Empathy in clinical practice: how individual dispositions, gender, and experience moderate empathic concern, burnout, and emotional distress in physicians

Abstract

To better understand clinical empathy and what factors can undermine its experience and outcome in care-giving settings, a large-scale study was conducted with 7,584 board certified practicing physicians. Online validated instruments assessing different aspects of empathy, distress, burnout, altruistic behavior, emotional awareness, and well-being were used. Compassion satisfaction was strongly associated with empathic concern, perspective taking and altruism, while compassion fatigue (burnout and secondary traumatic stress) was more closely related to personal distress and alexithymia. Gender had a highly selective effect on empathic concern, with women displaying higher values, which led to a wide array of negative and devalued feelings. Years of experience did not influence dispositional measures per se after controlling for the effect of age and gender. Participants who experienced compassion fatigue with little to no compassion satisfaction showed the highest scores on personal distress and alexithymia as well as the strongest indicators of compassion fatigue. Physicians who have difficulty regulating their negative arousal and describing and identifying emotions seem to be more prone to emotional exhaustion, detachment, and a low sense of accomplishment. On the contrary, the ability to engage in self-other awareness and regulate one's emotions and the tendency to help others, seem to contribute to the sense of compassion that comes from assisting patients in clinical practice.

Figure 1. Comparison of (A) empathy subscores, (B) professional quality of life subscores, and (C) work-related personal perceptions between male and female participants.

Error bars in A and B represent S. E. M.

Figure 2. Factor analysis on dispositional measures revealed two principal components.

Figure 3. Empathy subdomain scores for participants (A) in the low, average, and high groups across the different aspects of professional quality of life and (B) grouped based on their compassion satisfaction (CS) and compassion fatigue (CF) profiles.

Error bars are S. E. M.

Figure 4. Comparison of (A) professional quality of life and (B) empathy across physicians who had no alexithymia, borderline alexithymia and alexithymia, as determined by their scores on the TAS-20.

Figure 5. The top of the figure shows correlations between the tendency to favor indirect altruistic acts and the different aspects of professional quality of life.

Favoring indirect, abstract, helping behaviors was associated with higher scores of compassion satisfaction. The bar graphs compare scores on Compassion Satisfaction, Burnout, and Secondary Traumatic Stress between physicians who favor direct (ALT-D>ALT-I) and indirect (ALT-I>ALT-D) helping behaviors. Error bars are SEM. Grey dots/bars represent preferably direct helpers, while black bars represent preferably indirect helpers.

Figure 6. Summary findings from the present study highlighting the positive associations between individual dispositions and the positive and negative aspects of professional quality of life.

Values shown next to each arrow represent beta coefficients derived from simple linear regression analyses (i.e. each individual disposition’s effect on the corresponding ProQoL domain).