Empathy problematic in psychological aspects of professional medical care (review)



The article covers summary report of the main aspects of empathy research in medical care. Data of an empathy level diagnostics depending on social aspects is pre¬sented, as well as an issue of empathy consideration as a stable personal characteristic, its dependency on experience and doctor's specialization, context of medical activity (necessary pain infliction, emergency aid assistance) is discussed. Aspects of empathic communication for medical workers of various specialties, inter alia psychiatrists and oncologists, as well as communication strategies, developed for coping with cocurrent negative emotions are analyzed. An example of a medical interview facilitating the quality of interpersonal relationship in the pair patient-doctor alliance" is given. In conclusion there are presented actual scientific contra¬dictions and set the possible main lines of future researches.

General Information

Keywords: empathy, medical care, specialization, psychiatry, oncology, coping, communication strategies

Journal rubric: Theory and Methodology

Article type: scientific article

DOI: https://doi.org/10.17759/cpp.2015230202

For citation: Poddubnaya T.V. Empathy problematic in psychological aspects of professional medical care (review). Konsul'tativnaya psikhologiya i psikhoterapiya = Counseling Psychology and Psychotherapy, 2015. Vol. 23, no. 2, pp. 9–36. DOI: 10.17759/cpp.2015230202. (In Russ., аbstr. in Engl.)


  1. Agavelian R.O. Empatiia kak faktor psikhologicheskoi gotovnosti defektologa k profes­sional'noi deiatel'nosti: diss. … kand. psikhol. nauk. Erevan, 1995. 158 p.
  2. Berezhkovskaia E.L., Radinskaia N.G. Kul'turno-istoricheskaia i gumanisticheskaia psikhologiia: vozmozhnye tochki skhoda. Empatiia kak vysshaia psikhicheskaia funktsiia. Vestnik RGGU. 2006. № 1. Pp. 126—145.
  3. Bogacheva O.Iu. Empatiia kak professional'no vazhnoe kachestvo vracha (na primere vrachei terapevtov i vrachei khirurgov): diss. … kand. psikhol. nauk. Iaroslavl'. 2014. 168 p.
  4. Burno M.E. O samom glavnom v klinicheskoi klassicheskoi psikhoterapii (KKP) // Psikhoterapiia. 2011. № 1. Pp. 17—23.
  5. Vasil'kova A.P. Empatiia kak odin iz spetsificheskikh kriteriev professional'noi prigod­nosti budushchikh spetsialistov medikov: diss. … kand. psikh. nauk. Saint-Peterburg. 1998. 166 p.
  6. Vid V.D., Lozinskaia E.I. Sindrom peregoraniia v psikhiatrii i ego zavisimost' ot ter­apevticheskoi ideologii. Rossiiskii psikhoterapevticheskii zhurnal. 1998. № 1. Pp. 19—21.
  7. Grishchenko D.Iu. Motivatsiia vybora professii psikhologa: diss. … kand. psikhol. nauk. Moscow: RGB, 2003. 221 p.
  8. Danilov D.S. Komplaens v meditsine i metody ego optimizatsii (klinicheskie, psikho­logicheskie i psikhoterapevticheskie aspekty). Psikhiatriia i psikhofarmakoterapiia. 2008. T.10. № 1. Pp. 13—20.
  9. Donika A.D. Professional'nyi ontogenez: mediko-sotsiologicheskie i psikhologo-etich­eskie problemy vrachebnoi deiatel'nosti / Moscow: Publ. "Akademiia Estestvoznaniia". 2009. 300 p.
  10. Zenevich G.V. Rol' psikhoterapii pri shizofrenicheskikh remissiiakh. Voprosy psikhoter­apii. Moscow. 1958. Pp. 187—194.
  11. Im O.T. Psikhologicheskie osobennosti sindroma emotsional'nogo vygoraniia v zavisi­mosti ot stepeni refleksii i empatii u meditsinskikh sester. Al'manakh sovremennoi nauki i obrazovaniia. 2009. № 11 (30). Pp. 136—138.
  12. Karavanov G.A., Korshunova V.A. Individual'no-psikhologicheskie osobennosti vracha­khirurga / L'vov. 1974. 53 p.
  13. Kariagina T.D. Evoliutsiia poniatiia "empatiia" v psikhologii: diss. … kand. psikhol. nauk. Moscow, 2013. 175 p.
  14. Kipiani A.I. Razvitie kommunikativnoi kompetentnosti vracha-stomatologa kak uslovie professional'noi uspeshnosti: diss. … kand. psikhol. nauk. Stavropol', 2006. 214 p.
  15. Korzunin V.A. Zakonomernosti dinamiki professional'no vazhnykh kachestv voennykh vrachei v protsesse professionalizatsii: diss. … dokt. psikhol. nauk. Sankt-Peterburg, 2001. 555 p.
  16. Luriia R.A. Vnutrenniaia kartina bolezni i iatrogennye zabolevaniia / 4-e izd. Moscow: Meditsina, 1977. 112 p.
  17. Polishchuk Iu.I., Letnikova Z.V. Diagnosticheskoe i terapevticheskoe znachenie vra­chebnoi empatii v psikhiatrii. Sotsial'naia i klinicheskaia psikhiatriia. 2013. T. 23. № 3. Pp. 99—103.
  18. Smulevich A.B., Fil'ts A.O., Guseinov I.G., Drozdov D.V. K probleme nozogenii. Ipokhondriia i somatoformnye rasstroistva / Moscow: Logos, 1992. Pp. 111—123.
  19. Sovremennye problemy issledovaniia sindroma vygoraniia u spetsialistov kommunika­tivnykh professii: kollektivnaia monografiia / pod. red. V.V. Luk'ianova, N.E. Vo­dop'ianovoi, V.E. Orla, S.A. Posadnogo, L.N. Iur'evoi, S.A. Igumnova. Kursk. gos. un-t. Kursk, 2008. 336 p.
  20. Tashlykov V.A. Znachenie empaticheskogo otnosheniia vracha k bol'nomu v protsesse psikhoterapii nevrozov. Psikhologicheskie problemy psikhogigieny, psikhoprofilak­tiki i meditsinskoi deontologii / L., 1976. Pp. 121—122.
  21. Terent'ev I.A. Lichnostnye osobennosti proiavleniia empatii v deiatel'nosti vracha kurortnogo lechebnogo uchrezhdeniia: diss. … kand. psikhol. nauk. Sochi, 2007. 212 p.
  22. Khardi I. Vrach, sestra, bol'noi. Psikhologiia raboty s bol'nymi / Budapesht, 1988. 338 p.
  23. Iaspers K. Obshchaia psikhopatologiia / Moscow, 1997. 1053 p.
  24. Ancel G. Developing empathy in nurses: an in-service training program. Archives of psychiatric nursing. 2006. Vol. 20. № 6. Pp. 249—257.
  25. Avdi E., Barson P., Rischin I. Empathic communication skills in CALD medical stu­dent interviews. Prospect. 2008. Vol. 23. № 3. Pp. 4—11.
  26. Beckman H.B., Markakis K.M., Suchman A.L., Frankel R.M. The doctor-patient rela­tionship and malpractice. Lessons from plaintiff depositions. Arch Intern Med. 1994. Vol. 154. № 12. Pp. 1365—1370.
  27. Bellet P.S., Maloney M.J. The Importance of Empathy as an Interviewing Skill in Medicine. JAMA. 1991. Vol. 266. № 13. Pp. 1831—1832. doi:10.1001/jama.1991. 03470130111039.
  28. Bikker A.P., Mercer S.W., Reilly D.A pilot prospective study on the consultation and relational empathy, patient enablement, and health changes over 12 months in patients going to the Glasgow Homoeopathic Hospital. J Altern Complement Med. 2005. Vol. 11. № 4. Pp. 591—600.
  29. Bond M.R. Patients' experience of pain. Pharmacol Ther. 1981. Vol. 12. № 3. Pp. 563—573.
  30. Branch W.T., Malik T.K. Using 'Windows of Opportunities' in Brief Interviews to Understand Patients' Concerns. JAMA. 1993. Vol. 269. № 13. Pp. 1667—1668. doi:10.1001/jama.1993.03500130081036.
  31. Butow P.N., Brown R.F., Cogar S., Tattersall M.H., Dunn S.M. Oncologists' reactions to cancer patients' verbal cues. Psychooncology. 2002. Vol. 11. № 1. Pp. 47—58.
  32. Carmel S., Glick S.M. Compassionate-empathic physicians: personality traits and social-organizational factors that enhance or inhibit this behavior pattern. Soc Sci Med. 1996. Vol. 43. № 8. Pp. 1253—1261.
  33. Chen D., Lew R., Hershman W., Orlander J. A cross-sectional measurement of medical student empathy. J Gen Intern Med. 2007. Vol. 22. № 10. Pp. 1434—1438.
  34. Costa P., Magalhaes E., Costa M.J. A latent growth model suggests that empathy of medical students does not decline over time. Adv Health Sci Educ Theory Pract. 2013. Vol.18. № 3. Pp. 509—522. doi: 10.1007/s10459-012-9390-z.
  35. Cook S. Second Life / New York: Simon and Schuster, 1981.
  36. DeValck C., Bensing J., Bruynooghe R., Batenburg V. Cure-oriented versus care-orient­ed attitudes in medicine. Patient Education and Counseling. 2001. Vol. 45. Pp. 119—126.
  37. Eley D.S., Brooks K.D., Zink T., Cloninger C.R. Personality profiles of rural longitudi­nal integrated clerkship students who choose family medicine. Fam Med. 2015. Vol. 47. № 3. Pp. 194—203.
  38. Engel G.L. The need for a new medical model: a challenge for biomedicine. Science. 1977. Vol. 196. № 4286. Pp. 129—135.
  39. Everson N., Levett-Jones T., Lapkin, Pitt V., van der Riet P., Rossiter R., Jones D., Gilligan C., Courtney-Pratt H. Measuring the impact of a 3D simulation experience on nursing students' cultural empathy using a modified version of the Kiersma-Chen Empathy Scale. J Clin Nurs. 2015. Vol. 16. doi: 10.1111/jocn.12893
  40. Ford S., Fallowfield L., Lewis S. Can oncologists detect distress in their out-patients and how satisfied are they with their performance during bad news consultations? Br J Cancer. 1994. Vol. 70. № 4. Pp. 767—770.
  41. 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. 2003. Vol. 8. № 4.
  42. Gleichgerrcht E., Decety J. The relationship between different facets of empathy, pain perception and compassion fatigue among physicians. Front Behav Neurosci. 2014. Vol. 8. P. 243. doi: 10.3389/fnbeh.2014.00243.
  43. Gowans M.C., Glazier L., Wright B.J., Brenneis F.R., Scott I.M. Choosing a career in psy­chiatry: factors associated with a career interest in psychiatry among Canadian stu­dents on entry to medical school. Can J Psychiatry. 2009. Vol. 54. № 8. Pp. 557—564.
  44. Haslam N. Dehumanization: an integrative review. Pers Soc Psychol Rev. 2006. Vol. 10. № 3. Pp. 252—264.
  45. Haque O.S., Waytz A. Dehumanization in medicine: causes, solutions, and functions. Perspect Psychol Sci. 2013. Vol. 7. № 2. Pp. 176—186.
  46. Heaven C.M., Maguire P. Disclosure of concerns by hospice patients and their identifi­cation by nurses. Palliat Med. 1997. Vol. 11. № 4. Pp. 283—290.
  47. Hojat M., Loius D., Markham F., Wender R., Rabinowitz C., Gonnella J. Physicians' empathy and clinical outcomes for diabetic patients. Academic Medicine. 2011. Vol. 86. № 3. Pp. 359—364.
  48. Hojat M., Mangione S., Nasca T.J., Rattner S., Erdmann J.B., Gonnella J.S., Magee M. An empirical study of decline in empathy in medical school. Med Educ. 2004. Vol. 38. № 9. Pp. 934—941.
  49. Hojat M., Vergare M., Maxwell K., Brainard G., Herrine S., Isenberg G., Veloski J., Gonnella J. The devil is in the third year: a longitudinal study of erosion of empathy in medical school. Academic Medicine. 2009. Vol. 84. № 9. Pp. 1182—1191.
  50. Kennifer S.L., Alexander S.C., Pollak K.I., Jeffreys A.S., Olsen M.K., Rodriguez K.L., Arnold R.M., Tulsky J.A. Negative emotions in cancer care: do oncologists' respons­es depend on severity and type of emotion? Patient Educ Couns. 2009. Vol. 76. № 1. Pp. 51—56. doi: 10.1016/j.pec.2008.10.003.
  51. La Monica E.L., Wolf R.M., Madea A.R., Oberst M.T. Empathy and nursing care out­comes. Scholarly Inquiry for Nursing Practice. 1987. Vol 1. № 3. Pp. 197—213.
  52. Lebowitz M.S., Ahn W. Effects of biological explanations for mental disorders on clini­cians' empathy. Proceedings of the National Academy of Sciences of the United States of America. Available at: http://www.pnas.org/content/111/50/17786. abstract (accessed: 12.07.2015).
  53. Levinson W., Gorawara-Bhat R., Lamb J. A study of patient clues and physician responses in primary care and surgical settings. JAMA. 2000. Vol. 284. № 8. Pp. 1021—1027.
  54. Linn L.S. Care vs. cure: How the nurse practitioner views the patient. Nursing Outlook. 1974. Vol. 22. Pp. 641—644.
  55. Madjar I. Pain as embodied experience: a phenomenological study of clinically inflict­ed pain in adult patients: a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing at Massey University. Massey University. 1991.
  56. McKenna L., Boyle M., Brown T., Williams B., Molloy A., Lewis B., Molloy L. Levels of empathy in undergraduate midwifery students: an Australian cross-sectional study. Women and Birth. 2008. Vol. 24. Pp. 80—84.
  57. Morse D.S., Edwardsen E.A., Gordon H.S. Missed opportunities for interval empathy in lung cancer communication. Arch Intern Med. 2008. Vol. 168. № 17. Pp. 1853— 1858.
  58. Morse J.M., Bottorff J., Anderson G., O'Brien B., Solberg S. Beyond empathy: expand­ing expressions of caring. J Adv Nurs. 1992. Vol. 17. № 7. Pp. 809—821.
  59. Morse J.M., Mitcham C., van Der Steen W.J. Compathy or physical empathy: implica­tions for the caregiver relationship. Journal of Medical Humanities. 1998. Vol. 19, № 1. Pp. 51—65.
  60. Neumann M., Edelhauser F.,Tauschel D., Fischer M.R.,Wirtz M.,Woopen C. Empathy decline and its reasons: a systematic review of studies with medical students and residents. Acad. Med. 2011. Vol. 86. Pp. 996—1009. doi:10.1097/acm.0b013e 318221e615.
  61. Novak D.H. Therapeutic aspects of the clinical encounter. J Gen Intern Med. 1987. Vol. 2. Pp. 346—355.
  62. Paro H.B.M.S., Silveira P.S.P., Perotta B., Gannam S., Enns S.C. Empathy among med­ical students: is there a relation with quality of life and burnout? PLoS ONE. 2014. Vol. 9. № 4. doi:10.1371/journal.pone.0094133.
  63. Pollak K.I., Arnold R.M., Alexander S.C, Jeffreys A.S., Olsen M.K., Abernethy A.P., Rodriguez K.L., Tulsky J.A. Do patient attributes predict oncologist empathic responses and patient perceptions of empathy? Support Care Cancer. 2010. Vol. 18. № 11. Pp. 1405—1411. doi: 10.1007/s00520-009-0762-8.
  64. Pollak K.I., Arnold R.M., Jeffreys A.S., Alexander S.C., Olsen M.K., Abernethy A.P., Skinner C.S., Rodriguez K.L., Tulsky J.A. Oncologist communication about emo­tion during visits with Patients with advanced cancer // Journal of clinical oncolo­gy. 2007. Vol. 25. №. 36. Pp. 5748—5752.
  65. Rakel D.P., Hoeft T.J., Barrett B.P., Chewning B.A., Craig B.M., Niu M. Practitioner empathy and the duration of the common cold. Fam Med. 2009. Vol. 41. № 7. Pp. 494—501.
  66. Rosenhan D.L. On being sane in sane places. Science. 1973. Vol. 179. Pp. 250—258.
  67. Smith A.C. III, Kleinman S. Managing emotions in medical school: students' contacts with the living and the dead. Social Psychology Quarterly. 1989. Vol. 52. No. 1. Pp. 56—69.
  68. Stewart M.A. What is a successful doctor-patient interview? A study of interactions and outcomes. Soc Sci Med. 1984. Vol. 19. № 2. Pp. 167—175.
  69. Stilwell N.A., Wallick M.M., Thal S.E., Burleson J.A. Myers-Briggs type and medical specialty choice: a new look at an old question. Teach Learn Med. 2000. Vol. 12. № 1. Pp. 14—20.
  70. Suchman A.L., Markakis K., Beckman H.B., Frankel R. A model of empathic commu­nication in the medical interview. JAMA. 1997. Vol. 277. № 8. Pp. 678—682.
  71. Thomas M.R., Dyrbye L.N., Huntington J.L., Lawson K.L., Novotny P.J., Sloan J.A., Shanafelt T.D. How do distress and well-being relate to medical student empathy? A multicenter study. J Gen Intern Med. 2007. Vol. 22. № 2. Pp. 177—183.
  72. Zinn W. The empathic physician. Arch Intern Med. 1993. Vol. 153. № 3. Pp. 306—312.

Information About the Authors

Tat'iana V. Poddubnaya, Clinical Psychologist, Post-graduate Student of the Department of Individual and Group Psychotherapy of the Faculty of Consultative and Clinical Psychology, Moscow City University of Psychology and Education, Moscow, Russia, e-mail: tatiana-bor@yandex.ru



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