Editorial

Let’s Talk About Empathy in Rheumatology

I just returned from a remarkable conference where I had the privilege of speaking. As I am still thinking about what I learned, I wanted to start a discussion with all of you about the role of empathy in our profession.

The Patient Experience Summit is an annual event with several thousand attendees bringing together patient experience leaders, health care CEOs, innovators, nursing leaders, policymakers, major stakeholders and industry experts, as well as patients who appeared to be not only committed to the patient/caregiver experience, but also the human experience. The theme of this year’s 3-day, interprofessional conference was empathy. Check out the website and, if you are interested in this field, I strongly recommend attending next year.

Leonard H. Calabrese, DO
Leonard H. Calabrese

For those of you who have not thought deeply or in an academic sense about empathy, do not be off put. Most of us have our own working definitions of “empathy” and “empathic behavior” and, in general, believe that we individually have it. In fact, one of the challenges of working in the empathy field is the lack of a universally accepted definition. I think that, as with many other things, we know it when we see it but we have difficulty in putting our hands and arms around it.

I define empathy as having primarily a cognitive quality, but I recognize that its outer boundary clearly accommodates an affective component as well. Empathy allows us to appreciate and process the feelings of another person and then critically send back to them our recognition of such through spoken or unspoken communication. I will state categorically that I believe that empathy (my definition) is what all of us want for ourselves and for our families when we are suffering, especially when we are challenged by illness. If you disagree with this then you have my permission to stop reading.

If this appraisal is accurate, then why do we not focus on it at our meetings? If you search “empathy” and “rheumatic diseases” through Google or PubMed, there is a paucity of any significant work and virtually none by physicians. At our meetings, we are focused like a laser on disease activity scales, radiographic progression and (encouragingly) on quality of life measures. Increasingly, we discuss the critical nature of patients’ and providers’ shared decision-making and although this clearly involves perspective taking, we still have not appraised the role of empathy in these communication processes. The question is, why?

It is not that empathy cannot be measured. There are numerous validated scales to measure empathy, most notably the Jefferson Empathy Scale developed by Mohammadreza Hojat, PhD; I highly recommend his book, Empathy in Patient Care, which is specifically designed for health care settings and has been translated into more than 40 languages. There are numerous studies correlating empathy with everything from patient satisfaction, to provider professional satisfaction, reduced likelihood of being sued, reduced medical error and certain clinical outcomes. In addition, empathic physicians are less likely to display signs of burnout. To paraphrase the words of Dr. Hojat, “Empathic engagement is the pillar of the patient-doctor relationship, which is not only beneficial to the patient, but also to the doctor.”

I would like to use this column to start a dialogue about the role of empathy in the practice of rheumatology. Of note, I will mention I was privileged to discuss this at a clinical symposium during ACR on the role of mindfulness, empathy and burnout in rheumatology (A first!). Although this was a great start, we need to continue to build on this. Recognizing that empathy can be buffered, cultivated and grown — particularly thorough reflective practices such as writing, reading fiction, mindfulness practice and other activities which address the human condition — we need to study this in our field! Training directors need to address this directly as well.

empathy graphic

As many of you are aware, there are established general patterns of empathy in medicine with women having more than men, primary/cognitive-based practitioners having more than proceduralists and that we all risk having our empathy start to erode around the third year of medical school. My belief, though unproven, is that rheumatologists probably are in the upper quartile of empathic physicians if only from knowing what I know about our work and my colleagues. We base much of our care — or should — on relationships, which is critical for cultivating empathy. I will close with a call to action for our profession to increase our academic presence in this vital field.

If any of you are working in this space, please reach out to me by email at calabrl@ccf.org or on Twitter @LCalabreseDO.

Disclosure: Calabrese reports serving as an investigator and a consultant to Horizon Pharmaceuticals.

I just returned from a remarkable conference where I had the privilege of speaking. As I am still thinking about what I learned, I wanted to start a discussion with all of you about the role of empathy in our profession.

The Patient Experience Summit is an annual event with several thousand attendees bringing together patient experience leaders, health care CEOs, innovators, nursing leaders, policymakers, major stakeholders and industry experts, as well as patients who appeared to be not only committed to the patient/caregiver experience, but also the human experience. The theme of this year’s 3-day, interprofessional conference was empathy. Check out the website and, if you are interested in this field, I strongly recommend attending next year.

Leonard H. Calabrese, DO
Leonard H. Calabrese

For those of you who have not thought deeply or in an academic sense about empathy, do not be off put. Most of us have our own working definitions of “empathy” and “empathic behavior” and, in general, believe that we individually have it. In fact, one of the challenges of working in the empathy field is the lack of a universally accepted definition. I think that, as with many other things, we know it when we see it but we have difficulty in putting our hands and arms around it.

I define empathy as having primarily a cognitive quality, but I recognize that its outer boundary clearly accommodates an affective component as well. Empathy allows us to appreciate and process the feelings of another person and then critically send back to them our recognition of such through spoken or unspoken communication. I will state categorically that I believe that empathy (my definition) is what all of us want for ourselves and for our families when we are suffering, especially when we are challenged by illness. If you disagree with this then you have my permission to stop reading.

If this appraisal is accurate, then why do we not focus on it at our meetings? If you search “empathy” and “rheumatic diseases” through Google or PubMed, there is a paucity of any significant work and virtually none by physicians. At our meetings, we are focused like a laser on disease activity scales, radiographic progression and (encouragingly) on quality of life measures. Increasingly, we discuss the critical nature of patients’ and providers’ shared decision-making and although this clearly involves perspective taking, we still have not appraised the role of empathy in these communication processes. The question is, why?

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It is not that empathy cannot be measured. There are numerous validated scales to measure empathy, most notably the Jefferson Empathy Scale developed by Mohammadreza Hojat, PhD; I highly recommend his book, Empathy in Patient Care, which is specifically designed for health care settings and has been translated into more than 40 languages. There are numerous studies correlating empathy with everything from patient satisfaction, to provider professional satisfaction, reduced likelihood of being sued, reduced medical error and certain clinical outcomes. In addition, empathic physicians are less likely to display signs of burnout. To paraphrase the words of Dr. Hojat, “Empathic engagement is the pillar of the patient-doctor relationship, which is not only beneficial to the patient, but also to the doctor.”

I would like to use this column to start a dialogue about the role of empathy in the practice of rheumatology. Of note, I will mention I was privileged to discuss this at a clinical symposium during ACR on the role of mindfulness, empathy and burnout in rheumatology (A first!). Although this was a great start, we need to continue to build on this. Recognizing that empathy can be buffered, cultivated and grown — particularly thorough reflective practices such as writing, reading fiction, mindfulness practice and other activities which address the human condition — we need to study this in our field! Training directors need to address this directly as well.

empathy graphic

As many of you are aware, there are established general patterns of empathy in medicine with women having more than men, primary/cognitive-based practitioners having more than proceduralists and that we all risk having our empathy start to erode around the third year of medical school. My belief, though unproven, is that rheumatologists probably are in the upper quartile of empathic physicians if only from knowing what I know about our work and my colleagues. We base much of our care — or should — on relationships, which is critical for cultivating empathy. I will close with a call to action for our profession to increase our academic presence in this vital field.

If any of you are working in this space, please reach out to me by email at calabrl@ccf.org or on Twitter @LCalabreseDO.

Disclosure: Calabrese reports serving as an investigator and a consultant to Horizon Pharmaceuticals.