Should Doctors Cry (2): Empathy vs Sympathy

In the Fall 2003 issue of the Permanente Journal, James Hardee, M.D. presents what I feel is a very good overview of empathy and how it is different from sympathy. I have extracted the following from the Conclusion. Please read the entire article.

Despite some divergent opinion on the matter, we may propose a subtle but important distinction between empathy and sympathy.

Whereas empathy is used by skilled clinicians to enhance communication and delivery of care, sympathy can be burdensome and emotionally exhausting and can lead to burnout. Sympathy implies feeling shared with the sufferer as if the pain belonged to both persons: We sympathize with other human beings when we share and suffer with them. It would stand to reason, therefore, that completely shared suffering can never exist between physician and patient; otherwise, the physician would share the patient's plight and would therefore be unable to help.

Empathy is concerned with a much higher order of human relationship and understanding: engaged detachment. In empathy, we 'borrow' another's feelings to observe, feel, and understand them--but not to take them onto ourselves. By being a participant-observer, we come to understand how the other person feels. An empathetic observer enters into the equation and then is removed.

Harry Wilmer (Wilmer HA. The doctor-patient relationship and issues of pity, sympathy and empathy. Br J Med Psychol 1968 Sep;41(3):243-8.) summarizes these three emotions--Empathy, Sympathy, and Pity--as follows:

* Pity describes a relationship which separates physician and patient. Pity is often condescending and may entail feelings of contempt and rejection.
* Sympathy is when the physician experiences feelings as if he or she were the sufferer. Sympathy is thus shared suffering.
* Empathy is the feeling relationship in which the physician understands the patient's plight as if the physician were the patient. The physician identifies with the patient and at the same time maintains a distance. Empathetic communication enhances the therapeutic effectiveness of the clinician-patient relationship.

One of the difficulties written about in becoming truely empathetic is how we can "borrow" the true feelings of the patient, if physicians themselves have never experienced the same or similar stories. And even if the physicians did, might not their own individual past history, their own strengths and weaknesses affect their understanding of their patient's suffering? It is difficult but there is no doubt that not to provide empathy to a patient represents a great absence in the relationship and can have consequences for the patient's health. Empathy is the way to therapeutically and spiritually "connect" to the patient. This connection, if and when it occurs, is felt both on the part of the patient and also the physician. In fact, physicians will tell you that at the moment of this connection the physician may experience "goose-bumps", this event having such a physiological effect.

More on empathy later. ..Maurice.