In recent years, the role of empathy in the doctor- patient relationship has increased. The applications of empathy are especially relevant in the field of medicine where treatment of patients depend on effective doctor-patient interactions. Empathy has shown to improve not only the communication between the doctor and patient, but also the trust and clinical outcomes. The interaction between a physician and patient has shifted in recent decades from a relationship which discouraged empathy to one, that in today’s society requires it as a fundamental element. What is empathy? Empathy, at its simplest, is the awareness of the feelings and emotions of others. Empathy and sympathy are commonly confused with each other but they are not the same. Easily explained, sympathy is “feeling for” someone and empathy is “feeling with” that person, through the use of imagination. For example; a doctor encounters a patient that is feeling depressed and expresses feelings of sadness. The patient informs the physician that a member of his family has recently passed away. This can cause the physician to subconsciously recall his emotional state during a similar situation. In some case, he may not have experience death in his family but can still understand the emotional response required. In situations like these, the physician is able to respond empathetically due to the fact that he understands and can relate to the patient’s grief. In other cases, the physician may not associate death with grief. Instead, he associates death with joy and celebration. In these situations it is much more difficult for the physician to generate an empathic response because he does not understand the patient’s sorrow and the nature and circumstances of the patient’s emotional state. In situations like these, it is important for the physician to possess sufficient communication. A physician who may not actually feel empathy is still be able to generate an appropriate response because he understands how he should respond thus he possesses excellent communication skills. People who cannot communicate and express their feelings are often misunderstood by others around them in everyday life. Effective communication is a powerful instrument in the healthcare’s toolbox. Possessing a sufficient communication skill can result in a higher patient satisfaction, less likelihood to make mistakes and in result less malpractice cases. According to a review of research, it also affects a patients health outcome. It concluded that effective doctor-patient communication improves the patient’s emotional health, symptoms, physiological responses and pain levels. Clinical empathyEmpathy in a clinical context is in the simplest form the physician’s ability to understand the patient’s emotions and in result facilitate more accurate diagnoses and caring treatment. Researchers have for long discussed the utility of empathy in medicine. Many argue that it is not possible for a doctor to empathize with every single patient. That would be emotionally draining and difficult. These researchers paint a picture of a doctor who takes care of his patients best by remaining “clinically detached” (1). By not being emotionally involved with his patients, the doctor is able to make objective decisions concerning the patients care. Yet on the other hand, there is increasing evidence that patients tend to choose physicians who show affective concern more than technical competence (2). Being a medical student, you often hear descriptions of how  “good physicians” are suppose to be. One ability that is always mentioned as necessary to be a good doctor, is their listening skill. Patients wants to be treated as a person and not an illness. They want to make sure that the doctor understands the non-medical aspects of his/her condition. It goes without saying that doctors cannot fully experience the suffering of each patient. However, the point is not to experience everything oneself, it is instead to empathize and understand what a patient is feeling. If a patient tells you about her/his problem, the only way for the patient to know that the doctor is listening, is for the doctor to understand the patient’s concerns and in result respond empathetically. The doctor must balance between not becoming too emotionally involved with the patient and by not becoming involved enough. Researchers has also found that empathy is useful on other levels. It has shown to be therapeutic by reducing anxiety in patients (1).  Once a patient feels that a physician understands his/her condition, he/she may feel more comfortable when confiding in the physician. The process of the patient telling his/her story can be therapeutic and also help ease the healing process. Somatoform disorders can only also be diagnosed by a physician who is carefully observant and accustomed to the patient. It has also been demonstrated that physicians who are more empathic and aware of the psychosocial needs of their patients,  are less likely to experience burnout. Empathy in conflicts between physician and patientsHow is professional suppose to handle a situation where anger and frustration ruin the possibilities for good cooperation between physician and patients? Jodi Halpern tries to answer that question in the article “Empathy and Patient-Physician Conflicts” (3)  where she emphasizes the importance of physicians feeling empathy for their patients, even in emotionally charged situations. According to Halpern, there isn’t any literature that describes how physicians shouldbe emphatic towards patients who conveys negative feelings.  Based on theoretical work, clinical studies, social science research and observation studies, she found a five-step proposal that a doctor can apply. 1. Recognize own feelings- especially the negative ones. Self-awareness reduces number of errors and improves decision making. 2. Reflect on the negative feelings. By reflecting over their own feelings in a conflict, the physician may get a clue to how the patient is thinking thus gaining a understanding of the patients feelings3. Adapt to emotional messages in the patients story. Studies have shown that doctors miss opportunities for empathy by concentrating on facts instead of the hidden meaning of the patients story. 4. Interpret the non-verbal communication.Patients tend to give doctors non-verbal hints and it is as a doctor important to perceive these and interact with the patient in a way that the person feels safe enough to talk more open about his/her concerns. 5. Accept the negative feedback. In a conflict with a patient, it is very often that the doctor take control of the discussion thus become less susceptible to negative feedback. Receiving criticisms, without getting defensive can make the patients feel heard. How much empathy is too much empathy? Empathy matters for a couple of reasons. It not only builds trust which increases patient satisfaction but when patient feel as they can connect on common ground with the physician, they have better recovery rate. For some doctors in training, it is hard to find a balance and sometimes too much affective empathy can distract them from the difficult work they have to do. For example; a patient is afraid of needles and doesn’t want a tetanus shot. If you, as a physician empathize too much, you might decide that the patient doesn’t have to take the shot because of how troubled he/she seems. But once you gets back into the role of a doctor, you will soon instead realize that it is better to help the patient overcome the fear and much worse to reject the shot. Another example; When in cases of abdominal pain or suspicion of stomach bleeding, the doctor may suggest gastroscopy in which the patient says “never in a lifetime, i rather die”. Certainly, they don’t mean that they’d rather die than do the gastroscopy but in most cases, the patients are afraid to undergo with the procedure. The physician with a great skill in empathy can usually solve such a problem by persuading the patient and stating the risk it implies otherwise. If a doctor has the ability to understand the patient’s situation and where the nodes are, then it isn’t hard to find ways to solve them. Empathy also means trying to solve different problems, it is un-empathic and reluctant to say “the patient doesn’t want to, so that’s the way it will be”.  ConclusionJust as being able to use cognitive problem-solving skills doesn’t lead to the best outcome for patient, being too empathic and only using emotional skills doesn’t result in the best outcomes either.Empathy should not replace the professional approach to a situation but be a part of it. Empathy is only useful in certain degrees and in certain contexts but can in other situations be unproductive or destructive. A surgeon for example should be very empathic when discussing surgical options with the patient but during the surgery, the surgeon will need to regulate empathy. The key is understanding when empathy is called for and when it is not. The goal of the physicians should not be to; be more empathetic. They should instead aim to find the right balance.

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