To be or not to be empathic: the combined role of empathic concern and perspective taking in understanding burnout in general practice

Abstract

Background: General practice is stressful and burnout is common among family physicians. A growing body of evidence suggests that the way physicians relate to their patients could be linked to burnout. The goal of this study was to examine how patterns of empathy explained physicians' burnout.

Methods: We surveyed 294 French general practitioners (response rate 39%), measured burnout, empathic concern (EC) and perspective taking (PT) using self-reported questionnaires, and modeled burnout levels and frequencies with EC, PT and their interaction in linear and logistic regression analyses.

Results: Multivariate linear models for burnout prediction were associated with lower PT (β = -0.21, p < 0.001) and lower EC (β = -0.17, p < 0.05). Interestingly, the interaction (EC x PT) also predicted burnout levels (β = 0.11, p < 0.05). The investigation of interactions revealed that high scores on PT predicted lower levels of burnout independent from EC (odd ratios (OR) 0.37; 95% confidence interval (95% CI) 0.21-0.65 p < 0.001), and high scores on both EC and PT were protective against burnout: OR 0.31; 95% CI 0.15-0.63, p < 0.001).

Conclusions: Deficits in PT alone might be a risk factor for burnout, whereas higher PT and EC might be protective. Educators should take into account how the various components of empathy are potentially associated with emotional outcomes in physicians.

Figure 1

Perspective Taking, Empathic Concern and their Interaction as Predicting Burnout in 294 French General Practitioners (Odds Ratio Adjusted for Marital Status). We dichotomized Perspective Taking and Empathic Concern by the median; low Perspective Taking = score ≤ 53, high Perspective Taking = score > 53; low Empathic Concern = score ≤ 46 (n = 151), high Empathic Concern = score > 46 (n = 143). The odds for burnout were significantly lower in participants with high PT (OR 0.37, 95% CI 0.21–0.65, p < 0.001), high EC (OR 0.57, 95% CI 0.33–0.98), p < 0.05) and high on both PT and EC (OR 0.31, 95% CI 0.15–0.63, p < 0.001).

Figure 2

Interaction Between Perspective Taking and Empathic Concern to Explain Burnout Frequencies. PT = Perspective Taking; EC = Empathic Concern. Perspective Taking and Empathic Concern were dichotomized at the median. Low Perspective Taking = score ≤ 53, n = 153; High Perspective Taking = score > 53, n = 141; Low Empathic Concern = score ≤ 46, n = 151; High Empathic Concern = score < 46, n = 143. We divided the participants into four groups based on the distribution of their empathy scores: (1) low Empathic Concern–low Perspective Taking (n = 99), (2) low Empathic Concern–high Perspective Taking (n = 52), (3) high Empathic Concern–low Perspective Taking (n = 54) and (4) high Empathic Concern–high Perspective Taking (n = 89). Percentage of extreme burnout for low Empathic Concern–low Perspective Taking, low Empathic Concern–high Perspective Taking, high Empathic Concern–low Perspective Taking and high Empathic Concern–high Perspective Taking was 33%, 22%, 32% and 11% respectively.