Effectiveness of empathy in general practice: a systematic review

Frans Derksen; Jozien Bensing; Antoine Lagro-Janssen

doi:10.3399/bjgp13X660814

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Subdivisions of empathy.
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Selection process for papers on the effectiveness of empathy in general practice.

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Table 1.

Summary of included articles

Author	Country	Quality assessment score	Measure/empathy level	Design	Method	Sample size	Research question	Key findings
Hojat et al, 2011⁴⁴	US	6	JSPE/physician rating/cognitive and attitude	Quantitative/RCT with statistical controls	Laboratory results	891 patients/31 GPs	To test the hypothesis that physician empathy is associated with positive clinical outcomes for patients with diabetes.	Patients of physicians with high empathy scores were significantly more likely to have good control of HbA1c (56%) than were patients of physicians with low empathy scores (40%). Similarly, the proportion of patients with good LDL-C control was significantly higher for physicians with high empathy scores (59%) than for patients of physicians with low scores (44%).
Rakel et al, 2011⁴⁵	US	5	CARE/patient rating/skill and attitude	Quantitative/RCT	Questionnaire and laboratory results	348 patients/6 GPs	To evaluate the effects of patient–physician interaction on the severity and duration of the common cold.	The ‘physician empathy perfect’ group was associated with the shortest cold duration (5.89 days versus 7.00 days). The amount of change of interleukin-8 and neutrophil level was greater for the ‘physician empathy perfect’ group.
van Dulmen et al, 2004⁴¹	Netherlands	4	RIAS/observer rating/skills	Quantitative	Questionnaire and analysis of video consultations	698 patients/142 GPs	To examine the physicians’ responses to patients’ concerns in relation to the patient’s empathic preference and perception and the level of anxiety provoked by the medical visit.	95% of the patients reported that they have perceived their GP to be empathic. The patients who had perceived a more empathic GP reported lower levels of anxiety.
Mercer et al, 2008⁴⁶	Scotland	5	CARE/patient rating/skill and attitude	Qualitative/prospective	Questionnaires	323 patients/5 GPs	To investigate the relationships between GPs’ empathy, patient enablement and patient-assessed outcomes in primary care consultations in an area of high socioeconomic deprivation in Scotland.	There is a direct relationship between physician empathy and patient enablement.
Hojat et al, 2011⁴⁰	US	6	JSPPPE physician rating cognitive and attitude	Qualitative/RCT	Questionnaires	535 patients	To develop and examine an instrument to measure patients’ overall satisfaction with their GP.	A large correlation between the perception of physician empathy and patient satisfaction.
Buszewicz et al, 2006⁴³	UK	6	TAR/patient rating/long working relationships	Qualitative	Patient interviews	20 patients/12 GPs	To identify which aspects of GP consultations patients presenting with psychological problems experience as helpful or unhelpful.	Genuine interest and empathy, within a continuing relationship, was highly valued both for psychological and non-psychological problems.
Levinson and Roter, 1995⁴²	US	6	RIAS/observer rating/skills	Qualitative	Analysis of audiotapes	412 patients/29 GPs	To assess the relationship between physicians’ beliefs about the psychosocial aspects of patient care and their routine communication with patients.	Physicians who had positive attitudes used more statements of emotions, such as empathy, reassurance, and fewer closed-ended questions than did their colleagues who had less positive attitudes. The patients of these physicians offer more information about psychological and social issues.

CARE = the Consultation and Relational Empathy measure. HbA1c = gylcosylated haemoglobin. JSPE = Jefferson scale of Physician Empathy. JSPPPE = Jefferson Scale of Patient Perception of Physician Empathy. LDL-C = low-density lipoprotein cholesterol. RCT = randomised controlled trial. RIAS = Roter Interaction Analysis System. TAR = Tape Assistance Recall method.