Open Access Open Access  Restricted Access Subscription Access

Building empathy among the people of an Emergency Department: Staff and patients, a two-way interaction

Matt Luther, Fergus Gardiner, Bernadette Brady


Background: The sharing of a story, related to a co-worker or patient, is believed to lead to an increased personalisation of the empathy message. Previous clinical interventions aimed at improving empathy, primarily considered one stakeholder and were often patient-centric.

Objective: The aim of this study was to test whether an intervention consisting of audio clips concerning the experiences of the people of an Emergency Department, can lead to increases in measured empathy.

Methods: To promote a multidisciplinary approach, the researchers included patients (including their significant others) and clinical staff in the study design. The researchers recorded interviews focusing on the participants lived experience within the Emergency Department (ED).The audio recordings aimed to capture the perspective of: working in the ED (including the multidisciplinary team), being a patient in the ED and being a significant other in the ED (the people of an Emergency Department). This design enabled sharing of the lived experience of the participants, thus encouraging empathetic feelings bilaterally, between the patient and clinician.

Results: Participants indicated that after listening to a story, 93.2% (n=55) felt they had a better understanding of the situation experienced by emergency department staff, patients or their visitors/significant others. Furthermore, 88.3% (n=53) of participants indicated that their empathy towards the people of the ED increased. Participants were asked to indicate their ability to empathise before listening to a recording, with a resulting weighted average of 3.25/5. This was then compared to their weighted average result, following listening to an audio recording of 4.17/5. Overall, the participant results were highly significant t(6.1174)=0.0001, p=<0.001.

Conclusion: Audio recordings, demonstrating patient and healthcare clinician experiences, from a 360° perspective, are an effective way to share the familiarities of the people of an ED, promoting an ability in the listener to ‘walk in another’s shoes’.


Clinical communication, communication, compassion, detachment, emergency care, empathy, humanities, measurement, person-centered healthcare, sympathy

Full Text:



Buie, D.H. (1981). Empathy: its nature and limitations. Journal of the American Psychoanalytic Association 29 (2) 281-307.

Bratek, A., Bulska, W., Bonk, M., Seweryn, M. & Krysta, K. (2015). Empathy among physicians, medical students and candidates. Psychiatria Danubina 27 (1) 48-52.

Kelm, Z., Womer, J., Walter, J.K. Feudtner, C. (2014). Interventions to cultivate physician empathy: a systematic review. BMC Medical Education 14, 1-11.

Blumgart, H. (1964). Caring for the patient. New England Journal of Medicine 270, 449-456.

Aring, C. (1958). Sympathy and empathy. Journal of the American Medical Association 167, 448-452.

Zinn, W. (1993). The empathic physician. Archives of Internal Medicine 153 (3) 306-312.

Halpern, J. (2003). What is clinical empathy? Journal of General Internal Medicine 18 (8) 670-674.

Derksen, F., Bensing, J. & Lagro-Janssen, A. (2013). Effectiveness of empathy in general practice: a systematic review. British Journal of General Practice 63, e76-e84.

Bertakis, K.D., Roter, D. & Putnam, S.M. (1991). The relationship of physician medical interview style to patient satisfaction. Family Practice 32, 175-181.

Epstein, R.M., Hadee, T., Carroll, J., Meldrum, S.C., Lardner, J. & Shields, C.G. (2007). “Could this be something serious?” Reassurance, uncertainty, and empathy in response to patients’ expressions of worry. Journal of General Internal Medicine 22, 1731-1739.

Hojat, M., Louis, D.Z., Maxwell, K., Markham, F.W., Wender, R.C. & Gonnella, J.S. (2011). A brief instrument to measure patients’ overall satisfaction with primary care physicians. Family Medicine 43 (6) 412-417.

Kim, S.S., Kaplowitz, S. & Johnston, M.V. (2004). The effects of physician empathy on patient satisfaction and compliance. Evaluation & the Health Professions 27, 237-251.

Pollack, K.I., Alexander, S.C., Tulsky, J.A., Lyna, P., Coffman, C.J., Dolor, R.J., Gulbrandsen, P. & Ostbye, T. (2011). Physician empathy and listening: associations with patient satisfaction and autonomy. Journal of the American Board of Family Medicine 24 (6) 665-672.

Zachariae, R., Pedersen, C.G., Jensen, A.B., Ehrnrooth, E., Rossen, P.B. & von der Maase, H. (2003). Association of perceived physician communication style with patient satisfaction, distress, cancer-related self-efficacy, and perceived control over the disease. British Journal of Cancer 88 (5) 658-665.

Stewart, M.A. (1984). What is a successful doctor-patient interview? A study of interactions and outcomes. Social Science & Medicine 19, 167-175.

Squier, R.W. (1990). A model of empathic understanding and adherence to treatment regimens in practitioner-patient relationships. Social Science & Medicine 30, 325-339.

Zolnierek, K.B. (2009). Physician communication and patient adherence to treatment: a meta-analysis. Medical Care 47, 826-834.

Attar, H.S. & Chandramani, S. (2012). Impact of physician empathy on migraine disability and migraineur compliance. Annals of the Indian Academy of Neurology 15, S89-S94.

Hojat, M., Louis ,D.Z., Markham, F.W., Wender, R., Rabinowitz, C. & Gonnella, J.S. (2011). Physicians' empathy and clinical outcomes for diabetic patients. Academic Medicine 86 (3) 359-364.

Lobchuk, M.M., Bokhari, S.A. (2008). Linkages among empathic behaviors, physical symptoms, and psychological distress in patients with ovarian cancer: a pilot study. Oncology Nursing Forum 35, 808-814.

Rakel, D.P., Hoeft, T.J., Barrett, B.P., Chewning, B.A., Craig, B.M. & Niu, M. (2009). Practitioner empathy and the duration of the common cold. Family Medicine 41 (7) 494-501.

Rakel, D., Barrett, B., Zhang, Z., Hoeft, T., Chewning, B., Marchand, L. & Scheder, J. (2011). Perceptions of empathy in the therapeutic encounter: Effects on the common cold. Patient Education and Counseling 85 (3) 390-397.

Thomas, M.R., Dyrbye, L.N., Huntington, J.L., Lawson, K.L., Novotny, P.J., Sloan, J.A. & Shamnafelt, T.D. (2007). How do distress and well-being relate to medical student empathy? A multicenter study. Journal of General Internal Medicine 22 (2) 177-183.

DiLalla, L.F., Hull, S.K. & Dorsey, J.K. (2004). Effect of gender, age, and relevant course work on attitudes toward empathy, patient spirituality, and physician wellness. Teaching and Learning in Medicine 16, 165-170.

Shanafelt, T.D., West, C., Zhao, X., Novotny, P., Kolars, J., Habermann, T. & Sloan, J. (2005). Relationship between increased personal well-being and enhanced empathy among internal medicine residents. Journal of General Internal Medicine 20 (7) 559-564.

Hojat, M., Gonnella, J.S., Nasca, T.J., Mangione, S., Veloski, J.J. & Magee, M. (2002). The Jefferson Scale of Physician Empathy: Further Psychometric Data and Differences by Gender and Specialty at Item Level. Academic Medicine 77 (10) S58-S60.

Beckman, H.B., Markakis, K.M., Suchman, A.L. & Frankel, R.M. (1994). The doctor-patient relationship and malpractice. Lessons from plaintiff depositions. Archives of Internal Medicine 154 (12) 1365-1370.

Levinson, W., Roter, D.L., Mullooly, J.P., Dull, V.T. & Frankel, R.M. (1997). Physician-patient communication. The relationship with malpractice claims among primary care physicians and surgeons. Journal of the American Medical Association 277 (7) 553-559.

Epstein, R.M., Franks, P., Shields, C.G., Meldrum, S.C., Miller, K.N., Campbell, T.L. & Fiscella, K. (2005). Patient-centered communication and diagnostic testing. Annals of Family Medicine 3 (5) 415-421.

Pollak, K.I., Arnold, R.M., Jeffreys, A.S., Alexander, S.C., Olsen, M.K., Abernethy, A.P., Sugg Skinner, C., Rodriquez, K.L. & Tulsky, J.A. (2007). Oncologist communication about emotion during visits with patients with advanced cancer. Journal of Clinical Oncology 25 (36) 5748-5752.

Easter, D.W. & Beach, W. (2004). Competent patient care is dependent upon attending to empathic opportunities presented during interview sessions. Journal of Current Surgery 61, 313-318.

Morse, D.S., Edwardsen, E.A. & Gordon, H.S. (2008). Missed opportunities for interval empathy in lung cancer communication. Archives of Internal Medicine 168, 1853-1858.

Neumann, M., Edelhäuser, F., Tauschel, D., Fischer, M.R., Wirtz, M., Woopen, C., Haramati, A. & Scheffer, C. (2011). Empathy decline and its reasons: a systematic review of studies with medical students and residents. Academic Medicine 86 (8) 996-1009.

Tulsky, J.A., Arnold, R.M., Alexander, S.C., Olsen, M.K., Jeffreys, A.S., Rodriquez, K.L., Skinner, C.S., Farrell, D., Abernethy, A.P. & Pollak, K.I. (2011). Enhancing communication between oncologists and patients with a computer-based training program: a randomized trial. Annals of Internal Medicine 155 (9) 593-601.

Winefield, H.R. & Chur-Hansen, A. (2000). Evaluating the outcome of communication skill teaching for entry-level medical students: does knowledge of empathy increase? Medical Education 34, 90-94.

Chunharas, A., Hetrakul, P., Boonyobol, R., Udomkitti, T., Tassanapitikul. T. & Wattanasirichaigoon, D. (2013). Medical students themselves as surrogate patients increased satisfaction, confidence, and performance in practicing injection skill. Medical Teacher 35 (4) 308-313.

Shapiro, J., Rucker, L., Boker, J. & Lie, D. (2006). Point-of-view writing: A method for increasing medical students’ empathy, identification and expression of emotion, and insight. Education for Health 19 (1) 96-105.

Office of Patient Experience: Cleveland Clinic; 2016 Available from: Last accessed: 03 May 2016.

Kerasidou, A. & Horn, R. (2016). Making space for empathy: supporting doctors in the emotional labour of clinical care. BMC Medical Ethics 17 (8) 1-5.

Maslach, C. (2003). Burnout: the cost of caring. Los Altos, CA: Malor Books.

Martin, E.J., Mazzola, N.M., Brandano, J., Luff, D., Zurakowski, D. & Meyer, E.C. (2015). Clinicians' recognition and management of emotions during difficult healthcare conversations. Patient Education and Counseling 98 (10) 1248-1254.

Halpern, J. (2001). From detached concern to empathy: humanizing medical practice. Cary, NC: Oxford University Press.



  • There are currently no refbacks.