Empathy in patient care: from ‘Clinical Empathy’ to ‘Empathic Concern’

As empathy gains importance within academia, we propose this review as an attempt to bring clarity upon the diverse and widely debated definitions and conceptions of empathy within the medical field. In this paper, we first evaluate the limits of the Western mainstream medical culture and discuss the origins of phenomena such as dehumanization and detached concern as well as their impacts on patient care. We then pass on to a structured overview of the debate surrounding the notion of clinical empathy and its taxonomy in the medical setting. In particular, we present the dichotomous conception of clinical empathy that is articulated in the debate around cognitive empathy and affective empathy. We thus consider the negative impacts that this categorization brings about. Finally, we advocate for a more encompassing, holistic conception of clinical empathy; one that gives value to a genuine interest in welcoming, acknowledging and responding to the emotions of those suffering. Following this line of reasoning, we advance the notion of ‘empathic concern’, a re-conceptualization of clinical empathy that finds its source in Halpern in Med Health Care Philos (2014) 17:301–311 engaged curiosity. We ultimately advance Narrative Medicine as an approach to introduce, teach and promote such an attitude among medical trainees and practitioners.

Detached Concern und Wohlbefinden: berufliche Selbstwirksamkeit und Sinnerfüllung als vermittelnde psychische Ressourcen

Zusammenfassung Ziel/Hintergrund. Die Studie erforscht den Zusammenhang von Detached Concern (DC) als emotionsregulierende Ressource in der Interaktion mit Klienten, und dem subjektiven Wohlbefinden von Beschäftigten in der Humandienstleistung. Untersucht werden die vermittelnden Rollen von beruflicher Selbstwirksamkeit und Sinnerfüllung in der Arbeit als zentrale individuelle Arbeitsressourcen. Fragestellung Angenommen wird, dass eine empathische Arbeitsweise, welche die Klientenbeziehung in den Vordergrund stellt, sowie eine hinreichende persönliche Abgrenzung, vermittelt über erhöhte Selbstwirksamkeit und Sinnerleben zum Wohlbefinden beitragen. Methode Daten von N = 527 Beschäftigten im Gesundheits-, Lehr- und Sozialwesen entstammen einer querschnittlichen Online-Fragebogenstudie. Alle Konstrukte wurden mit validierten und reliablen Skalen erhoben. Die DC-Skala für Humandienstleistungsberufe unterscheidet empathische Anteilnahme und Abgrenzungsfähigkeit. Die statistische Auswertung erfolgte mittels SPSS und Process als getrennte sowie moderierte serielle Mediationsanalysen für die beiden DC-Komponenten. Ergebnisse Hypothesenkonform wurden positive Zusammenhänge zwischen DC und Wohlbefinden statistisch seriell über berufliche Selbstwirksamkeit und Sinnerfüllung vermittelt. Weiterhin konnte ein Interaktionseffekt der beiden DC-Komponenten auf die Selbstwirksamkeit im Rahmen der seriellen Mediation nachgewiesen werden. Schlussfolgerungen Beide DC-Komponenten erfüllen wichtige emotionsbezogene Funktionen, um im Arbeitsalltag mit Klienten Selbstwirksamkeit und Sinnhaftigkeit zu erleben. Diese Zusammenhänge können als förderliche Quelle für das Wohlbefinden wirksam werden. Bewusstseinsbildung und Training einer reflexiven DC-Haltung sollten in der Ausbildung von Dienstleistern integriert werden.

Is it just semantics? Medical students and their ‘first patients’

There have been multiple factors involved in the decline of the anatomy course’s central role in medical education over the last century. The course has undergone a multitude of changes, in large part due to the rise in technology and cultural shifts away from physical dissection. This paper argues that, as the desire of medical schools to introduce clinical experiences earlier in the curriculum increased, anatomy courses began implementing changes that would align themselves with the shifting culture towards incorporating humanistic values early on in the medical curriculum. One of these changes, argued as a product of this shift, included calling a cadaver a ‘patient’ and introducing the cadaver as a student’s ‘first patient’. This change has been seen in different universities and textbooks. This paper argues that the use of the words ‘patient’ to describe the cadaver in order to promote principled habits in medical students may in fact create an environment that does the opposite. By equating an environment in which the subject of dissection is lifeless and incapable of participation, and the space is discouraging of emotions and conducive to untested coping mechanisms to the clinical environment through using the word ‘patient’, values like detached concern, a controversial practice in medicine, can be implicitly encouraged. An ethical analysis of the use of the word ’patient’ to describe the cadaver shows that this practice can promote unethical habits in students and that changing this aspect of anatomy lab culture could improve ethical dispositions of future physicians.

Detached Concern?: Emotional Socialization in Twenty-First Century Medical Education

Early works in medical sociology have been pivotal in the development of scholarly knowledge about emotions, emotional socialization, and empathy within medical training, medical education, and medical contexts. Yet despite major shifts in both medical education and in medicine writ-large, medical sociologists' focus on emotions has largely disappeared. In this paper, we argue that due to recent radical transformations in the medical arena, emotional socialization within medical education should be of renewed interest for sociologists. Developments in medical education such as increased diversity among enrollees, the rise of patient health movements, and curricular transformation have made this context a particularly interesting case for sociologists working on a variety of questions related to structural, organizational, and cultural change. We offer three areas of debate within studies in medical education that sociologists may be interested in studying: 1) gendered and racialized differences in the performance of clinical skills related to emotion, 2) differences in self-reported empathy among subspecialties, and 3) loss of empathy during the third year or clinical year of medical school.