The Importance of Empathy—As I Have Studied
and Experienced It
Mazie Tsang MSIII – Medical Student, Runner-Up
Empathy is a crucial component of the patient-physician relation-
ship and has been associated with improved patient outcomes
in multiple studies. The importance of empathy has been of
major interest to me as a student of the John A. Burns School of
Medicine (JABSOM). At the medical school I have learned that
Kim, et al,1 for example, analyzed the role of patient-perceived
empathy and demonstrated that affective empathy led to a
greater exchange of information, increased partnership, and
interpersonal trust. Both partnership and perceived empathy
had the largest effect on patient compliance and satisfaction.1
Empathy has been shown to me to be the crux of a good thera-
peutic relationship. In order to emphasize its importance, the
American Association of Medical Colleges (AAMC) has made
it an essential learning-objective for medical professionalism
so that schools will teach the meaning of and instill empathy.
Meeting this challenging task requires an understanding of the
meaning of empathy, the use of diverse educational techniques,
and incorporation of students’ personal experiences.
Acknowledging the role of empathy is easy, but teaching
empathy is difficult because empathy is an elusive idea. The
word is derived from the Greek empatheia, which means emo-
tions and feelings.2 Hojat, who developed the Jefferson Scale
of Physician Empathy (JSPE), further clarified the meaning
of empathy, differentiating it from sympathy in the following
definition: “predominantly a cognitive (as opposed to affec-
tive) attribute that involves an understanding (as opposed to a
feeling) of a patient’s concerns and experiences with a capacity
to communicate this understanding, and an intention to help.”3
Patients, however, perceive empathy as both cognitive and
affective. They define it as their “feelings being understood
and accepted by the physician” because empathetic physicians
recognize and convey the patients’ mental state (cognitive)
and tend to the patients’ emotional state (affective).4 Based on
these definitions, teaching empathy must address two important
aspects: the physicians’ understanding of patient concerns and
their ability to convey to the patient this understanding and
compassion.
In order to meet this AAMC learning objective, medical
schools have employed various techniques to train students to
be more compassionate and empathetic toward their patients. I
am grateful that JABSOM has utilized nearly all of the primary
teaching modalities that have been studied.5 First, JABSOM
emphasizes proper communication techniques through lectures,
problem-based learning, and clinical skills workshops. Our
Hawaiian custom of “talking story” is initially encouraged
at the beginning of an interview in order to establish rapport.
Studies have demonstrated a significant increase in empathy
from pre- to post-intervention when researchers employ com-
munication techniques as a learning modality.5 Second, the
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JABSOM Family Medicine clerkship asks students to write a
narrative on personal illness as a strategy to foster empathy.
The focus of this assignment is to place the medical student in
the role of a patient or her family member. In addition to this
particular session, the JABSOM Department of Family Medicine
also addresses patient care and empathy from other angles such
as cultural consideration and understanding the needs of the
marginalized in society. Participants in studies that employed
narrative as a learning modality have reported increased empathy
and understanding of illness.5 Third, several preceptors instill
empathy by having students experience medical care from the
patient’s perspective, such as when several of my classmates had
to wear a cast for weeks as though they had broken their arm.
In a study by Wilkes, et al,6 students who were taught empathy
by being admitted to a teaching hospital with fake diagnoses
had reported that that experience would help them be more
empathetic. Fourth and last, JABSOM stresses self-care (“taking
care of your goose”) from the first day of medical school. As
stress is inevitable in medicine, my professors promote well-
ness and balance so that students can attend to their own health
and happiness via time with loved ones, exercise, healthy diet,
hobbies, and spiritual activities. Because personal stress can be
a barrier to compassion and patience,7 this lifestyle does foster
empathy. Since I have studied at JABSOM, I feel well-trained
and equipped with the necessary skills that will be useful in
my patient interactions.
The first time I really experienced the gift of my JABSOM
training in empathy and communication was on my Internal
Medicine rotation. As I spoke with my middle-age male patient,
an alcoholic of 40 years, I did my best to utilize all the techniques
that my professors had taught me in order to show this patient
that I empathized with his suffering. Initially, my heart was
filled with compassion when I heard him relate his childhood
trauma that eventually led him to self-loathing and despair; I
saw in him a reflection of all those I know who yearn for love
and understanding in their darkest hours. Because of my JAB-
SOM training, I was able to be empathetic with my patient by
giving him my full attention, responding with comforting words
or body language, nodding appropriately, and asking reflective
questions. At the end of my history taking, the patient said that
I was the first person he had told about his past trauma and that
he did so because he felt I really cared about his welfare and had
made him comfortable. As honored as I was by his comment, I
also recognized that there were additional tests and physician
consults that my team would have to order; these tests, which I
would not have ordered otherwise, would be based on what he
shared with me. Through this experience, I finally understood
the supreme importance of the patient-physician relationship
and the role of empathy in fostering that relationship.
 My interactions with this former alcoholic led to one of my
most profound lessons in compassion and empathy to date. When
I spoke of my experience with a JABSOM faculty member
who is also a psychiatrist, he defined compassion to me as ac-
knowledging that we all are interconnected and interdependent.
He taught me that all people suffer; all people have a desire to
be heard, to be loved. He insisted that practicing compassion
is thus to identify and respond to my patient’s innate desire
to be heard and loved, which separates curing from healing.
My patient had been cured of his alcoholism in the past, but
he relapsed multiple times because he was not healed of his
compounding suffering which had begun in his childhood; he
continued to long for compassion and empathy. Our ability as
health care providers to make him feel heard and understood
makes us so different from a computer or person who follows
algorithms.
In conclusion, I realize that physicians fulfill a dual role, for
which empathy is indispensable. One of my JABSOM profes-
sors told me, “We cure with modern medicine, and we heal with
our presence and compassion.” Because we are both mind and
body, as is evident in fields such as psychiatry, primary care, and
oncology, this idea of healing and curing is rooted in the nature
of humanity. Never have I learned so much about human nature
as I have from my patients who are willingly open with me as
I am open with them. Their emotions are raw—comprised of
anger and despair as they face their impending death or happi-
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ness as they rejoice over the birth of their child, welcoming a
new life. I am honored to share in my patients’ emotions and
experiences, and I will do my best to be a good, responsible
steward of their trust. Working with patients during medical
school has brought together all the lessons I learned about
empathy and has taught me the privilege of being a physician:
my journey to becoming a good doctor necessitates empathy,
which is to understand my patients’ multi-dimensional suffer-
ing and to convey my compassion to them because we are all
interconnected. All of this reinforces my decision to continue
studying medicine.
References
1. Kim SS, Kaplowitz S, Johnston MV. The effects of physician empathy on patient satisfaction
and compliance. Evaluation and the Health Professions. 2004;27(3):237-251.
2. Merriam Webster Dictionary. Web. 14 December 2013.
3. Hojat, Mohammadreza. “Viewpoint: Guiding Medical Students Toward Empathetic Patient
Care - AAMC Reporter, June 2012 - AAMC Reporter - Newsroom - AAMC.” Viewpoint. AAMC
Reporter, 1 June 2012. Web. 28 Mar. 2013.
4. Kim SS, Kaplowitz S, Johnston MV. The effects of physician empathy on patient satisfaction
and compliance. Evaluation and the Health Professions. 2004;27(3):237-251.
5. Stepien, K.A. and Baernstein A. Educating for Empathy. Journal of General Internal Medicine.
2006;21:524-530.
6. Wilkes et al. Towards more empathic medical students: a medical student hospitalization
experience. Medical Education. June 2002;36(6):528-33.
7. Stepien, K.A. and Baernstein A. Educating for Empathy. Journal of General Internal Medicine.
2006;21:524-530.
Author’s Affiliation:
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
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