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March 1, 2005

JAMA commentary: Empathy is part of the healing process

Seattle—Business scholars for more than 20 years have explored the concept of "emotional labor"—i.e., the management of emotions to present a certain image in service workers. Now, researchers from Group Health Cooperative and the University of Washington Business School have teamed up to explore how the concept can be applied to the medical profession.

"We propose that the emotional labor of physicians is characterized by the display of empathy," said Eric B. Larson, MD, MPH, director of Group Health Center for Health Studies and co-author of a commentary in the March 2 issue of the Journal of the American Medical Association.

"Empathy is essential to healing relationships, so it’s something all health professionals should be expected to show—even when it’s hard to do so."

Drawing from previous research that equates service workers’ labor to the work of stage actors, Larson and his co-author Xin Yao, a doctoral student in the UW Business School, describe a model for applying acting techniques to the delivery of empathy in doctor-patient interactions. They suggest that doctors can use two techniques separately or in combination—"deep acting," which uses imagination and emotional memories to generate genuine feelings of empathy for the patient, and "surface acting," in which the doctor forges emotional expressions inconsistent with internal feelings. This would allow the doctor to display behaviors the patient can interpret as empathic.

The authors contend that deep acting is preferred because it makes doctors more effective as healers. They also believe doctors have greater professional satisfaction and less professional burnout when they practice deep acting, but doctors may have to rely on surface acting when genuine empathy seems impossible. Surface acting may be needed, for example, in situations in which the doctor’s values or beliefs are entirely different from the patient’s.

The authors urge doctors to recognize that their work has an element of emotional labor and to consciously practice deep and surface acting to empathize with their patients. They also recommend long-term, regular training to help doctors develop empathy.

"This will be valuable for both physicians and patients facing the increasingly fragmented and technological world of modern medicine," the authors write.

"For patients, our message is that it’s reasonable to expect physicians to show empathy," said Larson. "It’s part of the physician’s job."

Larson also urged health care consumers to seek long-term, continuous relationships with physicians they like. "The better the physician knows you, the easier it is to develop an empathic, healing relationship."

About Group Health Center for Health Studies

Group Health Center for Health Studies conducts research related to prevention, diagnosis, and treatment of major health problems. Funded primarily through government and private research grants, the Center is located in Seattle, Washington. Group Health is a consumer-governed, nonprofit health care system that coordinates care and coverage. Based in Seattle, Group Health and Group Health Options, Inc. serve more than 540,000 members in Washington and Idaho.

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