COMMENTARY

Can Empathy Be Taught?

Helen Riess, MD

Disclosures

February 01, 2013

In This Article

Introduction

Plato's ancient question, "Can virtue be taught?" has spawned controversy about whether medical schools ought to be schools of virtue. When newly minted doctors take the Hippocratic Oath on graduation day, they swear to provide ethical and compassionate care for their patients. What can be done to ensure that they will keep their promise?

Compassionate care implies greater patient satisfaction but is also tied to benefits far beyond the exam room, including better treatment adherence, improved health outcomes,[1,2,3] and fewer medical errors and malpractice claims.[4]

The research team that I lead set out to determine whether specific training in empathy could improve patients' perceptions of their physicians' care in a randomized controlled trial.[5] I started by creating a series of 3 training modules grounded in the recent literature on the neurobiology and physiology of empathy and emotions.[6,7]

Evidence Base

Research has shown that empathic observers have neural activity and autonomic arousal -- as measured by heart rate and skin conductance -- mirroring that of a person experiencing pain or distress firsthand. Nearly everyone has had the experience of flinching when observing another person in pain, such as when someone's hand is slammed in a car door.

Studies have shown that the same pain matrix gets activated in the observer's brain as in the person experiencing the pain, but to an attenuated degree.[8] This brain mapping, the physical substrate of empathy, is thought to be related to the evolution of prosocial behavior because it motivates us to help others in pain.[9]

Neuroimaging research has informed the development of empathy training tools that can help doctors recognize nonverbal cues, such as posture, tone of voice, and facial expressions.[10]

Our training also helps doctors recognize their own physiologic responses to emotional encounters and teaches them how to respond.

One strategy for raising emotional awareness is showing videos of emotionally charged visits between patients and doctors with both of their skin conductance tracings superimposed.[11] Not all medical professionals are aware of the powerful physiologic effects on patients of not listening, being dismissive or arrogant, or abandoning them. Such careless communications have profound effects on patient trust, alliance, and patient safety.[12]

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