The Emotional Domains of Empathy Matter, Too

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Drs. Hojat and Gonnella’s1 Invited Commentary highlights a need to choose research instruments that provide valid, useful information on physician skills and attitudes that affect care. While we appreciate that physician behaviors are of utmost importance for our patients, we challenge the notion that the emotional domains of empathy are irrelevant. These domains interact significantly with physician behavior, and with important physician indicators including compassion, resilience, burnout, and distress. Emotion is a fact of human experience. Even doctors—after undergoing the acculturating and neuro-remodeling2 of medical education—are hardwired for emotion sensing by micro-experiencing of others’ emotions, largely through mirror neurons.3 Furthermore, neurobiology research supports that effortful cognitive work can undercut gain—for instance, cognitive reappraisal of distress when exposed to another’s suffering is less effective than compassion for increasing altruism and reducing distress.4 Until it is clear how empathy relates to other critical concepts influencing physicians’ abilities to sustainably and compassionately care for their patients, it seems premature and counterproductive to excuse emotional aspects of empathy from examination. In our pilot work, we found that curricula designed to improve empathy skills, focused significantly on the emotional aspects of empathy, reduce emotional exhaustion and increase empathic concern. We encourage researchers with interest in patient–physician relationships to continue to be curious about how to train physicians in all aspects of their capacity, emotional and cognitive, to enable them to take empathic care of patients, while bolstering them against the stressors of medical practice.
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