COMMENTARY

Can Empathy Be Taught?

Helen Riess, MD

Disclosures

February 01, 2013

In This Article

Teaching Empathy

Our study is among the first to obtain patient ratings on physician empathy rather than relying on physician self-reports. Self-reports can be misleading; only patients can say how their physicians come across to them.

Communication-skills courses have long been considered a "soft science" of medicine and therefore have taken a backseat to evidence-based sciences.

Empathy training for medical professionals is much more likely to be accepted and implemented if it is grounded in the scientific basis for human emotion and empathy. Neuroscience has shown that empathy can be degraded by factors such as fatigue and chronic exposure to pain.[18]

Several studies suggest that the erosion of empathy begins in medical school, with the sharpest decline in the third year, when most students emerge from the lecture hall and begin interacting with patients and mentors on the wards.[19,20]

If empathy can be downregulated, our study aimed to show that it can also be upregulated with specific training. Medical educators and patient advocates are arguing for medical school applicants' interpersonal skills and empathy to be assessed before being offered a seat in medical school.

Others argue that all doctors in training need to acquire special empathy skills because of the challenges that exposure to chronic pain, suffering, and dying present to even the most empathic individuals. What happens in the third year of medical school? A progressive process called dehumanization seems to occur, where patients' humanity is subtly replaced by objectification.[17] This process must be challenged with specific learning opportunities that promote empathy and humanism.

More than a decade ago, leading bioethicist Dr. Daniel Sulmasy noted in an editorial, "The cynics will contend that virtue cannot be taught, that students come to us already morally packaged and incapable of change. Against this...the data...show that students can, and in fact do, change. Unfortunately, this change is in the wrong direction."[21]

Sulmasy argues that virtue can only be lost. In contrast, our study demonstrates that empathy training can change behavior in the right direction, and that with no training, empathy diminishes in resident physicians.

Medical students' empathy declines in the third year for a variety of reasons, some of which may be protective in nature. Empathy may diminish because students perform painful procedures on their patients. Compassion fatigue may also accrue after repeated personal distress at the suffering of their patients.

Regardless of the reasons for empathy decline, patients still deserve compassionate care. With empathy training, students can learn the cognitive components of empathy even if the affective component is not present.[22] They can learn to acknowledge how hard it is to be sick or in pain. They can also learn how to comport themselves. By sitting down with patients and reading the emotion on their faces, they may begin to connect meaningfully, because our brains are designed to do just that. By teaching students to make a human connection, virtue can surface and move them in the right direction.

Perhaps medical schools could begin by valuing both humanistic skills and academic skills when selecting medical students. Because studies show that empathy is challenged during medical training, medical schools could welcome the opportunity to cultivate virtue.

As we have seen, virtue can be learned or lost. Given this choice, it should be an easy decision for medical schools to embrace teaching virtue, laying the foundation on which residency programs and continuing medical education programs fostering humane care can be built.

Empathy must be reinforced and strengthened with targeted training, rather than allowing it to erode and be replaced with cynicism. Our patients, our families, and we all need much more than that.

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