The Science of Empathy in Rheumatology

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Rheumatology has arguably benefited like no other field from the proliferation of an increasingly effective pipeline of therapeutics. These medications have dramatically raised the bar for clinical outcomes for our patients in a way that we could not have envisioned a short generation ago. With such therapeutic progress now reaching a widening circle of rheumatic diseases, we would be justified to ask why the topic of empathy would be of interest and importance to our field? 

The answer is simple and reflects the reality that our diseases (actually our patients’ diseases) are more than the sum of immune biomarkers, CDAI scores, Sharp scores, SLEDAI scores or most other commonly used metrics; they are conditions experienced by people manifesting the sum total of the human condition. 

As the brilliant medical humanist Eric Cassel states in The Nature of Healing, our patients experience sickness, which has its manifestations intricately bound up in the phenomenon of meaning, while their diagnosis is what we, the providers, give to them.¹ It is in this personal domain that the role of empathy in the provider-patient relationship serves as a powerful force both for the patient, for whom it helps achieve their desired goals, as well as the provider for whom, as I will argue, it can promote more meaningful work, less burnout and greater compassion. 

From the outset, I assert that empathy, as an evolving field of medical science, is seriously understudied in rheumatology, which can be easily proved by a quick PubMed or Google search. I also assert that now is an ideal time to fill this void in care and caring for our patients.

Empathy in Medical Science 

Most of us have an implicit internal definition of empathy and empathic behavior in our patient care interactions, and I believe most of us feel we have it. An obstacle to studying empathy is the lack of a universally accepted definition, and thus, for this review I use the definition advocated by Mohammadreza Hojat, the architect of the Jefferson Empathy Scale (JES), a psycho­metric test based on this definition and explicitly designed for the study of empathy in the healthcare profession.² It has been translated into 56 languages and is the most widely used metric for quantitative study of empathy in the medcal sciences. 

The construct of the JES is based on a definition that asserts that empathy is predominantly a cognitive attribute that involves an understanding of the experiences, concerns and perspective of the patient, combined with a capacity to communicate this understanding and an intention to help. 

Importantly, the JES differentiates empathy from sympathy, which is clearly related, but predominantly an emotional attribute and if overabundant can potentially lead to emotional fatigue. Empathy as a cognitive function includes the critical component of perspective taking, which allows us to briefly stand in the shoes of our patients, but does not require us to live in them.

The study of empathy in providers, including physicians, nurses, medical students and other allied health professionals, has repeatedly demonstrated a variety of positive outcomes. Numerous studies performed on physicians have documented that those with higher self-reported empathy are more likely associated with increased patient satisfaction, good patient rapport, less likelihood of being sued, fewer medical errors and higher physician retention.^3,4 

Data also exist that support a correlation of empathy in patient care with some clinical outcomes, ranging from the treatment of the common cold, irritable bowel syndrome and enhanced control of diabetes in most but not in all studies.^5-7 There is also a rich neurobiological research base on empathy demonstrating that empathy has a neurophysiologic basis and is a trait with societal and evolutionary implications.³