Defining Empathy to Better Teach, Measure, and Understand Its Impact.

No consensus on the definition of empathy exists. Empathy has been described as emotional and spontaneous, cognitive and deliberate, or some combination of the two. Attentive nonverbal reactions, feeling reflections, reassurance, sympathy, and compassion all have been conflated with empathy, making it impossible to differentiate empathy from other communication skills. This confusion over the definition of empathy has affected its measurement. For example, the authors of the Interpersonal Reactivity Index see empathy as multidimensional, involving both emotional and cognitive aspects, while the authors of the Jefferson Scale of Physician Empathy see empathy as a predominately cognitive process. Researchers, such as Yamada and colleagues in their study in this issue, then must straddle these conceptualizations, which is a limitation to their work.To address this problem, the author of this Invited Commentary proposes adopting the cognitive definition of empathy, noting that it allows physicians to distinguish between empathy and other communication skills and is the most consistent with counseling psychology descriptions. The author defines cognitive empathy as a conscious, strenuous, mental effort to clarify a patient's muddy expression of her experience using a soft interpretation of her story. Accurate empathic responses are unadulterated by a physician's reactions to a patient and the patient's experience. The author describes four aspects of empathy that are rarely noted in the medical literature but that are fundamental to understanding its practice: the "as if" condition, the use of soft interpretation, the primacy of cognition, and the relevance of reflection.

Empathy Among Internal Medicine Residents in a Community-Based Training Program: A Pilot Study.

This article was migrated. The article was marked as recommended. Background: Empathy in patient care is a highly valuable skill that is promoted in medical education; however, research conducted in academic centers strongly suggests a declining trend in empathy as years of medical education increase. Objective: To assess residents' empathy levels in a community-based internal medicine training program. We hypothesized that empathy in our program did not decrease with years of training. Methods: A cross-sectional, observational study of 22 resident physicians who completed the Jefferson Scale of Physician Empathy between May and October of 2013. The residents were at the end of their first (PGY1), second (PGY2), or third (PGY3) year of training, or were incoming interns (PGY0) at the beginning of their first year. Results: Of 48 eligible residents, responses of 22 (45%) are included in the analysis. The empathy scores for participants ranged from 96 to 136 with a mean of 117.4 and a SD of 10.1. Incoming residents, PGY1, 2 and 3 residents' mean scores were 109.7, 117.2, 114.3 and 124.0 respectively. There was no statistical difference between males and females or between PGY1 and PGY2 residents. A statistically significant difference in mean empathy scores was found between incoming residents and PGY3, with PGY3 residents scoring higher in empathy. Conclusion: The empathy scores in our internal medicine residency program identified higher levels of empathy associated with residents at the end of training. This may be related to our targeted curricula which includes behavioral science and geriatric medicine curriculums.

Relinquishing the truth.

In this essay, the author reflects on a case involving a client who presents to therapy asking for professional guidance as to whether she should tell her adult child of her true paternity. The child was the product of a paternal rape. The author explores the impact of this case on her thinking about truth as prerequisite to healing.

Diagnosis-specific management of somatoform disorders: moving beyond "vague complaints of pain".

UNLABELLED: The DSM IV category, somatoform disorders, is composed of disorders that are characterized by symptom amplification-most typically, amplification of pain. Other than this commonality, there is considerable variability among the disorders in terms of etiology, course, comorbidities, and the presence or absence of insight. The heterogeneous nature of the somatoform group has led to calls to remove or radically alter the category in the next DSM revision. Despite these concerns, teaching articles addressing somatoform disorders tend to generalize across the category when making patient treatment recommendations. In this report, the authors encourage moving beyond catch phrases such as, "the somatic patient" and "vague complaints of pain," and toward accurate differential diagnosis between somatoform disorders. They argue that accurate diagnosis of somatoform disorders is both achievable and necessary to provide optimal care for this diverse population of patients. Diagnosis and patient-centered management is contrasted with more generalized treatment recommendations. PERSPECTIVE: This article highlights the appropriate diagnosis and treatment of somatoform disorders for patients with pain. In contrast to the majority of literature on the subject, the authors emphasize the importance of differential diagnosis between somatoform disorders as well as patient-specific and diagnosis-specific treatment. The authors argue that there has been an incorrect tendency to overgeneralize across disorders, an error that is magnified by the exceptional weakness of the somatoform category.

Perspective: A grand challenge to academic medicine: speak out on gay rights.

Social responsibility, a dearly held value in the medical community, requires that medicine use its influence to end discrimination and to reduce barriers that affect access to care. Although the gay, lesbian, bisexual, and transgender (GLBT) population has been identified as suffering from health care disparities and oppression, the medical community and its affiliated organizations have done little to lobby in defense of the GLBT population. And with regard to the specific issue of gay marriage, medicine has yet to raise its voice in that debate, even if only to correct unscientific, capricious, and slanderous depictions of GLBT relationships. Closer to home, in medical schools and residencies, GLBT faculty and students are not provided with a safe and equal environment in which to work and learn. No credentialing provisions require residencies and their affiliate hospitals to include GLBT status in their nondiscrimination policies or to offer GLBT faculty and residents equal benefits. There is no assurance that those in power at peer-reviewed journals will use reviewers who are familiar with the research on sexual minorities to review manuscripts on GLBT topics, a situation that likely contributes to the community's status as an understudied population. Medicine cannot fulfill its obligation to GLBT patients, students, and faculty without a considerable and determined commitment to change. Some of the suggested remedies would require amending policy at the level of the Accreditation Council for Graduate Medical Education and the Association of American Medical Colleges.

Sociocultural interpretations of social phobia in a non-heterosexual female.

Social Phobia is a prominent anxiety disorder that is not well-understood, especially among socially marginalized, non-heterosexual individuals. A case description of Social Phobia symptoms in a female who is unsure of her sexual identity is presented and analyzed. The diagnostic assumptions of Social Phobia as applied to the case are critically examined. The goal is to highlight unanswered questions regarding social anxiety among non-heterosexuals and to open a discussion of cultural etiological theory. Implications for treating Social Phobia with a cultural component are discussed.