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The Relationship Between Physician Empathy and Disease Complications: An Empirical Study of Primary Care Physicians and Their Diabetic Patients in Parma, Italy

Canale, Stefano Del MD, PhD; Louis, Daniel Z. MS; Maio, Vittorio PharmD, MS, MSPH; Wang, Xiaohong MS; Rossi, Giuseppina MD; Hojat, Mohammadreza PhD; Gonnella, Joseph S. MD

doi: 10.1097/ACM.0b013e3182628fbf
Physician Empathy

Purpose: To test the hypothesis that scores of a validated measure of physician empathy are associated with clinical outcomes for patients with diabetes mellitus.

Method: This retrospective correlational study included 20,961 patients with type 1 or type 2 diabetes mellitus from a population of 284,298 adult patients in the Local Health Authority, Parma, Italy, enrolled with one of 242 primary care physicians for the entire year of 2009. Participating physicians’ Jefferson Scale of Empathy scores were compared with occurrence of acute metabolic complications (hyperosmolar state, diabetic ketoacidosis, coma) in diabetes patients hospitalized in 2009.

Results: Patients of physicians with high empathy scores, compared with patients of physicians with moderate and low empathy scores, had a significantly lower rate of acute metabolic complications (4.0, 7.1, and 6.5 per 1,000 patients, respectively, P < .05). Logistic regression analysis showed physicians’ empathy scores were associated with acute metabolic complications: odds ratio (OR) = 0.59 (95% confidence interval [CI], 0.37–0.95, contrasting physicians with high and low empathy scores). Patients’ age (≥69 years) also contributed to the prediction of acute metabolic complications: OR = 1.7 (95% CI, 1.2–1.4). Physicians’ gender and age, patients’ gender, type of practice (solo, association), geographical location of practice (mountain, hills, plain), and length of time the patient had been enrolled with the physician were not associated with acute metabolic complications.

Conclusions: These results suggest that physician empathy is significantly associated with clinical outcome for patients with diabetes mellitus and should be considered an important component of clinical competence.

Dr. Del Canale is research coordinator, Local Health Authority of Parma, Emilia-Romagna, Italy, and primary care physician and coordinator of a primary care team, Local Health Authority of Parma, Emilia-Romagna, Italy.

Mr. Louis is managing director, Center for Research in Medical Education and Health Care, and research associate professor, Department of Family and Community Medicine, Jefferson Medical College, Philadelphia, Pennsylvania.

Dr. Maio is associate professor of population health, School of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania.

Ms. Wang was research programmer/analyst, Center for Research in Medical Education and Health Care, Jefferson Medical College, Philadelphia, Pennsylvania at the time of this study.

Dr. Rossi is head, Department of Development and Integration of Primary Care Services, Local Health Authority of Parma, Emilia-Romagna, Italy.

Dr. Hojat is research professor of psychiatry and human behavior, Department of Psychiatry and Human Behavior, and director, Jefferson Longitudinal Study for Medical Education, Center for Research in Medical Education and Health Care, Jefferson Medical College, Philadelphia, Pennsylvania.

Dr. Gonnella is dean emeritus, distinguished professor of medicine, and founder and director, Center for Research in Medical Education and Health Care, Jefferson Medical College, Philadelphia, Pennsylvania.

Correspondence should be addressed to Mr. Louis, Center for Research in Medical Education and Health Care, Jefferson Medical College, 1025 Walnut St., Suite 119, Philadelphia, PA 19107; e-mail: Daniel.Louis@Jefferson.edu.

© 2012 by the Association of American Medical Colleges