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Commentary: The Practice of Empathy

Spiro, Howard MD

doi: 10.1097/ACM.0b013e3181b18934

In response to the articles in this issue about measuring physician empathy by Hojat and colleagues, Di Lillo and colleagues, and Kataoka and colleagues, this commentary further explores the concept of empathy. It is posited that empathy is an emotion important to medical care, but it is emphasized that it really doesn’t matter whether empathy is a thought or an emotion. Retaining or enhancing it in medical care givers is worth doing and may be achieved through (1) the selection of medical students and others who will care for the sick, (2) the training caretakers receive, and more fundamentally even, (3) reconsideration of what doctors do in a world so much changed and so diverse.

Empathy is the foundation of patient care, and it should frame the skills of the profession. It may be that empathy can be taught by example, but the minds of students, like soil, must be prepared before they can nourish seeds of knowledge, and in some soils little grows. Physicians must have the time to listen to their patients. Listening can create empathy—if physicians remain open to be moved by the stories they hear. Empathy has always been and will always be among a physician’s most essential tools of practice.

Dr. Spiro is Emeritus Professor of Medicine, Yale Medical School, New Haven, Connecticut.

Correspondence should be addressed to Dr. Spiro, 393 Temple St., New Haven, CT 06511; e-mail: (

Editor’s Note: This is a commentary on Hojat M, Vergare MJ, Maxwell K, et al. The devil is in the third year: A longitudinal study of erosion in empathy in medical school. Acad Med. 2009;84:1182–1191; Kataoka HU, Koide N, Ochi K, Hojat M, Gonnella JS. Measurement of empathy among Japanese medical students: Psychometrics and score differences by gender and level of medical education. Acad Med. 2009;84:1192–1197; and Di Lillo M, Cicchetti A, Lo Scalzo A, Taroni F, Hojat M. The Jefferson Scale of Physician Empathy: Preliminary psychometrics and group comparisons in Italian physicians. Acad Med. 2009;84:1198–1202.

© 2009 Association of American Medical Colleges