Empathy and symptom control in rheumatology practice: Time to get real
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Over the past decade, I have been fortunate to have a platform on which to reflect about the varying dimensions of empathy as it applies to medical practice, and in particular its relevancy to the field of rheumatology.
My apologies for the repeated visits to this topic, but I am passionate about the subject.
I began my journey learning about empathy and its relationship to practice when I assumed the course directorship in our newly formed program focused on medical humanities. Since that time, I have written extensively about empathy in medicine and began — and have continued — research in this field focusing on its relationship to both practitioner and patient wellbeing, as well as its influence on clinical outcomes.
In this month’s exclusive of Healio Rheumatology, I am excited that we have engaged a group of experts on empathy and medicine — including Luana Colloca, MD, Mohammadreza Hojat, PhD, John C. Licciardone, DO, and Karen McKerihan, MSN, NP-C — several of them being my good friends and collaborators. I am happy to say that, while at the beginning of my journey much of the discussion surrounding empathy and medicine was based on theoretic constructs, we now have mounting data on its clinical importance to the care of the patient. Accordingly, I now argue that the role of empathy in patient care is no longer a matter of theory, but something we must actively incorporate into practice.
For most practitioners, however, empathy remains poorly defined, with many believing it to be a trait that some naturally have in abundance while others have, unfortunately, very little.
The general understanding of empathy is that it is our capacity to understand the feelings of others — and for those of us in medicine, that refers specifically to our patients. Although this general concept is accurate, empathy as it applies to medicine has an additional dimension, namely our capacity to communicate our feelings and understanding back to the patient.
The impetus and focus of our current roundtable discussion is the growing data, now finding its way into high impact publications, demonstrating that practitioner empathy — and, more importantly, the patient’s recognition of their caregivers empathy — is a powerful force in healing. Previous work has demonstrated a positive correlation between a patient’s perception of provider empathy and clinical outcomes, including control of diabetes as just one example.
A recent publication in JAMA Network Open by Dr. Licciardone, who kindly participated in our roundtable, demonstrated that among patients longitudinally followed for low back pain, those who are treated by empathic physicians, who communicated this well to their patients, had statistically and clinically significant improvements in pain and quality of life over follow-up.
This high-impact publication has significant ramifications for our field, in my opinion. Empathy’s mechanism of action in such settings may well be mediated by the biologic placebo response, which we have noted in previous roundtables to be similarly poorly understood and marginalized in rheumatology practice and research.
Empathy in medicine is a complex field and an emerging science, and cannot be encapsulated in a brief editorial. There is now growing literature on this area, including a magnificent textbook by Professor Hojat, the architect of the Jefferson Empathy Scale and one of our discussants. If these data are true, then why are we not discussing empathy actively in our publications and meetings?
Although empathy may be a psychologic trait that we are born with, and which is influenced by our upbringing, it is not immutable. It can clearly grow or be lost over a lifetime. In medicine, the advanced communication skills needed to project our empathic feelings to our patients are in fact teachable. Unfortunately, up until now, such skills were rarely formally taught — or even discussed — with trainees. They have instead, by default, been relegated to being passed down via the informal curriculum of role modeling by caring physicians.
The time is now to take empathy seriously and incorporate it into our education, research and patient care. I hope you enjoyed this roundtable, and would like to hear your views on the power of empathy, and your own experience with it, in your practice. Please share your thoughts with me at calabrl@ccf.org, rheumatology@healio.com or on X (formerly Twitter) at @LCalabreseDO.
- References:
- Calabrese, LH. (2021, January). The Science of Empathy in Rheumatology. The Rheumatologist. https://www.the-rheumatologist.org/article/the-science-of-empathy-in-rheumatology/5/?singlepage=1.
- Hojat, M. (2016). Empathy in Health Professions Education and Patient Care. Springer.
- Licciardone JC, et al. JAMA Network Open. 2024;doi:10.1001/jamanetworkopen.2024.6026.
- For more information:
- Leonard H. Calabrese, DO, is the Chief Medical Editor, Healio Rheumatology, and Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, and RJ Fasenmyer Chair of Clinical Immunology at the Cleveland Clinic.
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