Jefferson study shows physician's empathy directly associated with positive clinical outcomes

(Press-News.org) PHILADELPHIA – It has been thought that the quality of the physician-patient relationship is integral to positive outcomes but until now, data to confirm such beliefs has been hard to find. Through a landmark study, a research team from Jefferson Medical College (JMC) of Thomas Jefferson University has been able to quantify a relationship between physicians' empathy and their patients' positive clinical outcomes, suggesting that a physician's empathy is an important factor associated with clinical competence. The study is available in the March 2011 issue of Academic Medicine.

"The purpose of this study was to provide an evidence-based scientific foundation for the study of empathy as a clinically important factor in patient outcomes," said Mohammadreza Hojat, Ph.D., research professor, Department of Psychiatry and Human Behavior; and director, Jefferson Longitudinal Study of Medical Education in the Center for Research in Medical Education and Health Care at JMC. "Our results show that physicians with high empathy scores had better clinical outcomes than other physicians with lower scores."

Participants in this study were 891 diabetic patients, treated between July 2006 and June 2009, by 29 physicians in the Department of Family and Community Medicine at Thomas Jefferson University Hospital. Researchers used the Jefferson Scale of Empathy (JSE) – developed in 2001 as an instrument to measure empathy in the context of medical education and patient care. This validated instrument relies on the definition of empathy in the context of patient care as a predominately cognitive attribute that involves an understanding and an intention to help. The scale includes 20 items answered on a seven-point Likert-type scale (strongly agree = 7, strongly disagree = 1).

The 29 physicians completed the JSE. Each physician was identified by a numeric code printed on the JSE scanning form and was told that the code would be used to correlate their JSE scores with their diabetic patients' test results.

To measure how a physician's empathy impacted a diabetic patient's treatment, the researchers used hemoglobin A1c test results to measure the adequacy of blood glucose control according to national standards. They also analyzed the patients' LDL cholesterol level. They believed that there would be a direct association between a higher physician JSE score and a better control of patients' hemoglobin A1c and LDL cholesterol levels. A1c tests were marked as following: good control (9.0 percent) and moderate control (≥ 7.0 percent and ≤ 9.0 percent). LDL cholesterol levels were marked as following: good control (< 100 mg/dL), poor control (>130 mg/dL) and moderate control (≥100 and ≤ 130 mg/dL).

The likelihood of good control was significantly greater in patients of physicians with high empathy scores than in the patients of physicians with low scores. Conversely, the likelihood of poor control was significantly lower in the patients of physicians with high empathy scores than it was in patients of physicians with low scores. The same can be said for the LDL cholesterol portion of the analysis. This data points to the conclusion that empathic engagement in patient care can contribute to patient satisfaction, trust, and compliance which lead to more desirable clinical outcomes.

"These findings, if confirmed by larger scale research, suggest that empathy should be viewed as an integral component of a physician's competence," said Dr. Hojat. "This study supports the recommendations of such professional organizations as the Association of American Medical Colleges and the American Board of Internal Medicine of the importance of assessing and enhancing empathetic skills in undergraduate and graduate medical education."

"For those of us in primary care medicine who have devoted much of our working lives to developing empathic relationships with our patients, research findings of improved patient outcomes among the more empathic physicians is very gratifying indeed. We have long believed in the importance of empathy and finding measurably better outcomes lends support to our attempts to nurture empathetic medical students and residents who will pursue careers in every kind of medical and surgical specialty," said Fred Makham, M.D., professor, Department of Family and Community Medicine, who is also one of the study's co-authors.

Richard Wender, M.D., Alumni Professor and Chair, Department of Family and Community Medicine, one of the coauthors of the study indicated that: "Although physicians intuitively value empathy, the clinical importance of empathy has not been known. We're now on our way to showing the power of physician empathy to impact the health of our patients."

### The study's other co-authors, all from the Center for Research in Medical Education and Health Care, are: Daniel Z. Louis, M.S., Managing Director; Carol Rabinowitz, Research and Program Analyst; and Joseph S. Gonnella, M.D., Founder and Director.