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Journal of Clinical Oncology, Vol 22, No 11 (June 1), 2004: pp. 2258-2259 © 2004 American Society of Clinical Oncology. DOI: 10.1200/JCO.2004.99.302
Empathy in the Doctor-Patient RelationshipLega Italiana per la Lotta contro i Tumori; and S Croce General Hospital, Cuneo, Italy To the Editor: Through a case report, Dr Korones appropriately describes the relevance, in a doctor-patient relationship, of approaching the patient with the aim of understanding his innermost personal experience of cancer.1 He also shows how important it is to take time going deeper in the patient's life, and shares an episode of her life not in direct connection with the clinical course of the illness. This way of caring for someone can be called empathy, and has been the subject of thorough study in human sciences. In psychology, Carl Rogers first defined empathy, and in 1957 published the results of his oldest studies in this field.2 He believed empathy to be one of the necessary conditions of a functioning caregiving relationship. Empathy was described as an accurate understanding of another person's inner experience—the attitude of comprehending their feelings and emotions and seeing things from their point of view. Understanding the internal frame of reference of the other person, as well as the subjective way of decoding events, helps to be more effective in caring for them. Since the first observations of Dr Rogers, followed in the psychoanalytic field by those such as Kohut,3 the concept of empathy has reached an important role in psychological research and application. In psycho-oncology, Larson's study4 about working with people facing life-threatening illness underline the importance of caregivers' empathy, specifically in regards to the end-of-life conversation.5 A study confirming that the specific feature of a good doctor-patient relationship is the high frequency of empathic sentences was recently published by Razavi et al.6 A commonly followed protocol of giving bad news, "SPIKES" (setting, perception, invitation, knowledge, emphathize, summary) acknowledges empathy to be the key instrument of communication and one of the six steps of the protocol.7 As human science and study emphasize, empathy is a necessary dimension of the work of the caregiver (physician, psychologist, psychotherapist, nurse) who wants to facilitate an efficacious result. The effects of an empathic relationship are positive both for the patient and for the physician. It can increase patient satisfaction, trust, coping skills, and compliance with therapy, while also enriching the doctor-patient experience. Moreover, if empathy is combined with competence and the appropriate setting, it can protect caregivers from burn-out and support their therapeutic power. As Dr Korones reveals, spending time listening to patients is feasible, even when the physician is busy; empathy does not take time from routine clinical work because it is embodied in the physician's overall attitude when dealing with the patient. Given that a doctor obviously cannot attend every important life event of his patients, the core condition of empathy is to share their clinical journey and seize the clues offered during examination. Creating an empathic relationship should be considered part of the physician's training, because it is a skill that can be learned. Authors' Disclosures of Potential Conflicts of Interest The authors indicated no potential conflicts of interest. REFERENCES
1. Korones DN: Taking time. J Clin Oncol21:3366–3367, 2003 2. Rogers CR: The necessary and sufficient conditions of psychotherapeutic personality change. J Consult Psychol21:95–103, 1957[CrossRef][Medline] 3. Kohut H: Introspection, empathy and psychoanalysis; An examination of the relationship between mode of observation and theory. J Am Psychoanalytic Assoc7:459–483, 1959 4. Larson DG: The Helper's Journey: Working with people facing grief, loss, and life-threatening illness. Research Press, Champaign, 1993
5. Larson DG, Tobin DR: End-of-life conversations: Evolving practice and theory. JAMA284:1573–1578, 2000
6. Razavi D, Merckaert I, Marchal S, et al: How to optimize physicians' communication skills in cancer care: Results of a randomized study assessing the usefulness of posttraining consolidation workshops. J Clin Oncol21:3141–3149, 2003
7. Baile WF, Buckman R, Lenzi R, et al: SPIKES—A six-step protocol for delivering bad news: Application to the patients with cancer. Oncologist5:302–311, 2000
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Copyright © 2004 by the American Society of Clinical Oncology, Online ISSN: 1527-7755. Print ISSN: 0732-183X
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