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Published in: Medicine, Health Care and Philosophy 2/2017

01-06-2017 | Editorial

Empathizing with patients: the role of interaction and narratives in providing better patient care

Author: Carter Hardy

Published in: Medicine, Health Care and Philosophy | Issue 2/2017

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Abstract

Recent studies have revealed a drop in the ability of physicians to empathize with their patients. It is argued that empathy training needs to be provided to both medical students and physicians in order to improve patient care. While it may be true that empathy would lead to better patient care, it is important that the right theory of empathy is being encouraged. This paper examines and critiques the prominent explanation of empathy being used in medicine. Focusing on the component of empathy that allows us to understand others, it is argued that this understanding is accomplished through a simulation. However, simulation theory is not the best explanation of empathy for medicine, since it involves a limited perspective in which to understand the patient. In response to the limitations and objections to simulation theory, interaction theory is presented as a promising alternative. This theory explains the physicians understanding of patients from diverse backgrounds as an ability to learn and apply narratives. By explaining how we understand others, without limiting our ability to understand various others, interaction theory is more likely than simulation theory to provide better patient care, and therefore is a better theory of empathy for the medical field.
Footnotes
1
The term “empathy” has a rich history in both philosophy and aesthetics, and the translations of other terms such as the German terms Einfühlung and Mitgefühl to the English term empathy often seem arbitrary (Lanzoni 2012, p. 306). As such, it is important to make sure that a terminological debate is being avoided. It is important that empathy is being discussed based on how well the phenomenon attached to the term is being explained.
 
2
The JSPE is particularly important because it was specifically designed to measure empathy in medical practitioners. While there are other measures for empathy, this was the first developed specifically for the medical field (Hojat et al. 2004, pp. 935–936, 2009, p. 1183). The JSPE has two forms: one for measuring the ability to empathize in medical students (S-Version) and the other to measure the same ability is physicians (HP-Version) (Hojat et al. 2004, p. 936, 2009, pp. 1183–1184). In order to develop the JSPE, researchers first needed to settle on a specific definition for empathy, as well as an explanation of how we empathize (Hojat et al. 2004, p. 936). It is only with this in place that researchers were able to design a scale to measure empathy as it is defined. This scale was then tested and refined based on how well it actually measured empathy. The final result is a list of 20 items that medical students and physicians must answer. The answers to the questions are provided on a 7-point Likert scale, based on how strongly they either agree or disagree with the given statements (Hojat et al. 2004, p. 936, 2009, p. 1183).
 
3
The JSPE is often criticized as discussing empathy too metaphorically as “levels” (Hooker 2015, p. 543), as well as for only really measuring the medical student’s and/or professional’s belief in the importance that empathy serves for medicine (Pedersen 2009). That is, they do not actually measure empathy itself but rather one’s belief that empathy is either important or unimportant.
 
4
By testing medical students with the student version of the JSPE at both the beginning and the end of their third year, it was determined that this is when empathy seems to be the most affected (Hojat et al. 2004, p. 937).
 
5
Halpern call this “compassion fatigue” (Halpern 2014, p. 301).
 
6
To be fair, it should be noted that “empathy did not decline for some students (a minority of 27%) [which] suggests that there may be certain protective factors that defuse the harmful influences” (Hojat et al. 2009, p. 1189). This could mean that some students did not adapt this attitude towards medicine and therefore continued to believe that empathy is important.
 
7
There is an additional background assumption here that affective practices cannot provide objective knowledge. They only allow for subjective understanding of oneself. As such, affects are traditionally seen as contrary to reason, and therefore will more often than not either mislead a physician’s rational judgments or provide false information themselves (Eikeland et al. 2014, p. 4; Halpern 2001, p. 30). Though this view has not been entirely rejected, it is fairly outdated. Most philosophers accept that at least some affects, such as emotions, have rational components. Emotions do not act contrary to reason. On the contrary, they are essential to reason, either by acting as judgments of the world or by focusing our attention such that we can make judgments.
 
8
The belief that empathy is a simulation of the other is not new. ST has a rich tradition dating to Theodore Lipps, who adapted a theory of aesthetic empathy to be used in philosophy of mind (Lanzoni 2012, p. 306).
 
9
Stein has her own arguments against simulation-based theories of empathy. They can be found in her work On the Problem of Empathy.
 
10
One of the ways that this is done is by defining the cognitive skill of understanding others as empathy and the affective skill of feeling for others as sympathy (Gerdes 2011; Hojat et al. 2009). Following this, it is not uncommon to then praise empathy and condemn sympathy as the ability that physicians are actually trying to avoid (Hojat et al. 2009, p. 1183; Svenaeus 2015, p. 275). In this way, all of the negative effects that were traditionally associated with empathy are now associated with some other phenomenon.
 
11
ST may be able to provide an answer to this problem by appealing to mirror neurons, the possibility of which is addressed below.
 
12
They also note several other problems with internal, unconscious simulation in this work.
 
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Metadata
Title
Empathizing with patients: the role of interaction and narratives in providing better patient care
Author
Carter Hardy
Publication date
01-06-2017
Publisher
Springer Netherlands
Published in
Medicine, Health Care and Philosophy / Issue 2/2017
Print ISSN: 1386-7423
Electronic ISSN: 1572-8633
DOI
https://doi.org/10.1007/s11019-016-9746-x

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