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244]

Original Article

Are Empathy and Emotional Intelligence Missing in Dental

Practitioner’s Toolkit in Saudi Arabia? A Cross‑Sectional Study
ST Gokhale, SM Al-Qahatani, RS Raj1, BS Al-Qahatani, SK Vaddamanu2, AA Jathmi, WA Alshehri, RR Nagati

Department of Periodontics Background: Empathy and emotional intelligence  (EI) of a dentist are two

Abstract
and Community Dental
Sciences, 1Pediatric
factors vital for developing fruitful relations between clinicians and patients.
Dentistry and Orthodontic Establishing a good relationship with patients may improve patients’ outcomes.
Sciences, College of Data on empathy and EI in dental practitioners in the Kingdom of Saudi
Dentistry, 2Department Arabia is scarce. Aims: Hence, we aimed to evaluate and compare empathy
of Dental Technology, and EI among dental practitioners in Abha and Khamis Mushayat cities of
College of Applied Saudi Arabia. Methods: We conducted a cross‑sectional survey study. A  total
Medical Science, King
Khalid University, Abha,
of 183 dental practitioners who were reachable at survey time were included.
Kingdom of Saudi Arabia A  self‑administered questionnaire on empathy and EI was structured based on
Jefferson Scale of Physician Empathy  (health professions version) and Schutte’s
Emotional Intelligence Scale, respectively. Statistical analysis was done using
Mann–Whitney and Kruskal–Wallis tests. Results: No significant difference
was observed between both genders regarding empathy and EI (P  =  0.73 and
0.97, respectively). Similarly, no significant difference was observed between
participants with different qualifications or different work settings  (P  >  0.05).
However, a statistically significant positive correlation was observed between
empathy and EI  (r  =  0.722). Conclusions: Irrespective of gender, qualification,
or different work settings, dental practitioners in both cities showed adequate
empathy and EI levels. Dentists with high empathy scores seem to show high EI
levels. Clinical Significance: Evaluating and monitoring empathy and EI practice
among dental practitioners have paramount importance to improve clinical practice
and healing potential of patients. Low levels of empathy and EI practice would
suggest modifications to training curriculum or healthcare policies.

Date of Acceptance: Keywords: Emotional intelligence, empathy, Jefferson scale of physician

31-May-2019 empathy, Schutte’s emotional intelligence scale

Introduction lacking, clinical empathy may improve treatment quality.

T he relationship between a dentist and a patient is
a core component of dental care. Empathy plays
a significant role in building a strong doctor–patient
relationship.[1] Indeed, clinicians who implement a warm,
friendly reassuring manner are more effective than
those who keep patient consultations strictly formal.[2]
Understanding patient’s complaint, previous experiences
with doctors, and previous diseases or symptoms, and
actually communicating this understanding efficiently
to patients are the primary components of clinical
empathy.[3] Although evidence of a direct relationship is
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Many patients view treatment quality in the eye of
empathy shown by the clinician.[4] According to current
evidence, empathy is missing in modern‑day health care
and this may include dental care.[5] Empathy is a higher
order emotion, and its degree differs between individuals.[1]
Address for correspondence: Dr. RR Nagati,
Department of Periodontics and Community Dental Sciences,
College of Dentistry, King Khalid University, Abha‑61471,
Saudi Arabia.
E‑mail: rnagati@kku.edu.sa
This is an open access journal, and articles are distributed under the terms of the
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For reprints contact: reprints@medknow.com

DOI: 10.4103/njcp.njcp_605_18
How to cite this article: Gokhale ST, Al-Qahatani SM, Raj RS, Al-Qahatani BS,
Vaddamanu SK, Jathmi AA, et al. Are empathy and emotional intelligence
PMID: ******* missing in dental practitioner's toolkit in Saudi Arabia? A cross-sectional
study. Niger J Clin Pract 2019;22:1403-7.

© 2019 Nigerian Journal of Clinical Practice | Published by Wolters Kluwer ‑ Medknow 1403

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Gokhale, et al.: Empathy and emotional intelligence in dentists
Emotional intelligence (EI) is the ability to
perceive, connect, and manage others and your own
emotions.[6,7] Since some essential emotions play a
significant role at workplace among dentist, patients,
and hospital staff, EI should be incorporated in
dentist training from student level. EI is a conjectural
cognitive ability of a dentist and can be developed
with time.[8,9] Emotional intelligence may enhance
clinical practice. Since dentists commonly face
stress in several instances in their career, educational
institutions like dental schools are recognizing the
importance of developing students’ empathy and EI.
Providing adequate health care is the ultimate aim
of any health care professional, which requires hard
as well as soft skills. There has been tremendous
research done in the field of hard skills, while the soft
skills and their role are less explored.[10]
In this study, we focused on soft skills like empathy
and EI. Several studies assess empathy and EI among
nursing[5] and dental students[8,11‑20] in different parts
of the world. However, data regarding empathy and
EI practice in dental practitioners particularly in the
Kingdom of Saudi Arabia is scarce. Accordingly, we
aimed to evaluate empathy and EI in dental practitioners
in two major cities (Abha and Khamis Mushayat) in
the Kingdom of Saudi Arabia. Furthermore, we aim to
assess the relationship between empathy and EI with
gender, qualification, and work settings of a dental
practitioner.
Materials and Methods
We conducted a descriptive cross‑sectional observational
study. Prior ethical committee approval was obtained
from the institutional ethical committee board  (Ethical
committee number: SRC/ETH/2017‑18/078) of the
College of Dentistry, King Khalid University, Abha,
Kingdom of Saudi Arabia. The study was conducted
in Abha and Khamis Mushayat cities of Saudi Arabia
between September 1, 2018 and September 30, 2018.
Eligibility criteria included being an active dental
practitioner, reachable during questionnaire distribution,
and willing to participate in the survey. Included
participants were involved in clinical practice or
academic practice or both. Those who did not consent
or failed to complete the questionnaire were excluded.
A  list of teaching faculty and Saudi board postgraduate
students was obtained from College of Dentistry, King
Khalid University, Abha and a list of practitioners
in private practice was obtained from Saudi Health
Commission of Abha and Khamis Mushayat cities.
A specially designed questionnaire was prepared to
collect data, and printed in both Arabic and English
1404 Nigerian Journal of Clinical Practice  ¦  Volume 22  ¦  Issue 10  ¦  October 2019
languages. Participants were free to select their
convenient language. Preceding giving off questionnaires,
a brief explanation on study aims and confidentiality of
participants’ data was presented. The questionnaire had
a provision for recording the sociodemographic details
of participants which included the name  (optional), age,
gender, work settings [dental practitioners, academicians
both  (dental practitioners  +  academicians) postgraduate
students in dentistry], work experience  (number of
years), socioeconomic status  (annual income), phone
number, and e‑mail address.
We used the 20‑item Jefferson Scale of Physician
Empathy—Health Professions version  (JSP‑HP) and the
Schutte’s Emotional Intelligence Scale (SEIS,1998).[7,13,21]
The first part included questions regarding empathy
(20 questions) and the second included questions on
EI (33 questions). The questionnaire was adapted for use
by dentists by substituting the words “physician” and
“doctor” with “dentist” and “medical” with “dental”.
Questionnaire validity was tested by two preventive
and community health dentists, and corrections were
made according to their suggestions. Each item had a
five‑point Likert scale answer. For each question, five
represents the highest score and one represents the
lowest score. Total score for each participant ranged
from 20 to 100 for empathy and 33 to165 for EI. Higher
scores represent more empathetic and EI behavior of
participant.
Statistical analysis
Data was entered in SPSS version  17. Intergroup
comparisons were made using Mann–Whitney test and
Kruskal–Wallis tests. Correlation between empathy
and EI was estimated using Spearman’s rank‑order
correlation test. P value  <0.05 was considered
statistically significant.
Results
A total of 200 questionnaires were distributed and
collected back from the respondents making the
response rate of 100%. Fourteen questionnaires received
were incomplete and hence were excluded. Among the
186 responses, 154  (83%) were males and 32  (17%)
were females. There were no statistically significant
differences in mean Empathy and EI scores between
gender (P > 0.05) [Table 1].
According to educational levels of dentists, highest
response was obtained from those having Bachelor’s
degree  (113) followed by master’s degree  (54) and
postgraduate students  (19). There were no statistically
significant differences in mean Empathy and EI scores
among dentists with different educational qualifications
(P > 0.05) [Table 2].
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Gokhale, et al.: Empathy and emotional intelligence in dentists

Table 1: Comparison of empathy and emotional intelligence between both genders using the Mann–Whitney test
Gender n Mean Score Standard Deviation Z and P
Empathy Score Male 154 91.94 9.447 0.351; 0.726; NS
Female 32 92.50 9.466
Emotional Intelligence Score Male 154 151.03 15.896 0.034; 0.973; NS
Female 32 151.84 15.836
NS=Nonsignificant (P>0.05), N=Sample size

Table 2: Comparison of empathy and emotional intelligence based on qualification using the Kruskal–Wallis test
Qualification n Mean Score Standard Deviation H and P
Empathy Score Bachelor’s degree in dentistry 113 92.03 9.433 0.139; 0.933; NS
Master’s degree in dentistry 54 91.85 9.561
Saudi board postgraduate students in dentistry 19 92.63 9.488
Emotional Intelligence Bachelor’s degree in dentistry 113 151.18 15.891 0.099; 0.952; NS
Score Master’s degree in dentistry 54 150.83 15.974
Saudi board postgraduate students in dentistry 19 152.11 16.024
NS=Nonsignificant (P>0.05)

Table 3: Comparison of empathy and emotional intelligence based on work settings using the Kruskal–Wallis test
Work settings n Mean Score Standard Deviation H and P
Empathy Score In Dental Practitioners 113 92.03 9.433 0.139; 0.987; NS
In Academicians 46 91.76 9.594
Dental Practitioners + Academicians 8 92.38 9.999
Postgraduate Students in Dentistry 19 92.63 9.488
Emotional Intelligence Score In Dental Practitioners 113 151.18 15.891 0.503; 0.918; NS
In Academicians 46 150.61 16.027
Dental Practitioners + Academicians 8 152.13 16.686
Postgraduate Students in Dentistry 19 152.11 16.024
NS=Nonsignificant (P>0.05)

Table 4: Correlation between empathy and emotional
intelligence using Spearman’s rank‑order correlation
test
Mean Score Standard Deviation R and P
Empathy Score 92.04 9.427 0.722;
Emotional 151.17 15.846 <0.001**
Intelligence Score
**P<0.001 (statistically significant)
According to work settings, highest response was from
dentists in clinical practice  (113), followed by those in
academic practice  (46), postgraduate students  (19), and
those working in both clinical and academic practice  (8).
However, there were no statistically significant differences
in mean Empathy and Emotional Intelligence scores among
dentists with different work settings  (P  >  0.05) [Table  3].
Emotional intelligence was found to have a strong positive
correlation with empathy scores (r = 0.72) [Table 4].
Discussion
In this cross‑sectional study, we evaluated and
compared empathy and emotional intelligence among
all reachable dental practitioners in Abha and Khamis
Mushayat cities of Saudi Arabia. Our study included
those in clinical, academic, and both clinical and
academic practice as well as postgraduate students.
Unreachable practitioners were excluded from the study
as well as those who filled questionnaires inadequately.
Responders with higher scores seem to have better
empathy and EI practice.
The word “empathy” was firstly introduced in the
1980s when a German psychologist coined the term
“einfuhlung.”Although different definitions of empathy
were proposed, empathy broadly means appreciating the
emotions of others. Putting in mind our aim, we chose to
use health professional version  (HP) of Jefferson Scale
of Empathy  (JSPE) which was designed exclusively for
the assessment of clinical empathy.[17]
Emotional intelligence (EI), though a recent concept, is also
vital in upholding relations. According to Daniel Goleman,
who has several studies on EI, EI is more important and
powerful than intelligence quotient.[9] In this study, we
adopted the Schutte’s Emotional Intelligence Scale (SEIS)
to assess EI as it has appropriate psychometric properties
and consists of only 33 questions thus preventing
questionnaire fatigue.[22] Due to the complexity of day to
day practice in dentistry, empathy and EI are vital factors

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Gokhale, et al.: Empathy and emotional intelligence in dentists
to be considered in order to achieve favorable healing both
physically and mentally.[15,23,24]
Some recent studies by Diaz‑Narvaez et al., Aggarwal [12]
et al.,[16] Shah and Thingujam,[25] Rastegar et al.,[21]
and Di‑Lillo et al.[26] Showed there was no difference
between both genders among dental students in showing
empathy toward patients. Contrarily, previous studies
by Duarte et al.,[27] Sherman and Cramer,[17] Imran
et al.,[28] and Ciarrochi et al.,[29] showed that females
show empathy more than males. According to our study
results, neither males nor females were significantly
superior regarding empathy and EI.
Some researchers suggest empathy skills decline in
dental students along their graduate curriculum from
first to final year.[17] In a previous study by Anushka and
Nagesh,[30] there was a significant difference regarding
showing empathy between participants with different
qualifications. Conversely, there is no significant
difference observed in our current study in mean scores
of empathy or EI among participants with different work
setting practices and specialties. Also in contrary to the
previous study,[30] although not statistically significant,
postgraduate students showed relatively higher empathy
and EI scores in our study. Both studies suggest there
is no significant difference regarding empathy and
EI among participants with different occupations.[30]
Lack of studies evaluating empathy and EI in dental
practitioners based on type of practice hinders more
comparisons.
A statistically significant positive correlation was
observed between empathy and EI in the current study.
Also in previous studies by Anushka and Nagesh,[30]
Rastegar et al.,[21] and Faye et al.,[31] empathetic
practitioners showed more EI scores suggesting a
positive correlation between empathy and EI. Long‑term
patient satisfaction and doctor–patient relationship
depend on empathy and EI.[32] Based on our current
study results, it is evident that Saudi Arabia is trying to
train students to provide dental practitioners with equally
important both cognitive and soft skills.
Conclusion
According to current study results, empathy and
emotional intelligence seem adequate and unaltered
with gender, qualification/specialty of practice at
different work settings. Furthermore, there is a
positive correlation observed between empathy
and EI among dental practitioners in Abha and
Khamis Mushayat cities of the Kingdom of Saudi
Arabia. Further longitudinal observational studies
are recommended to observe changes in these two
practices over time.
1406 Nigerian Journal of Clinical Practice  ¦  Volume 22  ¦  Issue 10  ¦  October 2019
Acknowledgements
We would like to appreciate and acknowledge Dr. Vijay
Apparaju and Dr.  Shreyas Tikare for their constant
support in literature search.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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