American Osteopathic Association

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Studies Show Physician Empathy Increases Patient Satisfaction and Outcomes

Oct. 27, 2014   

(SEATTLE)— Is empathy a core component of “evidence-based medicine?”  One prominent researcher and author in the area of empathy in patient care argues that the answer is unequivocally “yes” and says that it can and should be evaluated, taught and sustained, as studies show a high correlation between patient satisfaction and outcomes with empathy scores. 

Mohammadreza Hojat, PhD, research professor of psychiatry and human behavior and director of the Jefferson Longitudinal Study at the Center for Research in Medical Education and Health Care, Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia, presented on “Empathy in the Realm of Evidence-Based Medicine,” during a presentation co-hosted by the Cleveland Clinic at the  American Osteopathic Association’s OMED 2014, the Osteopathic Medical Conference & Exposition in Seattle.

“Empathy is predominantly a cognitive attribute which involves an understanding of experiences, concerns, and perspective of the patient, combined with a capacity to communicate this understanding and an intention to help,” said Dr. Hojat.

He explains that sympathy is predominantly an affective attribute and about feeling patient pain, while empathy is predominantly a cognitive attribute and about understanding patient pain. But Dr. Hojat warns, “A physician having an overabundance of sympathy can be detrimental for the patient and the physician; it leads to physician burnout and exhaustion."

Dr. Hojat contends that empathy can be considered in the realm of evidence-based medicine because it can be operationally defined and can be measured by a psycho-medically sound instrument—the Jefferson Scale of Empathy, which contains 20 Likert-type items on a 7 point scale.  Data support the validity and reliability of the Jefferson Scale, which is used by medical students, residents, physicians and other health care professionals and is available in 47 languages in more than 70 countries. 

He also said that empirical evidence confirms significant associations between empathy and clinical competence and tangible patient outcomes, showing that medical students with higher empathy scores rated higher on clinical competence as evaluated by their faculty, and physicians with higher empathy scores are more likely to produce better patient outcomes.

In addition, he found that those with higher empathy scores were more likely to enter specialty practices in people-oriented specialties; and those with lower scores were more likely to enter hospital-based or procedure-oriented specialties. 

Can empathy be taught?

Dr. Hojat says the good news is that empathy can be learned. He cited several studies where the Jefferson Scale was used, that shows enhanced empathy with a targeted education program. “Additional reinforcement could sustain or improve empathy among residents,” he said.

Some examples include:

  • The Rocking Chair Project:  A free rocking chair was given to indigent expectant mothers by residents in family medicine; the resident had to take the chair to the mother in her home and talk about newborn care too. Going into the home, talking to the mom and assembling the chair prevented a decline of empathy by residents. For those residents who didn’t participate, their empathy declined.

  • Shadowing: Those residents who shadowed patients in the emergency room helped to maintain their empathy of residents vs. those whose empathy declined.

  • Aging Game: Students at Midwestern University Chicago College of Osteopathic Medicine and Chicago College of Pharmacy were coached to perform the role of an elderly patient. Other medical students had to sit and watch. This increased empathy for all students by watching and/or participating in the role play for 15 minutes vs. those who didn’t participate.

  • Narrative Skills Training: The Cleveland Clinic did a study on narrative skills training with residents that showed that while there was no significant improvement in empathy, residents did not lose empathy vs. those who weren’t exposed to training.

  • Movie Clips Experiment:  When residents were shown video clips of patient-physician encounters selected from three movies and analyzed positive and negative aspects of each interaction, their empathy score increased.

The caveat in empathy training: when researchers followed up with the subjects from the Aging Game and Movie Clip studies months later; most had lost what they gained, and empathy was not sustained. 

“There needs to be additional reinforcement for empathy to be sustained; if no reinforcement, empathy gains will be lost,” Dr. Hojat said.

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The American Osteopathic Association (AOA) proudly represents its professional family of more than 104,000 osteopathic physicians (DOs) and osteopathic medical students; promotes public health; encourages scientific research; serves as the primary certifying body for DOs; and is the accrediting agency for osteopathic medical schools. More information on DOs/osteopathic medicine can be found at


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Nicole Grady
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