THE 4 DIMENSIONS OF EMPATHY IN PATIENT CARE

Generally speaking, EMPATHY means understanding or appreciating how someone else feels. This definition of empathy has been expanded in the clinical context to include 4 dimensions: 1. emotional - the doctors ability to imagine the patients emotions and perspectives 2. moral - the doctors internal motivation and willingness to empathize 3. cognitive - the doctors intellectual ability to identify and understand the patients emotions and perspectives 4. behavioral - the doctors ability to convey understanding of those emotions and perspectives back to the patient through language and behaviour. All 4 dimensions of empathy may be required to benefit patients. For example, a doctor could cognitively perceive a patients anxiety but fail to signal this understanding or do anything about it. If the doctor adds the desire to empathize (the moral dimension), and becomes emotionally engaged by imagining what the patients anxiety must feel like (the emotional dimension), his facial expression and tone of voice (the behavioral dimension) are more likely to make the patient feel understood, not merely labeled. Verbally, the doctor may use a combination of the following: - exploratory language to find out how the patient feels (typically in the form of questions, e.g. How are you feeling about this news?) - empathetic language to show understanding of the patients feelings (e.g. I can tell you werent expecting to hear this.) - validating language to show that the patients feelings are normal and to be expected (e.g. I can understand why you feel like that.) In turn, the patients sense of being truly understood is likely to encourage disclosure and foster trust.

Empathy vs sympathy
Confusion of empathy with sympathy is a conceptual difficulty encountered by those interested in clinical empathy. Medical students may consider sympathy to be the same as the emotional component of empathy. For example, a group of medical students who had completed a literature course found that increased empathy for patients . . . being able to be at one with the patient and be in the patients shoes was the most valuable outcome of taking the literature course. Here, I can imagine my patients emotions and I share my patients emotions are not distinguished. Sympathy is defined as experiencing another persons emotions, as opposed to empathy, which refers to appreciating or imagining those emotions. Sympathy is also quite distinct from empathy in terms of potential outcomes. Doctors who sympathize with patients share their suffering, which could lead to lack of objectivity and emotional fatigue, whereas empathy has a uniformly positive impact on doctor-patient interactions.

Source: adapted from - Stepien, K., Baernstein, A., Educating for Empathy A Review, Journal of General Internal Medicine, 2006(21), p.524-530 - McCullagh, M., Wright, R., Good Practice Communication Skills in English for the Medical Practitioner, Cambridge University Press, 2009, p.90.