Health professionals should show more empathy - essential to healing relationships

Business scholars for more than 20 years have explored the concept of 'emotional labor,' or the management of emotions to present a certain image in service workers. Now, researchers from the University of Washington Business School and Group Health Cooperative 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 Dr. Eric B. Larson, director of Group Health's 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 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 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 healers. They also believe doctors have greater professional satisfaction and less professional burnout when they practice deep acting, but 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.

"We suggested viewing physician empathy as emotional labor and how doctors can achieve empathy through acting," said Yao, who did the work for her doctoral dissertation. "Thus, by learning about and consciously engaging oneself in deep acting and surface acting, physicians can be more prepared to meet patients' needs."

The authors say doctors need 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," they 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 healthcare 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."