Empathy in Practice: Comparing Physicians’ Self-assessment and Patient Perceptions Using the Jefferson Scales

doi:10.21203/rs.3.rs-5041703/v1

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Research Article

Empathy in Practice: Comparing Physicians’ Self-assessment and Patient Perceptions Using the Jefferson Scales

https://doi.org/10.21203/rs.3.rs-5041703/v1

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Background

Empathy in clinical practice is a pivotal tool for patient-centered care and improved outcomes. This study investigates the correlation between physicians’ self-assessed empathy and patient-perceived empathy, and explores how different factors influence these perceptions.

Methods

A hospital-based cross-sectional study was conducted with 40 physicians and 400 patients. Physicians were categorized according to their specialty, and empathy scores were assessed using the Jefferson Scale of Empathy. Physicians and their respective patients were given structured questionnaires to give their feedback.

Results

Of the 40 physicians, 47.5% were under 35 years, 42.5% were between 35–50 years, and 10% were over 50 years. Male physicians scored higher on empathy than females, but this difference had no statistical significance. Physicians aged 35–50 years rated themselves as being most empathetic, however, those over 50 years received the highest empathy scores (mean 32.05, p = 0.038) from the patients. Technical skill-oriented specialities (e.g., Dermatology, Surgery) had lower empathy scores (mean 30.8) compared to person-oriented specialties (mean 31.64).

Discussion

The study reveals an obvious discrepancy between self-assessment of physicians’ empathy score and patient perceptions. Older physicians received higher empathy scores, possibly due to their extensive experience and communication skills refined over the years. In contrast, younger physicians' self-ratings were higher, probably reflecting an idealized self-view. Specialties requiring more patient interaction scored higher in empathy, suggesting the realization and importance of communication skills in these departments.

Empathy

Medical curriculum

Jefferson scale

Physician and patient empathy

Empathy is the capacity to imagine another’s feelings from one’s own perspective. It is the ability to gain understanding into others’ physical and emotional experiences either by interpreting their behavioral cues or by mentally recreating those experiences and moving through them as if they were one’s own. ¹

Empathy can be classified into cognitive, affective, behavioural, social and ecological elements, though the predominance of one or the other differs amongst scholars. ^2–6 Empathy has to be distinguished from the similar concept of sympathy, which is the recognition of another’s affective experience without re-experiencing it, either through interpretation or mental simulation.

With regards to patient care, empathy is believed to be a cognitive skill that helps to develop a relationship between health professionals and their health care users which reinforces their cooperation towards a tailor-made therapeutic plan, enhancing the patient’s satisfaction from the therapeutic process. This way, quality of care is enhanced, errors are eliminated, and an increased percentage of health care recipients positively experience therapy with better compliance.⁷ Such an approach might enhance the sense of usefulness among healthcare providers, ensuring better job satisfaction and preventing burnout.⁸

Various studies have shown that empathy varies depending on the country, gender of the healthcare worker, the specialty, the evaluation instrument used and the evaluator.^9–12 Literature supports the need of incorporating empathy during the training and practice years of practitioners.¹³

Owing to the critical role of empathy in physician–patient relation and clinical outcomes, the purpose of this study is to evaluate empathy status in physicians and correlation of empathy scores by patients, with demographic features in a tertiary care centre in South India.

Study design and setting

This is a cross sectional study conducted at a super specialty tertiary care teaching hospital with outpatient and inpatient capacity.

Participants

In order to obtain a widespread idea of empathy among physicians, data was collected from randomly selected physicians from the departments of Medicine, Surgery, Ophthalmology, ENT, Obstetrics and Gynecology, Orthopedics and Medical Gastroenterology of the institute. These specific departments were chosen due to their varying levels of patient complexity.¹⁴

Sample size and study period

A total of 40 physicians from the specialties of Medicine, Surgery, Ophthalmology, ENT, Obstetrics and Gynecology, Orthopedics and Medical Gastroenterology and their respective patients (5 patients per physician) were assessed. The research data was collected from January 2024 to June 2024.

Data collection and study tool

Physicians were asked to analyse their empathy using the questionnaire ‘The Jefferson Scale of Empathy (JSE)-HP version’. Patients treated by the same primary physician and his/her team on an inpatient or outpatient basis at PSGIMS&R were asked to give their perception of their treating physicians’ empathy by using questionnaire ‘Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE)’.

Permission to collect data was obtained from each individual professional and patient.

The Jefferson Scale of Empathy

The Jefferson Scale of Empathy (JSE) is an instrument to measure clinical empathy in physicians and practicing health professionals (HP-version), medical students (S-version), and health professions students other than medical students (HPS-version).¹⁵ The three versions have been developed with minor alterations in them to make them relevant for each target population.¹⁶It is a 20-item answered on 7 point Likert-type scale (1- Strongly Disagree, 7- Strongly Agree) which takes upto 5 minutes to fill.¹⁷A global score is calculated with higher scores (ranging from 20 to 140 for the total scale) reflecting a higher empathetic approach.

The Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE) is a brief, 5 item survey developed for measuring patient perceptions of their physician’s empathy. Each item of the survey is answered on a 7-point Likert scale (1-Strongly Disagree, 7-Strongly Agree).

Satisfactory evidence of the Jefferson Scales, in support of its validity and reliability properties, amongst various healthcare workers has been reported.

Ethical approval

The study was conducted according to principles of the institutional human ethics committee (IHEC Project 23/266).

Inclusion and exclusion criteria

40 physicians in total, from ‘people-oriented’ and ‘technology-oriented’ specialties were included. The selection of participants was by convenient sampling.

Adult population patients coming to outpatient clinics or inpatient care of the respective departments during the study period were included. Patients were added in a consecutive manner till required sample size was attained. The departments of Psychiatry and Pediatrics and their patients were excluded as it was felt that a level of discrepancy may arise.

Procedure

Physicians were initially asked to fill the questionnaires before they saw the patients on an out-patient or in-patient basis. Outpatients were given the questionnaires on the same day after their consultation with their primary physician. In-patients were given the questionnaires on the 2nd day of their stay in hospital. Since the hospital is a private tertiary care center, English is the mode of instruction between patients and physicians and language barriers, if present, were bridged by the volunteers. Volunteers were involved in the study to clarify doubts brought up by professionals or patients and helped avoid any bias.

Sample size

The sample size was calculated with the following assumptions: a population size of 2000 patients, a confidence interval of 95%, a margin of error of 5%, and a population proportion of 50%. The estimated sample size was 323, which was rounded up to 400. From a population size of 40 physicians, a confidence interval equal to 95%, margin of error is 5 and population proportion 50%; the estimated sample size is 37, which was increased to 40.

Data analysis

The Statistical Package for the Social Sciences (SPSS) version 23 (SPSS Inc., Chicago, IL, USA) was used to analyze the data; t test was used to compare the means and ANOVA was used when there were more than two groups.

Out of the total of 40 physicians, 19 (47.5%) were <35 years of age, 17 (42.5%) were in the age group 35-50 years and only 4 (10%) doctors were above the age of 50 years (Figure 1).

Overall it was observed that the male physicians received a higher empathy score then their female counterparts, however this was not statistically significant (Figure 2). In the self-assessment, doctors in the age group of 35-50 years gave themselves a higher score, followed by doctors younger than 35 years, and the least scores were given by the doctors older than 50 years who gave themselves a score of 70.5 (SD 7.83). However it was interesting to note that the patients gave a higher score of empathy (mean 32.05) for physicians above the age of 50 years. This was a significant finding. (p=0.038]. Specialties focused on technique (such as Dermatology, Otolaryngology, Surgery, Ophthalmology, and Orthopaedics) had a lower average score of 30.8 (SD 0.93) compared to person-oriented specialties (including General Medicine, Obstetrics and Gynecology, and Medical Gastroenterology), which had a higher average score of 31.64 (SD 1.71) (Figures 3&4).

Empathy, compassion, and communication skills are strongly linked to physician traits that have been demonstrated to enhance patient-centered outcomes. This study was undertaken to identify the current perception of empathy amongst the clinicians and their respective clients.

Our hospital-based cross-sectional study involving 400 patients and 40 physicians found a negative correlation between physicians' self-assessment and clients' perceptions of empathy during clinical encounters.

Previous studies using various scales, such as the Toronto Composite Empathy Scale and the Consultation and Relational Empathy Scale, also reported a lack of correlation between physician and patient ratings of empathy.^18,19

The physicians all considered themselves to be empathetic but there was an inverse correlation with the score given by the patients seen by them. This may be due to the physician's inability to address the patient's unmet need for supportive care, despite their inherent empathy. Effective communication with patients is an art developed through years of training and practice. This was observed in our study too, wherein the physicians older than 50 years got a higher empathy score by the patients, even though they gave themselves a low score. This could also be due to the more humble nature of the older physicians. In previous studies, it has been noted that older, more experienced physicians rate themselves better than younger physicians.^20,21As physicians gain more experience and interact with patients over time, they develop a broader perspective that allows them to approach illnesses more holistically. Experienced physicians often deal with a reduced diagnostic burden, enabling them to concentrate more on the human aspects of care. Furthermore, senior physicians typically manage fewer complex cases compared to younger colleagues, who tend to see a larger number of patients.

Our study population consisted of people from the similar ethnic and racial backgrounds, and hence, there was no correlation found with regards to the client and physicians’ backgrounds.

It is anticipated that observable physician characteristics such as gender and department will affect the client's perception of empathy. In our study, contrary to other studies, the male physicians were perceived to be more empathetic than the female counterparts. ^22,23 This could be attributed to the fact that most female physicians were working in stressful specialties like Obstetrics and Gynecology where duty hours are longer and also the waiting time for the patients is higher. However this finding had no statistical significance. It was interesting to note that specialties that required more patient interaction and communication fared better in the empathy score compared to the technique-oriented specialties. This could be due to the fact that the physicians in these departments need to spend more time in history taking to come to the differential diagnoses while the other specialties are more focused on procedurals and technical skills and tend to spend less time communicating with the patients.

This study highlights a notable disparity between physicians’ self-assessed empathy and patients’ perceptions of their empathy, as measured by the Jefferson Scales. There are lacunae globally, in the medical curricula, typically lacking substantial emphasis on empathy training. Empathy plays a significant role in successful clinical encounter, patient satisfaction and treatment outcomes.

Experienced physicians, particularly those over the age of 50, tend to receive higher empathy scores from patients, despite giving themselves lower self-assessment scores. This may indicate that while self-perception of empathy may diminish with age and experience, patients may appreciate the depth of care and communication skills developed over years of practice. Conversely, younger physicians may rate themselves higher, possibly reflecting an idealized view of their empathetic capabilities that does not always align with patient feedback.

We also observed that specialties demanding greater patient interaction and communication scored higher on empathy compared to more technique-focused specialties. This suggests that the nature of the specialty has an influence on the practice and perception of empathy, with specialties that prioritize patient communication and relational skills inherently fostering higher empathy.

This study highlights the importance of continuous training and self-reflection to bridge the gap between physicians' self-assessments and patient perceptions of empathy. Setting up regular feedback systems and improving communication skills training can aid physicians in better understanding and addressing patient expectations, thereby enhancing patient satisfaction and care outcomes. Future research should evaluate the factors behind the discrepancies and propose interventions aimed at aligning physicians' self-perceptions with patient assessment to promote a more empathetic healthcare environment

Funding – Not applicable
Conflicts of interest/competing interests – The authors declare no conflicts of interest.
Ethics approval – Approval was obtained from the institutional human ethics committee (IHEC Project 23/266) and consent was taken from all the participants.
Data availability statement - The authors confirm that all data generated or analysed during this study are included in the article.
Study conception and design was by Eliz Thomas. Shwetha Shenod and Bhavana Madhu conceived initial ideas for the article, were involved in data collection and prepared the first draft. All authors commented on and edited additional iterations of the first draft, and contributed written material. All authors are in agreement to the final product prepared for submission.

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No competing interests reported.

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You are reading this latest preprint version

Empathy in Practice: Comparing Physicians’ Self-assessment and Patient Perceptions Using the Jefferson Scales

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Version 1

Abstract

Background

Methods

Results

Discussion

Figures

INTRODUCTION

MATERIALS AND METHODS

The Jefferson Scale of Empathy

RESULT

DISCUSSION

CONCLUSION

Declarations

References

Additional Declarations

Status:

Version 1