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The Relationship Between Empathy and Burnout in Physicians and Medical Students

Updated: Jul 25, 2021

Author: Hadeel Alhadi

Empathy is an important, yet an often misunderstood and neglected pillar in the physician-patient relationship. It involves understanding the emotional experience and needs of the patient, which may help ease their stress, and hence, establish a relationship based on trust and compassion. It only seems natural that clinical empathy is a key trait for physicians, but can a physician have too much empathy?

To answer this question, a distinction must be made between two emotional scales: (1) empathic concern (EC) and (2) personal distress (PD) [1]. Empathic concern evaluates feelings of compassion, concern, and warmth for others [1]. In comparison, personal distress evaluates emotional reactions that are self-oriented rather than other-oriented, including feelings of discomfort and apprehension towards other people’s negative experiences [1].

“It is important…to protect both the physician and patient since burnout leads to increased medical errors, reduced empathy, and affects the overall quality of care.”

Using these two scales as types of empathy, researchers at Florida International University studied the relationship between empathy and burnout among new medical students [7]. Over 3 years of study, the researchers used the Maslach Burnout Inventory and Davis’ Interpersonal Reactivity Index to study how EC and PD impact three components of burnout: (1) emotional exhaustion, (2) depersonalization, and (3) personal accomplishment. The study found that students with high EC empathy scored low on the burnout scale, while students with high PD empathy had higher scores on the burnout scale [7].

It is a common concern amongst physicians that empathy may pose a risk to their wellbeing [7]. A study conducted by the University of Milan aimed to address these concerns by measuring the relationship between empathy levels and moral distress, job satisfaction, and intention to quit their job [6]. The researchers used questionnaires to collect data and multiple linear and logistic regressions to analyze the results [6]. The results indicated that empathy is not a risk factor in developing moral distress or physicians’ intentions to quit their job; in fact, empathy was found to increase job satisfaction [6].

It is safe to say that the relationship between empathy and burnout is not that simple; the literature contains much conflicting evidence. One of the biggest questions that researchers investigate is the reason behind the decline of medical students’ and physicians’ empathy levels as they progress in their medical careers [3]. A neuroscientific study by Neumann et al. suggests that empathy decline is a coping mechanism for “extreme emotional arousal” [3]. According to their findings, the down regulation of empathy pathways in the brains of medical professionals, particularly physicians, is a sign of extreme distress [3]. The study crowns empathy as an underlying cause of compassion fatigue, and emotional exhaustion [3].

It is important to care for physicians’ and medical students’ mental health by managing how their level of empathy impacts them [7]. This is necessary to protect both the physician and patient since burnout leads to increased medical errors, reduced empathy, and affects the overall quality of care. Therefore, physicians and medical students must have access to mental health support and training on emotion-regulation and burnout prevention [4]. For instance, the American Medical Association (AMA) provides online training modules that teach healthcare workers team-based care and communication skills [4]. The very existence of these training modules marks a major advancement in recognizing the organizational and environmental factors that contribute to burnout.

Editors

Ibrahim Alayche, Mouayad Ali, Rhea Verma

Designers

Richard Chen

Additional Credits

Header Image by SwyftOps on Twitter

Image 1: by Jacqueline Day @jacday_alabaster from Unsplash

References

  1. Fernández-Abascal E, Martín-Díaz M. Relations between dimensions of emotional intelligence, specific aspects of empathy, and non-verbal sensitivity. Frontiers In Psychology [Internet]. 2019 May 14 [cited 2020 Aug 16];10:1-20. Available from: doi:10.3389/fpsyg.2019.01066

  2. Gleichgerrcht E, Decety J. Empathy in clinical practice: how individual dispositions, gender, and experience moderate empathic concern, burnout, and emotional distress in physicians. PloS One [Internet]. 2013 Apr 19 [cited 2020 Aug 16];8(4):1-12. Available from doi:https://doi.org/10.1371/journal.pone.0061526

  3. Neumann M, Edelhäuser F, Tauschel D, Markus W, Woopen, C, Haramati, A, et al. Empathy decline and its reasons: a systematic review of studies with medical students and residents. Acad Med [Internet]. 2011 Aug [cited 2020 Aug 16];86(8):996-1009. Available from: doi:10.1097/ACM.0b013e318221e615

  4. Linzer M, Guzman-Corrales L, Poplau, S [Internet]. Chicago (IL): American Medical Association: Steps Forward: 2020. Physician burnout: improve physician satisfaction and patient outcomes; 2020 [cited 2020 Aug 16]. Available: https://www.stepsforward.org/modules/physician-burnout

  5. Lamiani G, Dordoni P, Vegni E, Barajon I. Caring for critically ill patients: clinicians’ empathy promotes job satisfaction and does not predict moral distress. Frontiers in Psychology [Internet]. 2020 Jan 8 [cited 2020 Aug 16];10(2902):1-8. Available from: https://doi.org/10.3389/fpsyg.2019.02902

  6. Samra, R. (2018). Empathy and Burnout in Medicine—Acknowledging Risks and Opportunities. Journal Of General Internal Medicine, 33(7), 991-993. doi: 10.1007/s11606-018-4443-5

  7. von Harscher, H., Desmarais, N., Dollinger, R., Grossman, S., & Aldana, S. (2018). The impact of empathy on burnout in medical students: new findings. Psychology, health & medicine, 23(3), 295–303. https://doi.org/10.1080/13548506.2017.1374545

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