In response to the insightful cover story, "'A potent medicine': In matters of pain and trust, empathy may make all the difference," published in the Healio Rheumatology January 2025 issue, I would like to highlight the key data on empathy.
First, research over the past 25 years has shown that both the cognitive and affective empathy of most allopathic and osteopathic students declines as they progress through their undergraduate medical education, with declines on the osteopathic side less pronounced than those seen among allopathic students.
This erosion of empathy can negatively impact the bond of trust between physician and patient. Even though medical schools know this erosion occurs, little has been done to teach students effective cognitive empathic communication skills, while helping them understand how to blunt an excessive affective empathic response to an emotionally charged patient encounter.
Part of the decline in medical student communication skills can be attributed to the use of smartphones, where texting and social media sites replace face-to-face human contact. For example, as a standardized patient I have seen firsthand the inability of most medical students to express cognitive empathy during an observed structured clinical examination.
In many of the standardized cases, there is a family member, usually a parent, who has died. When the students hear this during the patient history portion of the encounter, almost every one of them gives the concrete, memorized answer of "I'm sorry to hear that," with many of the students not even making eye contact as they write their chart notes.
As the patient, I do not feel their sincerity that I lost a parent. Thus, they are not making an empathic connection with me. Instead, I feel they are expressing sympathy, which patients infer as pity vs. a cognitive empathic response. In my notes back to the students, I indicate that their "pat" empathic answers are not going to be sufficient to form a bond of trust or comfort their patients.
Fortunately, the ability to adequately express cognitive empathy can be taught, whereas learning to not over-blunt an affective empathic response, and thus be misconstrued by patients as callous and uncaring, may be a more difficult endeavor.
Therefore, it behooves all medical schools to increase their efforts to inform and teach students about the importance of building an empathic bond of trust with their patients. This is especially true of new medical schools that are building their curriculum, where the administration can devote enough time to the empathic aspect of communication skills in the didactic and clinical portions of training.
In addition, faculty need to make sure that the hidden curriculum does not undermine the student's understanding that the humanistic portion of their training is just as important as the basic sciences. It is especially critical that physicians need to be empathic, positive role models the students can emulate when dealing with patients. Hopefully, the upcoming generation of physicians will have the opportunity to learn the importance of being truly empathetic when dealing with patient illnesses.
Campbell University Jerry M. Walace School of Osteopathic Medicine