Effectiveness of empathy in general practice: a systematic review

Frans Derksen; Jozien Bensing; Antoine Lagro-Janssen

doi:10.3399/bjgp13X660814

Abstract

Background Empathy as a characteristic of patient–physician communication in both general practice and clinical care is considered to be the backbone of the patient–physician relationship. Although the value of empathy is seldom debated, its effectiveness is little discussed in general practice. This literature review explores the effectiveness of empathy in general practice. Effects that are discussed are: patient satisfaction and adherence, feelings of anxiety and stress, patient enablement, diagnostics related to information exchange, and clinical outcomes.

Aim To review the existing literature concerning all studies published in the last 15 years on the effectiveness of physician empathy in general practice.

Design and setting Systematic literature search.

Method Searches of PubMed, EMBASE, and PsychINFO databases were undertaken, with citation searches of key studies and papers. Original studies published in English between July 1995 and July 2011, containing empirical data about patient experience of GPs’ empathy, were included. Qualitative assessment was applied using Giacomini and Cook’s criteria.

Results After screening the literature using specified selection criteria, 964 original studies were selected; of these, seven were included in this review after applying quality assessment. There is a good correlation between physician empathy and patient satisfaction and a direct positive relationship with strengthening patient enablement. Empathy lowers patients’ anxiety and distress and delivers significantly better clinical outcomes.

Conclusion Although only a small number of studies could be used in this search, the general outcome seems to be that empathy in the patient–physician communication in general practice is of unquestionable importance.

INTRODUCTION

Patients consider empathy as a basic component of all therapeutic relationships and a key factor in their definitions of quality of care.1,2 One hundred years ago, Tichener introduced the word ‘empathy’ into the English literature, based on the philosophical aesthetics concept of ‘Einfühlung’ of Theodor Lipps.3 Another important historical moment is the way Rogers speaks about empathy in 1961 in his book: On Becoming a Person: a Therapist’s View of Psychotherapy.4 Since then, various authors have written about empathy in the setting of psychotherapy and about its functionality in patient–physician communication. Neuroscientific research of recent decades has achieved significant progress in establishing the neurobiological basis for empathy, after discovering the mirror neuron system (MNS)5,6 as probably being related to people’s capacity to be empathic.7 Scientists have now added new insights, based on functional magnetic resonance imaging (fMRI) experiments. They have discovered that the MNS consists of mirror neurons in the ventral premotor cortex and the parietal area of the brain and neurons in the somatosensory areas and in limbic and paralimbic structures.8 The insula plays a fundamental role in connecting these regions.9 fMRI experiments have shown that individuals who score higher in a questionnaire measuring their tendency to place themselves in the other person’s shoes activate their MNS more strongly while listening to other people’s problems.10,11 These results draw the ‘soft’ concept of empathy into ‘hard’ science, which opens a challenging new field of research with potentially important clinical implications.12 However, these neurobiological studies do not give information about the impact of empathy in clinical care. Within the current opinion of ‘evidence-based health care’, it is important also to get evidence about the effectiveness of empathy in the daily practice of GPs.

To assess the effectiveness of empathy, it is necessary to define what authors mean when using the term ‘empathy’. Although many authors experience difficulties in giving a clear definition,1,2,13,–,20 a number of core elements can be identified. In general, authors consider empathy as the competence of a physician to understand the patient’s situation, perspective, and feelings; to communicate that understanding and check its accuracy; and to act on that understanding in a helpful therapeutic way. It has an affective, a cognitive, and a behavioural dimension.1,21,–,24

Empathy can therefore be defined at three levels: as an attitude (affective),25,26 as a competency (cognitive),2,15 and as a behaviour.2,16

Attitude is based on moral standards in the mind of the physician; such as respectfulness for the authenticity of the other person, interest in the other person, impartiality, and receptivity. These standards are formed by a physician’s own human development, their socialisation process, their medical training, their personal experience with patients; by reading professional literature; and by watching movies and reading books.13,15,22,27,–,29

How this fits in

Empathy is seen, as well as by patients as by physicians, as the base of good patient-physician communication. Despite these opinions one can see a decrease of interest in good patient-physician communication. There is an increase of technological aspects of care and of a prevalence on productivity in general practice. This systematic review shows that also a “soft” skill like empathy has its effectiveness on patient satisfaction, adherence, decrease of anxiety and stress, better diagnostics and outcomes and patient enablement. Physicians should be more aware of this. In the near future it is a challenge to draw the attention of policy makers and health insures on these aspects of empathy.

Competency can be subdivided into empathic skill, a communication skill, and the skill to build up a relationship with a patient based on mutual trust. Empathic skill is the approach by which the physician can elicit the inner world of the patient and get as much information as possible from the patient, while at the same time recognising the patient’s problem.2,30,31 Communication skill is used to check, clarify, support, understand, reconstruct, and reflect on the perception of a patient’s thoughts and feelings.15,23 The skill to build up a trusting and long-standing patient–physician relationship encourages physicians to resonate with the patient emotionally. These long-term relationships are important for telling and listening to the stories of illness.32,33

Behaviour has a cognitive and an affective part. The cognitive part includes verbal and/or non-verbal skills.14,15,22,25,26 The affective part includes recognition of the emotional state or situation of the patient, being moved, and recognising a feeling of identification with someone who suffers with anger, grief, and disappointment. After this recognition, the physician, in their behaviour, reflects on and communicates their understanding to the patient (Figure 1).20,23

Figure 1

Subdivisions of empathy.

Both patients and physicians mention empathy as the basis for a humane patient-centred method in general practice, and as an important component of professionalism.1,17,34 A large number of patients, nearly 80%, would recommend an empathic physician to other individuals.35

Despite these opinions, one can see a decrease of interest in good patient–physician communication. Reynolds et al report a low level of empathy in professional relationships.34 In their view, this is widespread in modern medicine and many recipients of professional help may not feel that their situation is understood by professionals.34 A study by Kenny et al suggests that physicians and patients have a different perspective on physicians’ communication skills: the perceptions of the medical encounter have been characterised as being so different that they appear to be from ‘different worlds’.36

Moreover, different authors report a rising prevalence in the last decade of technological and biomedical aspects of care and of more emphasis on effectiveness and productivity in family care.17,20,37Peabody proved to be prophetic when, in 1927, in his lecture The Care of the Patient, he expressed concern that rapidly growing scientific technology was crowding out human values in the management of patients.38 Just as Spiro asks attention for the ‘unseen and unheard’ patient in these developments,20 it is important to pay attention to the effectiveness of empathy in patient–physician communication.

The purpose of this literature review is to get a clear view on the proven effectiveness of empathy in patient–physician communication, in particular in general practice.

METHOD

A search was undertaken of PubMed, EMBASE, and PsychINFO databases, between July 1995 and July 2011, with the support of a professional librarian, to identify studies of general practice, empathy, and effectiveness or outcome of empathy. The search terms used are shown in Box 1. The search was performed using major medical subject heading (MeSH) terms in titles and/or abstracts (Box 1). After removal of duplicate studies, titles and abstracts were assessed as to whether the articles were pertinent to this literature review and whether they dealt with general practice. Potentially relevant articles were read in full text. Further papers were sought by checking references and citation searches of included and other leading articles (snowball method). After this selection, articles were assessed as to whether or not they fitted within the inclusion criteria.

Box 1. Database search terms used

((empathy[MeSH] OR empath*[tiab])) AND (Physicians, Family[MeSH] OR Primary Health Care[MeSH] OR Family Practice[MeSH] OR “General Practice”[MeSH] OR “General Practitioners”[MeSH] OR Family Physician*[tiab] OR Primary Health Care[tiab] OR Primary Healthcare[tiab] OR Primary Care[tiab] OR Family Practice*[tiab] OR General Practice*[tiab] OR General Practitioner*[tiab] OR Family Medicine[tiab]) AND outcome*[tw]

To fulfil the inclusion criteria, articles had to detail original and empirical studies, published in English. Studies had to contain patient experience, and outcome measures of empathy and measures of GPs’ empathy. Exclusion criteria were: reviews, guidelines, and theoretical or opinion articles. In the last selection, the studies were evaluated by the criteria of quality developed by Giacomini and Cook (Box 2).39 From the initial 964 papers, seven meeting the inclusion and qualitative criteria were identified (Figure 2).

Figure 2

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

Box 2. Giacomini and Cook’s criteria39

The participant selection is well reasoned and the inclusion is relevant to the research question; the population is representative.
The data-collection methods are appropriate for the research objectives and setting; the data collection is valid and reliable.
The data-collection process, which includes field observation, interviews, and document analysis, must be comprehensive enough to support rich and robust description of the observed events.
The data must be appropriately analysed and the findings adequately corroborated by using multiple sources of information.

RESULTS

Seven studies were found (Table 1).40,–,46 The effectiveness of empathy in patient–physician communication in the studies included is described as improvement of patient satisfaction and adherence, decrease of anxiety and distress, better diagnostic and clinical outcomes, and more patient enablement. Patient outcomes were measured by questionnaires and laboratory tests, and by analysing audio- and videotapes.

View this table:

Table 1.

Summary of included articles

Improvement of patient satisfaction and adherence

Hojat et al found a good correlation between patients’ satisfaction and their perceptions of physicians’ empathic engagement.40 Corrected item–total score correlations of the patient satisfaction scale ranged from 0.85 to 0.96; correlation between patient satisfaction scores and patient perception of physician empathy was 0.93.40

Decrease of anxiety and distress

In the study by van Dulmen et al it was found that the more anxious patients were, the more adequately their GPs tended to respond. Patients who perceived their GP as empathic reported lower levels of anxiety.41

Better diagnostics and clinical outcomes

Levinson and Roter confirm that communication between physicians and patients is associated with underlying physician attitudes.42 Specifically, physicians with positive attitudes towards psychosocial issues make more statements expressing concern and empathy. The patients of these physicians offer relatively more information about psychological and social issues. These patterns of communication are associated with improved patient satisfaction and patient outcomes.42 An underlying attitude of genuine interest and empathy, within a continuing relationship, was highly valued. Patients described how the GP’s attitude helped or hindered them in discussing their problems. Patients also described how the GP helped them make sense of, or resolve, their problems and supported their efforts to change.43

Hojat et al found a positive relationship between physician empathy and patients’ clinical outcomes. Patients with diabetes had their glycosylated haemoglobin (HbA1c) and low-density lipoprotein (LDL) cholesterol levels checked. Both tests showed significantly better results in patients with a more empathic physician. It is suggested that more empathy in the physician–patient relationship enhances mutual understanding and trust between the physician and patient, which in turn promotes sharing without concealment, leading to a better alignment between patients’ needs and treatment plans, and thus more accurate diagnosis and greater adherence.44

Even the most common infectious disease on earth, a common cold, is shown to last for significantly less time and to be less severe in cases where there is good physician–patient empathy. A ‘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. Interleukin-8 and neutrophil counts were obtained from nasal wash at baseline and 48 hours later.45

More patient enablement

There is a direct positive relationship between GP empathy and patient enablement, as well as between enablement and changes in main complaint and wellbeing.46 Patient enablement was measured by the Patient Enablement Instrument (PEI), with questions on topics such as: ability to cope with life and illness, and patients’ confidence about their health and their ability to help themselves.46

DISCUSSION

Summary

This review investigates the relationship between GP empathy and patient outcomes. A GP’s daily practice involves many elements that are not evidence based. The existence and use of empathy in communication is one of these ‘soft’ elements. However, this review shows that there is empirical evidence for effects of human aspects in patient–physician interaction. There is a relationship between empathy in patient–physician communication and patient satisfaction and adherence, patients’ anxiety and distress, better diagnostic and clinical outcomes, and strengthening of patients’ enablement.

As mentioned in the introduction, there are different levels of empathy. Authors used different types of tests to measure these different levels, such as the Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE), a self-report measuring scale for cognitive and attitude factors; the Consultation and Relational Empathy Measure (CARE), a patient rating system that measures physicians’ communication skills and attitudes; the Roter Interaction Analysis System (RIAS), an observer rating system that measures empathy skills; and the Tape Assisted Recall method (TAR), which measures the development of a long working relationship.47

Strengths and limitations

A previous review by Beck et al mentioned that actual empirical data were relatively scarce.48 With the inclusion criteria used in this review, seven articles were found with a bearing on general practice.

This study has a potential cultural bias in interpreting and judging phenomena by standards inherent to European culture. General practice in Europe is most commonly delivered by GPs. In the US, primary care includes both general internists and paediatricians, as well as GPs.

A possible limitation of this review is the underexposure of ‘the danger of empathy’, such as a physician losing their professional distance, which, in certain situations, might make empathy a less desirable aspect of patient–physician communication.16,49

In focusing on empathy, the effects of contextual factors on specific health outcomes are possibly underexposed, such as intrinsic and/or extrinsic factors, healthcare setting, access to care, GP’s workload or pressure, and sociocultural factors.50

General limitations of this review are that only articles written in English are included. Furthermore, the existing measures of empathy have been taken as presented in the literature; no critical reflection of the validity of these measures has taken place.

Comparison with existing literature

The results of the studies seem to be supported by other authors. For patient satisfaction and adherence, Neumann et al,21 Kim et al,51 and Lelorain et al52 confirm the data; they found links between physician empathy and patient satisfaction, in various clinical settings. Mercer et al have shown that patients view quality of consultation in general practice as related to both the GP’s competence and the GP’s empathic care.53 Further, Neumann et al argue that affective-oriented effects of empathy are related to more satisfaction, adherence, and trust.16 Indirectly, patients who are more satisfied with the care received exercise greater adherence to agreed and recommended treatment regimens and courses of action.3

In relation to decrease of anxiety and distress, in experimental research in which a GP was trained in special communication styles, Verheul et al found that combining a warm and empathic communication style with raising positive expectations leads to positive effects on the patient’s anxiety.12

In relation to better diagnostics and clinical outcomes, authors have shown that empathic communication achieves the effect that patients talk more about their symptoms and concerns, enabling the physician to collect more detailed medical and psychosocial information. This leads to more accurate medical and psychosocial perception and ultimately to more accurate diagnosis and treatment regimens.13,22 Neumann et al based their ‘effect model of empathic communication in the clinical encounter’ on this evidence.16 It has also been mentioned that patients’ overall satisfaction with healthcare services, adherence to medical regimens, comprehension, and perception of a good personal relationship are positively related with interpersonal communication between the patient and care provider and are particularly related to the physician’s empathic behaviour.24,48,51,54,–,57 However, physician-perceived stress has also been shown to correlate negatively with enablement.57

Implications for practice and research

Empathy is a familiar term in the helping and caring literature. In 2008, the World Health Organization (WHO) reaffirmed the importance of primary health care with its report Primary Health Care Now More Than Ever.58 The key challenge was ‘to put people first, since good care is about people’.58 Rakel said that good medical care will continue to depend on care by concerned and compassionate family physicians who can communicate with patients, understand them, know their families, and see them as more than a case.59

Qualitative studies show that physicians link empathy to fidelity, prosocial behaviour, moral thinking, good communication, patient and professional satisfaction, good therapeutic relationships, fewer damage claims, good clinical outcomes, and building up a trusting relationship with the patient.15,24,25,60,61 In her study, Shapiro explored how primary care clinician-teachers actually attempt to convey empathy to medical students; they argued that the moral development of the GP, their basic willingness to help, their genuine interest in the other, and an emphasis on the other’s feelings are basic principles for acceptance of the empathic approach to the patient.25

In GPs’ views, limiting factors during consultation are: time pressure, heavy workload, a cynical view on the effectiveness of empathy, and a lack of skill.13,51,62 Neumann et al have shown that patients also see time pressure and busyness on the physician’s part as a limiting factor.21

Thus empathy can be seen as a part of patient–GP communication, characterised by feelings such as interest and recognition and the physician remaining objective. However, barriers exist for implementation in general practice.13,14,24,30,31,47,63,64

Another finding of this review is that some studies suggest that the degree of empathy shown by medical students declines over the course of their training.20,65,66 Empathy appears to increase during the first year of medical school, but decreases after the third year and remains low through the final year of medical school, measured using the Jefferson Scale of Physician Empathy–Student Version (JSPE-S).17,66,67 In the study by Hojat et al,66 there are no sex differences. On the other hand, Quince et al discovered that among males during medical education, in both the bachelor and clinical phases, affective empathy slightly but significantly declined and cognitive empathy was unchanged. Among females, neither affective nor cognitive empathy changed.68 It is ironic that there are indications that when students can finally begin doing the work they came to medical school to do (that is, taking care of patients) they seem to begin losing empathy.69 Possible explanations of the decline are: a lack of good role models and changes in general cultural and ethical views on illness, health, and portrayals of mankind. Interviews with physicians show that they think that, in current western society, it has become less a part of human nature to be interested in another person and to be affected by someone else’s misery.17 In their study of American college students, comparing the temporal changes between 1979 and 2009, Konrath et al showed that this development has social roots.65 Considering these possible tendencies in education and the above-mentioned technological changes within the healthcare system, which probably influence the patient–physician alliance negatively and could undermine empathy in these relationships, it makes sense to emphasise the results of the present review. The evidence of a correlation between empathy and clinical outcomes should be made widely known, especially among medical students and physicians. Some authors already believe empathy can be improved by targeted educational activities and they indicate opportunities to enhance empathy during education.16,17,26,38,69,–,71

It should be mentioned that, until now, the widely acclaimed benefits of empathy only have a small empirical base. Although a few studies of sufficiently high quality show promising results, much more research is needed to claim the effectiveness of empathy in clinical practice on evidence-based grounds. Neumann et al have already highlighted the need for an examination of the cost-effectiveness of empathy in the light of the recent focus of policy makers and health insurers on the efficiency of health care.16 It is a challenge to draw the attention of policy makers to empathy as an effective and efficient way of delivering health care. A vast majority of patients want empathic physicians, particularly, but not exclusively, in general practice.72 Indirectly, authors suppose empathic behaviour improves the physician–patient relationship and causes satisfaction for the patient but also for the physician,1,13,22 resulting in fewer cases of compassion fatigue or burn out.

Further research is needed on the practical use of empathy in general practice, with a focus on the effects and side effects of empathy and the expectations of patients and GPs. In this context, it is important to take account of how researchers have measured empathy. Measuring empathy is often based solely on self-reports and is therefore often remote from patients’ and physicians’ concrete feelings, experiences, and interpretations in practice. Only patient-perceived empathy is significantly related to patient outcomes. Therefore, it appears best to use a patient-perceived empathy scale to measure physician empathy in practice.47,48,63,65,73

It is remarkable that empirical studies on physician empathy are still relatively scarce. According to the results of the studies included in this systematic review, empathy is an important factor in patient satisfaction and adherence, in decreasing patients’ anxiety and distress, in better diagnostic and clinical outcomes, and in strengthening patient enablement. Thus, physician empathy seems to improve physical and psychosocial health outcomes.

Acknowledgments

I am most grateful to E Peters, specialist librarian of the medical library, for her help with the database searches.

Notes

Funding

The study was not funded.

Provenance

Freely submitted; externally peer reviewed.

Competing interests

The authors have declared no competing interests.

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Contribute and read comments about this article on the Discussion Forum: http://www.rcgp.org.uk/bjgp-discuss

Received February 26, 2012.
Revision received April 12, 2012.
Accepted June 28, 2012.

REFERENCES

1.↵
1. Mercer SW,
2. Reynolds WJ
(2002) Empathy and quality of care. Br J Gen Pract 52:S9–12.
OpenUrl Abstract/FREE Full Text
2.↵
1. Irving P,
2. Dickson D
(2004) Empathy: towards a conceptual framework for health professionals. Int J Health Care Qual Assur Inc Leadersh Health Serv 17(4–5):212–220.
OpenUrl CrossRef PubMed
3.↵
1. Stueber K
(2010) Rediscovering empathy, agency, folk psychology, and the human sciences. (The MIT Press, London).
4.↵
1. Rogers CR
(1961) On becoming a person: a therapist’s view of psychotherapy. (Houghton Mifflin Company, Boston, MA).
5.↵
1. Gallese V,
2. Fadiga L,
3. Fogassi L,
4. Rizzolatti G
(1996) Action recognition in the premotor cortex. Brain 119:593–609.
OpenUrl CrossRef PubMed
6.↵
1. Rizzolatti G,
2. Craighero L
(2004) The mirror-neuron system. Annu Rev Neurosci 27:169–192.
OpenUrl CrossRef PubMed
7.↵
1. Gallese V
(2003) The roots of empathy: the shared manifold hypothesis and the neural basis of intersubjectivity. Psychopathology 36:171–180.
OpenUrl CrossRef PubMed
8.↵
1. Kaplan JT,
2. Iacoboni M
(2006) Getting a grip on other minds: mirror neurons, intention understanding, and cognitive empathy. Soc Neurosci 1(3–4):175–183.
OpenUrl CrossRef PubMed
9.↵
1. Carr L,
2. Iacoboni M,
3. Dubeau MC,
4. et al.
(2003) Neural mechanisms of empathy in humans: a relay from neural systems for imitation to limbic areas. Proc Natl Acad Sci USA 100(9):5497–5502.
OpenUrl Abstract/FREE Full Text
10.↵
1. Singer T,
2. Seymour B,
3. O’Doherty JP,
4. et al.
(2006) Empathic neural responses are modulated by the perceived fairness of others. Nature 439:466–469.
OpenUrl CrossRef PubMed
11.↵
1. Bastiaansen JA,
2. Thioux M,
3. Keysers C
(2009) Evidence for mirror systems in emotions. Philos Trans R Soc Lond B Biol Sci 364(1528):2391–2404.
OpenUrl CrossRef PubMed
12.↵
1. Verheul W,
2. Sanders A,
3. Bensing J
(2010) The effects of physicians’ affect-oriented communication style and raising expectations on analogue patients’ anxiety, affect and expectancies. Patient Educ Couns 80(3):300–306.
OpenUrl CrossRef PubMed
13.↵
1. Larson EB,
2. Yao X
(2005) Clinical empathy as emotional labor in the patient–physician relationship. JAMA 293:1100–1106.
OpenUrl CrossRef PubMed
14.↵
1. Benbassat J,
2. Baumal R
(2004) What is empathy, and how can it be promoted during clinical clerkships? Acad Med 79(9):832–839.
OpenUrl CrossRef PubMed
15.↵
1. Norfolk T,
2. Birdi K,
3. Walsh D
(2007) The role of empathy in establishing rapport in the consultation: a new model. Med Educ 41(7):690–697.
OpenUrl CrossRef PubMed
16.↵
1. Neumann M,
2. Bensing J,
3. Mercer S,
4. et al.
(2009) Analyzing the ‘nature’ and ‘specific effectiveness’ of clinical empathy: a theoretical overview and contribution towards a theory-based research agenda. Patient Educ Couns 74(3):339–346.
OpenUrl CrossRef PubMed
17.↵
1. Shapiro J
(2008) Walking a mile in their patients’ shoes: empathy and othering in medical students’ education. Philos Ethics Humanit Med 3:10.
OpenUrl CrossRef PubMed
18.↵
1. Halpern J
(2003) What is clinical empathy? J Gen Intern Med 18(8):670–674.
OpenUrl CrossRef PubMed
19.↵
1. Ong LM,
2. de Haes JC,
3. Hoos AM,
4. Lammes FB
(1995) Doctor–patient communication: a review of the literature. Soc Sci Med 40(7):903–918.
OpenUrl CrossRef PubMed
20.↵
1. Spiro H
(2009) Commentary: the practice of empathy. Acad Med 84(9):1177–1179.
OpenUrl CrossRef PubMed
21.↵
1. Neumann M,
2. Wirtz M,
3. Bollschweiler E,
4. et al.
(2007) Determinants and patient-reported long-term outcomes of physician empathy in oncology: a structural equation modelling approach. Patient Educ Couns 69(1–3):63–75.
OpenUrl CrossRef PubMed
22.↵
1. Coulehan JL,
2. Platt FW,
3. Egener B,
4. et al.
(2001) ‘Let me see if I have this right …’: words that help build empathy. Ann Intern Med 135(3):221–227.
OpenUrl CrossRef PubMed
23.↵
1. Reynolds WJ,
2. Scott B
(1999) Empathy: a crucial component of the helping relationship. J Psychiatr Ment Health Nurs 6(5):363–370.
OpenUrl CrossRef PubMed
24.↵
1. Hojat M,
2. Gonnella JS,
3. Nasca TJ,
4. et al.
(2002) Physician empathy: definition, components, measurement, and relationship to gender and specialty. Am J Psychiatry 159(9):1563–1569.
OpenUrl CrossRef PubMed
25.↵
1. Shapiro J
(2002) How do physicians teach empathy in the primary care setting? Acad Med 77:323–328.
OpenUrl CrossRef PubMed
26.↵
1. Suchman AL,
2. Markakis K,
3. Beckman HB,
4. Frankel R
(1997) A model of empathic communication in the medical interview. JAMA 277(8):678–682.
OpenUrl CrossRef PubMed
27.↵
1. Noddings N
(2010) Complexity in caring and empathy. Abstracta (5):6–12.
28.↵
1. Carse A
(2005) The moral contours of empathy. Ethical Theory Moral Pract 8(1–2):169–195.
OpenUrl PubMed
29.↵
1. Duyndam J
Levinas en het gelaat. ‘Ik ben vrij omadat ik verantwoord elijk ben’. http://www.duyndam.demon.nl/gelaat.pdf [in Dutch] (accessed 19 November 2012).
30.↵
1. Lussier MT,
2. Richard C
(2007) Communication tips. Feeling understood: expression of empathy during medical consultations. Can Fam Physician 53(4):640–641.
OpenUrl FREE Full Text
31.↵
1. Lussier MT,
2. Richard C
(2007) Communication tips. Reflecting back: empathic process. Can Fam Physician 53:827–828.
OpenUrl FREE Full Text
32.↵
1. Charon R
(2001) The patient–physician relationship. Narrative medicine: a model for empathy, reflection, profession, and trust. JAMA 286(15):1897–1902.
OpenUrl CrossRef PubMed
33.↵
1. Lumma-Sellenthin A
(2009) Talking with patients and peers: medical students’ difficulties with learning communication skills. Med Teach 31(6):528–534.
OpenUrl PubMed
34.↵
1. Reynolds WJ,
2. Scott B
(2000) Do nurses and other professional helpers normally display much empathy? J Adv Nurs 31(1):226–234.
OpenUrl CrossRef PubMed
35.↵
1. Vedsted P,
2. Heje HN
(2008) Association between patients’ recommendation of their GP and their evaluation of the GP. Scand J Prim Health Care 26(4):228–234.
OpenUrl CrossRef PubMed
36.↵
1. Kenny DA,
2. Veldhuijzen W,
3. Weijden T,
4. et al.
(2010) Interpersonal perception in the context of doctor-patient relationships: a dyadic analysis of doctor–patient communication. Soc Sci Med 70(5):763–768.
OpenUrl CrossRef PubMed
37.↵
1. Back AL,
2. Arnold RM,
3. Baile WF,
4. et al.
(2010) When praise is worth considering in a difficult conversation. Lancet 376(9744):866–867.
OpenUrl PubMed
38.↵
1. Graham JR
(1983) Francis Peabody revisited: The care of the patient, 1983. Psychosomatics 24(9):779–783.
OpenUrl CrossRef PubMed
39.↵
1. Giacomini MK,
2. Cook DJ
(2000) Users’ guides to the medical literature: XXIII. Qualitative research in health care A. Are the results of the study valid? Evidence-Based Medicine Working Group. JAMA 284(3):357–362.
OpenUrl CrossRef PubMed
40.↵
1. Hojat M,
2. Louis DZ,
3. Maxwell K,
4. et al.
(2011) A brief instrument to measure patients’ overall satisfaction with primary care physicians. Fam Med 43(6):412–417.
OpenUrl PubMed
41.↵
1. van DulmenS,
2. van den Brink-Muinen A.
(2004) Patients’ preferences and experiences in handling emotions: a study on communication sequences in primary care medical visits. Patient Educ Couns 55(1):149–152.
OpenUrl CrossRef PubMed
42.↵
1. Levinson W,
2. Roter D
(1995) Physicians’ psychosocial beliefs correlate with their patient communication skills. J Gen Intern Med 10(7):375–379.
OpenUrl CrossRef PubMed
43.↵
1. Buszewicz M,
2. Pistrang N,
3. Barker C,
4. et al.
(2006) Patients’ experiences of GP consultations for psychological problems: a qualitative study. Br J Gen Pract 56(528):496–503.
OpenUrl Abstract/FREE Full Text
44.↵
1. Hojat M,
2. Louis DZ,
3. Markham FW,
4. et al.
(2011) Physicians’ empathy and clinical outcomes for diabetic patients. Acad Med 86(3):359–364.
OpenUrl CrossRef PubMed
45.↵
1. Rakel D,
2. Barrett B,
3. Zhang Z,
4. et al.
(2011) Perception of empathy in the therapeutic encounter: Effects on the common cold. Patient Educ Couns 85(3):390–397.
OpenUrl CrossRef PubMed
46.↵
1. Mercer SW,
2. Neumann M,
3. Wirtz M,
4. et al.
(2008) General practitioner empathy, patient enablement, and patient-reported outcomes in primary care in an area of high socio-economic deprivation in Scotland ’ a pilot prospective study using structural equation modeling. Patient Educ Couns 73(2):240–245.
OpenUrl CrossRef PubMed
47.↵
1. Pedersen R
(2009) Empirical research on empathy in medicine ’ a critical review. Patient Educ Couns 76(3):307–322.
OpenUrl CrossRef PubMed
48.↵
1. Beck RS,
2. Daughtridge R,
3. Sloane PD
(2002) Physician–patient communication in the primary care office: a systematic review. J Am Board Fam Pract 15(1):25–38.
OpenUrl Abstract
49.↵
1. Landau R
(1993) Selective empathy. (Yale University Press, New Haven).
50.↵
1. Street RL Jr.,
2. Makoul G,
3. Arora NK,
4. Epstein RM
(2009) How does communication heal? Pathways linking clinician–patient communication to health outcomes. Patient Educ Couns 74(3):295–301.
OpenUrl CrossRef PubMed
51.↵
1. Kim SS,
2. Kaplowitz S,
3. Johnston MV
(2004) The effects of physician empathy on patient satisfaction and compliance. Eval Health Prof 27(3):237–251.
OpenUrl CrossRef PubMed
52.↵
1. Lelorain S,
2. Brédart A,
3. Dolbeault S,
4. Sultan S
(2012) A systematic review of the associations between empathy measures and patient outcomes in cancer care. Psycho-Oncology 10:1–10.
OpenUrl
53.↵
1. Mercer SW,
2. Cawston PG,
3. Bikker AP
(2007) Quality in general practice consultations; a qualitative study of the views of patients living in an area of high socio-economic deprivation in Scotland. BMC Fam Pract 8:22.
OpenUrl CrossRef PubMed
54.↵
1. van Dulmen AM,
2. Bensing JM
(2002) Health promoting effects of the physician–patient enconter. Psych Health and Med 3:289–299.
OpenUrl
55.↵
1. Di BlasiZ,
2. Harkness E,
3. Ernst E,
4. et al.
(2001) Influence of context effects on health outcomes: a systematic review. Lancet 357:757–762.
OpenUrl CrossRef PubMed
56.↵
1. Mercer SW,
2. Watt GC,
3. Reilly D
(2001) Empathy is important for enablement. BMJ 322(7290):865.
OpenUrl FREE Full Text
57.↵
1. Howie JG,
2. Heaney D,
3. Maxwell M
(2004) Quality, core values and the general practice consultation: issues of definition, measurement and delivery. Fam Pract 21(4):458–468.
OpenUrl CrossRef PubMed
58.↵
1. World Health Organization.
(2008) The World Health Report. Primary health care now more than ever. (World Health Organization, Geneva).
59.↵
1. Rakel RE
(1996) Family medicine ’ meeting new challenges. Aust Fam Physician 25:S91–96, 9 suppl 2.
OpenUrl PubMed
60.↵
1. Levinson W,
2. Roter DL,
3. Mullooly JP,
4. et al.
(1997) Physician–patient communication. The relationship with malpractice claims among primary care physicians and surgeons. JAMA 277:553–559.
OpenUrl CrossRef PubMed
61.↵
1. Davidsen A
(2008) Experiences of carrying out talking therapy in general practice: a qualitative interview study. Patient Educ Couns 72:268–275.
OpenUrl CrossRef PubMed
62.↵
1. Hardee J
(2003) An overview of empathy. The Permanente Journal 7(4):29–32.
OpenUrl
63.↵
1. Mercer SW,
2. Maxwell M,
3. Heaney D,
4. Watt GC
(2004) The consultation and relational empathy (CARE) measure: development and preliminary validation and reliability of an empathy-based consultation process measure. Fam Pract 21(6):699–705.
OpenUrl CrossRef PubMed
64.↵
1. Heje HN,
2. Vedsted P,
3. Olesen F
(2011) General practitioners’ experience and benefits from patient evaluations. BMC Fam Pract 12:116–146.
OpenUrl CrossRef PubMed
65.↵
1. Konrath SH,
2. O’Brien EH,
3. Hsing C
(2011) Changes in dispositional empathy in American college students over time: a meta-analysis. Pers Soc Psychol Rev 15(2):180–198.
OpenUrl CrossRef PubMed
66.↵
1. Hojat M,
2. Vergare MJ,
3. Maxwell K,
4. et al.
(2009) The devil is in the third year: a longitudinal study of erosion of empathy in medical school. Acad Med 84(9):1182–1191.
OpenUrl CrossRef PubMed
67.↵
1. Chen D,
2. Lew R,
3. Hershman W,
4. Orlander J
(2007) A cross-sectional measurement of medical student empathy. J Gen Intern Med 22(10):1434–1438.
OpenUrl CrossRef PubMed
68.↵
1. Quince TA,
2. Parker RA,
3. Wood DF,
4. Benson JA
(2011) Stability of empathy among undergraduate medical students: a longitudinal study at one UK medical school. BMC Med Educ 11:90.
OpenUrl PubMed
69.↵
1. Treadway K,
2. Chatterjee N
(2011) Into the water ’ the clinical clerkships. N Engl J Med 364(13):1190–1193.
OpenUrl PubMed
70.↵
1. Fox FE,
2. Rodham KJ,
3. Harris MF,
4. et al.
(2009) Experiencing ‘the other side’: a study of empathy and empowerment in general practitioners who have been patients. Qual Health Res 19(11):1580–1588.
OpenUrl CrossRef PubMed
71.↵
1. Hojat M
(2009) Ten approaches for enhancing empathy in health and human services cultures. J Health Hum Serv Adm 31(4):412–450.
OpenUrl PubMed
72.↵
1. Mazzi MA,
2. Bensing J,
3. Rimondini M,
4. et al.
(2011) How do lay people assess the quality of physicians’ communicative responses to patients’ emotional cues and concerns? An international multicentre study based on videotaped medical consultations. Pat Educ Couns, doi:10.1016/j.pec.2011.06.010.
73.↵
1. Mercer SW,
2. McConnachie A,
3. Maxwell M,
4. et al.
(2005) Relevance and practical use of the Consultation and Relational Empathy (CARE) Measure in general practice. Fam Pract 22(3):328–334.
OpenUrl CrossRef PubMed

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[1] 1.↵
Mercer SW,
Reynolds WJ
(2002) Empathy and quality of care. Br J Gen Pract 52:S9–12.
OpenUrl Abstract/FREE Full Text

[2] Mercer SW,

[3] Reynolds WJ

[4] 2.↵
Irving P,
Dickson D
(2004) Empathy: towards a conceptual framework for health professionals. Int J Health Care Qual Assur Inc Leadersh Health Serv 17(4–5):212–220.
OpenUrl CrossRef PubMed

[5] Irving P,

[6] Dickson D

[7] 3.↵
Stueber K
(2010) Rediscovering empathy, agency, folk psychology, and the human sciences. (The MIT Press, London).

[8] Stueber K

[9] 4.↵
Rogers CR
(1961) On becoming a person: a therapist’s view of psychotherapy. (Houghton Mifflin Company, Boston, MA).

[10] Rogers CR

[11] 5.↵
Gallese V,
Fadiga L,
Fogassi L,
Rizzolatti G
(1996) Action recognition in the premotor cortex. Brain 119:593–609.
OpenUrl CrossRef PubMed

[12] Gallese V,

[13] Fadiga L,

[14] Fogassi L,

[15] Rizzolatti G

[16] 6.↵
Rizzolatti G,
Craighero L
(2004) The mirror-neuron system. Annu Rev Neurosci 27:169–192.
OpenUrl CrossRef PubMed

[17] Rizzolatti G,

[18] Craighero L

[19] 7.↵
Gallese V
(2003) The roots of empathy: the shared manifold hypothesis and the neural basis of intersubjectivity. Psychopathology 36:171–180.
OpenUrl CrossRef PubMed

[20] Gallese V

[21] 8.↵
Kaplan JT,
Iacoboni M
(2006) Getting a grip on other minds: mirror neurons, intention understanding, and cognitive empathy. Soc Neurosci 1(3–4):175–183.
OpenUrl CrossRef PubMed

[22] Kaplan JT,

[23] Iacoboni M

[24] 9.↵
Carr L,
Iacoboni M,
Dubeau MC,
et al.
(2003) Neural mechanisms of empathy in humans: a relay from neural systems for imitation to limbic areas. Proc Natl Acad Sci USA 100(9):5497–5502.
OpenUrl Abstract/FREE Full Text

[25] Carr L,

[26] Iacoboni M,

[27] Dubeau MC,

[28] et al.

[29] 10.↵
Singer T,
Seymour B,
O’Doherty JP,
et al.
(2006) Empathic neural responses are modulated by the perceived fairness of others. Nature 439:466–469.
OpenUrl CrossRef PubMed

[30] Singer T,

[31] Seymour B,

[32] O’Doherty JP,

[33] et al.

[34] 11.↵
Bastiaansen JA,
Thioux M,
Keysers C
(2009) Evidence for mirror systems in emotions. Philos Trans R Soc Lond B Biol Sci 364(1528):2391–2404.
OpenUrl CrossRef PubMed

[35] Bastiaansen JA,

[36] Thioux M,

[37] Keysers C

[38] 12.↵
Verheul W,
Sanders A,
Bensing J
(2010) The effects of physicians’ affect-oriented communication style and raising expectations on analogue patients’ anxiety, affect and expectancies. Patient Educ Couns 80(3):300–306.
OpenUrl CrossRef PubMed

[39] Verheul W,

[40] Sanders A,

[41] Bensing J

[42] 13.↵
Larson EB,
Yao X
(2005) Clinical empathy as emotional labor in the patient–physician relationship. JAMA 293:1100–1106.
OpenUrl CrossRef PubMed

[43] Larson EB,

[44] Yao X

[45] 14.↵
Benbassat J,
Baumal R
(2004) What is empathy, and how can it be promoted during clinical clerkships? Acad Med 79(9):832–839.
OpenUrl CrossRef PubMed

[46] Benbassat J,

[47] Baumal R

[48] 15.↵
Norfolk T,
Birdi K,
Walsh D
(2007) The role of empathy in establishing rapport in the consultation: a new model. Med Educ 41(7):690–697.
OpenUrl CrossRef PubMed

[49] Norfolk T,

[50] Birdi K,

[51] Walsh D

[52] 16.↵
Neumann M,
Bensing J,
Mercer S,
et al.
(2009) Analyzing the ‘nature’ and ‘specific effectiveness’ of clinical empathy: a theoretical overview and contribution towards a theory-based research agenda. Patient Educ Couns 74(3):339–346.
OpenUrl CrossRef PubMed

[53] Neumann M,

[54] Bensing J,

[55] Mercer S,

[56] et al.

[57] 17.↵
Shapiro J
(2008) Walking a mile in their patients’ shoes: empathy and othering in medical students’ education. Philos Ethics Humanit Med 3:10.
OpenUrl CrossRef PubMed

[58] Shapiro J

[59] 18.↵
Halpern J
(2003) What is clinical empathy? J Gen Intern Med 18(8):670–674.
OpenUrl CrossRef PubMed

[60] Halpern J

[61] 19.↵
Ong LM,
de Haes JC,
Hoos AM,
Lammes FB
(1995) Doctor–patient communication: a review of the literature. Soc Sci Med 40(7):903–918.
OpenUrl CrossRef PubMed

[62] Ong LM,

[63] de Haes JC,

[64] Hoos AM,

[65] Lammes FB

[66] 20.↵
Spiro H
(2009) Commentary: the practice of empathy. Acad Med 84(9):1177–1179.
OpenUrl CrossRef PubMed

[67] Spiro H

[68] 21.↵
Neumann M,
Wirtz M,
Bollschweiler E,
et al.
(2007) Determinants and patient-reported long-term outcomes of physician empathy in oncology: a structural equation modelling approach. Patient Educ Couns 69(1–3):63–75.
OpenUrl CrossRef PubMed

[69] Neumann M,

[70] Wirtz M,

[71] Bollschweiler E,

[72] et al.

[73] 22.↵
Coulehan JL,
Platt FW,
Egener B,
et al.
(2001) ‘Let me see if I have this right …’: words that help build empathy. Ann Intern Med 135(3):221–227.
OpenUrl CrossRef PubMed

[74] Coulehan JL,

[75] Platt FW,

[76] Egener B,

[77] et al.

[78] 23.↵
Reynolds WJ,
Scott B
(1999) Empathy: a crucial component of the helping relationship. J Psychiatr Ment Health Nurs 6(5):363–370.
OpenUrl CrossRef PubMed

[79] Reynolds WJ,

[80] Scott B

[81] 24.↵
Hojat M,
Gonnella JS,
Nasca TJ,
et al.
(2002) Physician empathy: definition, components, measurement, and relationship to gender and specialty. Am J Psychiatry 159(9):1563–1569.
OpenUrl CrossRef PubMed

[82] Hojat M,

[83] Gonnella JS,

[84] Nasca TJ,

[85] et al.

[86] 25.↵
Shapiro J
(2002) How do physicians teach empathy in the primary care setting? Acad Med 77:323–328.
OpenUrl CrossRef PubMed

[87] Shapiro J

[88] 26.↵
Suchman AL,
Markakis K,
Beckman HB,
Frankel R
(1997) A model of empathic communication in the medical interview. JAMA 277(8):678–682.
OpenUrl CrossRef PubMed

[89] Suchman AL,

[90] Markakis K,

[91] Beckman HB,

[92] Frankel R

[93] 27.↵
Noddings N
(2010) Complexity in caring and empathy. Abstracta (5):6–12.

[94] Noddings N

[95] 28.↵
Carse A
(2005) The moral contours of empathy. Ethical Theory Moral Pract 8(1–2):169–195.
OpenUrl PubMed

[96] Carse A

[97] 29.↵
Duyndam J
Levinas en het gelaat. ‘Ik ben vrij omadat ik verantwoord elijk ben’. http://www.duyndam.demon.nl/gelaat.pdf [in Dutch] (accessed 19 November 2012).

[98] Duyndam J

[99] 30.↵
Lussier MT,
Richard C
(2007) Communication tips. Feeling understood: expression of empathy during medical consultations. Can Fam Physician 53(4):640–641.
OpenUrl FREE Full Text

[100] Lussier MT,

[101] Richard C

[102] 31.↵
Lussier MT,
Richard C
(2007) Communication tips. Reflecting back: empathic process. Can Fam Physician 53:827–828.
OpenUrl FREE Full Text

[103] Lussier MT,

[104] Richard C

[105] 32.↵
Charon R
(2001) The patient–physician relationship. Narrative medicine: a model for empathy, reflection, profession, and trust. JAMA 286(15):1897–1902.
OpenUrl CrossRef PubMed

[106] Charon R

[107] 33.↵
Lumma-Sellenthin A
(2009) Talking with patients and peers: medical students’ difficulties with learning communication skills. Med Teach 31(6):528–534.
OpenUrl PubMed

[108] Lumma-Sellenthin A

[109] 34.↵
Reynolds WJ,
Scott B
(2000) Do nurses and other professional helpers normally display much empathy? J Adv Nurs 31(1):226–234.
OpenUrl CrossRef PubMed

[110] Reynolds WJ,

[111] Scott B

[112] 35.↵
Vedsted P,
Heje HN
(2008) Association between patients’ recommendation of their GP and their evaluation of the GP. Scand J Prim Health Care 26(4):228–234.
OpenUrl CrossRef PubMed

[113] Vedsted P,

[114] Heje HN

[115] 36.↵
Kenny DA,
Veldhuijzen W,
Weijden T,
et al.
(2010) Interpersonal perception in the context of doctor-patient relationships: a dyadic analysis of doctor–patient communication. Soc Sci Med 70(5):763–768.
OpenUrl CrossRef PubMed

[116] Kenny DA,

[117] Veldhuijzen W,

[118] Weijden T,

[119] et al.

[120] 37.↵
Back AL,
Arnold RM,
Baile WF,
et al.
(2010) When praise is worth considering in a difficult conversation. Lancet 376(9744):866–867.
OpenUrl PubMed

[121] Back AL,

[122] Arnold RM,

[123] Baile WF,

[124] et al.

[125] 38.↵
Graham JR
(1983) Francis Peabody revisited: The care of the patient, 1983. Psychosomatics 24(9):779–783.
OpenUrl CrossRef PubMed

[126] Graham JR

[127] 39.↵
Giacomini MK,
Cook DJ
(2000) Users’ guides to the medical literature: XXIII. Qualitative research in health care A. Are the results of the study valid? Evidence-Based Medicine Working Group. JAMA 284(3):357–362.
OpenUrl CrossRef PubMed

[128] Giacomini MK,

[129] Cook DJ

[130] 40.↵
Hojat M,
Louis DZ,
Maxwell K,
et al.
(2011) A brief instrument to measure patients’ overall satisfaction with primary care physicians. Fam Med 43(6):412–417.
OpenUrl PubMed

[131] Hojat M,

[132] Louis DZ,

[133] Maxwell K,

[134] et al.

[135] 41.↵
van DulmenS,
van den Brink-Muinen A.
(2004) Patients’ preferences and experiences in handling emotions: a study on communication sequences in primary care medical visits. Patient Educ Couns 55(1):149–152.
OpenUrl CrossRef PubMed

[136] van DulmenS,

[137] van den Brink-Muinen A.

[138] 42.↵
Levinson W,
Roter D
(1995) Physicians’ psychosocial beliefs correlate with their patient communication skills. J Gen Intern Med 10(7):375–379.
OpenUrl CrossRef PubMed

[139] Levinson W,

[140] Roter D

[141] 43.↵
Buszewicz M,
Pistrang N,
Barker C,
et al.
(2006) Patients’ experiences of GP consultations for psychological problems: a qualitative study. Br J Gen Pract 56(528):496–503.
OpenUrl Abstract/FREE Full Text

[142] Buszewicz M,

[143] Pistrang N,

[144] Barker C,

[145] et al.

[146] 44.↵
Hojat M,
Louis DZ,
Markham FW,
et al.
(2011) Physicians’ empathy and clinical outcomes for diabetic patients. Acad Med 86(3):359–364.
OpenUrl CrossRef PubMed

[147] Hojat M,

[148] Louis DZ,

[149] Markham FW,

[150] et al.

[151] 45.↵
Rakel D,
Barrett B,
Zhang Z,
et al.
(2011) Perception of empathy in the therapeutic encounter: Effects on the common cold. Patient Educ Couns 85(3):390–397.
OpenUrl CrossRef PubMed

[152] Rakel D,

[153] Barrett B,

[154] Zhang Z,

[155] et al.

[156] 46.↵
Mercer SW,
Neumann M,
Wirtz M,
et al.
(2008) General practitioner empathy, patient enablement, and patient-reported outcomes in primary care in an area of high socio-economic deprivation in Scotland ’ a pilot prospective study using structural equation modeling. Patient Educ Couns 73(2):240–245.
OpenUrl CrossRef PubMed

[157] Mercer SW,

[158] Neumann M,

[159] Wirtz M,

[160] et al.

[161] 47.↵
Pedersen R
(2009) Empirical research on empathy in medicine ’ a critical review. Patient Educ Couns 76(3):307–322.
OpenUrl CrossRef PubMed

[162] Pedersen R

[163] 48.↵
Beck RS,
Daughtridge R,
Sloane PD
(2002) Physician–patient communication in the primary care office: a systematic review. J Am Board Fam Pract 15(1):25–38.
OpenUrl Abstract

[164] Beck RS,

[165] Daughtridge R,

[166] Sloane PD

[167] 49.↵
Landau R
(1993) Selective empathy. (Yale University Press, New Haven).

[168] Landau R

[169] 50.↵
Street RL Jr.,
Makoul G,
Arora NK,
Epstein RM
(2009) How does communication heal? Pathways linking clinician–patient communication to health outcomes. Patient Educ Couns 74(3):295–301.
OpenUrl CrossRef PubMed

[170] Street RL Jr.,

[171] Makoul G,

[172] Arora NK,

[173] Epstein RM

[174] 51.↵
Kim SS,
Kaplowitz S,
Johnston MV
(2004) The effects of physician empathy on patient satisfaction and compliance. Eval Health Prof 27(3):237–251.
OpenUrl CrossRef PubMed

[175] Kim SS,

[176] Kaplowitz S,

[177] Johnston MV

[178] 52.↵
Lelorain S,
Brédart A,
Dolbeault S,
Sultan S
(2012) A systematic review of the associations between empathy measures and patient outcomes in cancer care. Psycho-Oncology 10:1–10.
OpenUrl

[179] Lelorain S,

[180] Brédart A,

[181] Dolbeault S,

[182] Sultan S

[183] 53.↵
Mercer SW,
Cawston PG,
Bikker AP
(2007) Quality in general practice consultations; a qualitative study of the views of patients living in an area of high socio-economic deprivation in Scotland. BMC Fam Pract 8:22.
OpenUrl CrossRef PubMed

[184] Mercer SW,

[185] Cawston PG,

[186] Bikker AP

[187] 54.↵
van Dulmen AM,
Bensing JM
(2002) Health promoting effects of the physician–patient enconter. Psych Health and Med 3:289–299.
OpenUrl

[188] van Dulmen AM,

[189] Bensing JM

[190] 55.↵
Di BlasiZ,
Harkness E,
Ernst E,
et al.
(2001) Influence of context effects on health outcomes: a systematic review. Lancet 357:757–762.
OpenUrl CrossRef PubMed

[191] Di BlasiZ,

[192] Harkness E,

[193] Ernst E,

[194] et al.

[195] 56.↵
Mercer SW,
Watt GC,
Reilly D
(2001) Empathy is important for enablement. BMJ 322(7290):865.
OpenUrl FREE Full Text

[196] Mercer SW,

[197] Watt GC,

[198] Reilly D

[199] 57.↵
Howie JG,
Heaney D,
Maxwell M
(2004) Quality, core values and the general practice consultation: issues of definition, measurement and delivery. Fam Pract 21(4):458–468.
OpenUrl CrossRef PubMed

[200] Howie JG,

[201] Heaney D,

[202] Maxwell M

[203] 58.↵
World Health Organization.
(2008) The World Health Report. Primary health care now more than ever. (World Health Organization, Geneva).

[204] World Health Organization.

[205] 59.↵
Rakel RE
(1996) Family medicine ’ meeting new challenges. Aust Fam Physician 25:S91–96, 9 suppl 2.
OpenUrl PubMed

[206] Rakel RE

[207] 60.↵
Levinson W,
Roter DL,
Mullooly JP,
et al.
(1997) Physician–patient communication. The relationship with malpractice claims among primary care physicians and surgeons. JAMA 277:553–559.
OpenUrl CrossRef PubMed

[208] Levinson W,

[209] Roter DL,

[210] Mullooly JP,

[211] et al.

[212] 61.↵
Davidsen A
(2008) Experiences of carrying out talking therapy in general practice: a qualitative interview study. Patient Educ Couns 72:268–275.
OpenUrl CrossRef PubMed

[213] Davidsen A

[214] 62.↵
Hardee J
(2003) An overview of empathy. The Permanente Journal 7(4):29–32.
OpenUrl

[215] Hardee J

[216] 63.↵
Mercer SW,
Maxwell M,
Heaney D,
Watt GC
(2004) The consultation and relational empathy (CARE) measure: development and preliminary validation and reliability of an empathy-based consultation process measure. Fam Pract 21(6):699–705.
OpenUrl CrossRef PubMed

[217] Mercer SW,

[218] Maxwell M,

[219] Heaney D,

[220] Watt GC

[221] 64.↵
Heje HN,
Vedsted P,
Olesen F
(2011) General practitioners’ experience and benefits from patient evaluations. BMC Fam Pract 12:116–146.
OpenUrl CrossRef PubMed

[222] Heje HN,

[223] Vedsted P,

[224] Olesen F

[225] 65.↵
Konrath SH,
O’Brien EH,
Hsing C
(2011) Changes in dispositional empathy in American college students over time: a meta-analysis. Pers Soc Psychol Rev 15(2):180–198.
OpenUrl CrossRef PubMed

[226] Konrath SH,

[227] O’Brien EH,

[228] Hsing C

[229] 66.↵
Hojat M,
Vergare MJ,
Maxwell K,
et al.
(2009) The devil is in the third year: a longitudinal study of erosion of empathy in medical school. Acad Med 84(9):1182–1191.
OpenUrl CrossRef PubMed

[230] Hojat M,

[231] Vergare MJ,

[232] Maxwell K,

[233] et al.

[234] 67.↵
Chen D,
Lew R,
Hershman W,
Orlander J
(2007) A cross-sectional measurement of medical student empathy. J Gen Intern Med 22(10):1434–1438.
OpenUrl CrossRef PubMed

[235] Chen D,

[236] Lew R,

[237] Hershman W,

[238] Orlander J

[239] 68.↵
Quince TA,
Parker RA,
Wood DF,
Benson JA
(2011) Stability of empathy among undergraduate medical students: a longitudinal study at one UK medical school. BMC Med Educ 11:90.
OpenUrl PubMed

[240] Quince TA,

[241] Parker RA,

[242] Wood DF,

[243] Benson JA

[244] 69.↵
Treadway K,
Chatterjee N
(2011) Into the water ’ the clinical clerkships. N Engl J Med 364(13):1190–1193.
OpenUrl PubMed

[245] Treadway K,

[246] Chatterjee N

[247] 70.↵
Fox FE,
Rodham KJ,
Harris MF,
et al.
(2009) Experiencing ‘the other side’: a study of empathy and empowerment in general practitioners who have been patients. Qual Health Res 19(11):1580–1588.
OpenUrl CrossRef PubMed

[248] Fox FE,

[249] Rodham KJ,

[250] Harris MF,

[251] et al.

[252] 71.↵
Hojat M
(2009) Ten approaches for enhancing empathy in health and human services cultures. J Health Hum Serv Adm 31(4):412–450.
OpenUrl PubMed

[253] Hojat M

[254] 72.↵
Mazzi MA,
Bensing J,
Rimondini M,
et al.
(2011) How do lay people assess the quality of physicians’ communicative responses to patients’ emotional cues and concerns? An international multicentre study based on videotaped medical consultations. Pat Educ Couns, doi:10.1016/j.pec.2011.06.010.

[255] Mazzi MA,

[256] Bensing J,

[257] Rimondini M,

[258] et al.

[259] 73.↵
Mercer SW,
McConnachie A,
Maxwell M,
et al.
(2005) Relevance and practical use of the Consultation and Relational Empathy (CARE) Measure in general practice. Fam Pract 22(3):328–334.
OpenUrl CrossRef PubMed

[260] Mercer SW,

[261] McConnachie A,

[262] Maxwell M,

[263] et al.

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