person you are dealing with back to him or her. Physicians’ communication skills are consequently crucial.
The functions of empathy in medical consultations for physicians are as follows:
to understand their patients;
to offer their patients support by showing them it is worth taking the time to try to understand their emotions; and
to manage their patients’ emotions.
The functions of empathy in medical consultations for patients are as follows:
to be comforted by the fact that they feel understood; and
to develop a reflective attitude that will enable them to think about their emotions and put them in perspective (to become aware of and take a step back from their emotions).
Acknowledgment
This article in the series “Communication Tips” has been adapted from an article that originally appeared in the French-language journal L’Omnipracticien. We thank Merck Frosst Canada for covering the costs of adaptation and translation.
References
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