Empathy in MediCINE

Anwar Jusuf
Departemen Pendidikan Kedokteran FKUI
 Mantan Ketua Konsil Kedokteran Indonesia:
“jadilah dokter yang disayangi pasien”
 Medical professionals
should present Davies H, Joshi H, Holsgrove G and Rowley D (Eds): Developing

and maintaining an assessment system –a PMETB guide to good practice, 2007.

Medical knowledge and skills

Psychosocial & humanistic qualities,
such as:
caring
empathy
Social responsibility
Humility and compassion
Sensitivity to people’s culture & belief
A father’s joy
Empathy in hospital service system
“ To put your feet in other’s shoes”
Which face shows empathy/sympathy?
Mercer&Reynolds’widely accepted definition of
physician empathy
Neumann,M PhD, Edelhäuser F, Tauschel D, Fischer MR, Wirtz M, PhD, Woopen C Haramati A, Scheffer : Empathy Decline and
Its Reasons: A Systematic Review of Studies With Medical Students and Residents 996 Academic Medicine, Vol. 86, No. 8 /
August 2011 996-1009

Physician empathy is the ability Empathy is the ability of a

of a physician to person to
 “(a) understand the patient’s  “(a) understand other
situation, perspective and person’s situation, perspective
feelings (and their attached and feelings (and their
meanings), attached meanings),
 (b) communicate that  (b) communicate that
understanding and check its understanding and check its
accuracy and accuracy and
• (c) act on that understanding • (c) act on that understanding
with the patient in a helpful with the person in a helpful
(therapeutic) way.” (therapeutic) way.”
 4 qualities of empathy
• Perspective taking, the ability to take other
person’s perspectives
• Stay out of judgment
• Recognizing the emotion of other people
• Communicating
 2 components of empathy
Riess H, Kraft-Todd G. E.M.P.A.T.H.Y.: a tool to enhance nonverbal communication between clinicians and
their patients. Academic medicine : journal of the Association of American Medical Colleges. 2014
Aug;89(8):1108-12. PubMed PMID: 24826853.

• Cognitive component
pemahaman persepsi orang lain secara rasional dan
kontekstual, sehingga pemahaman ini dapat digunakan untuk secara hati-
hati memilih respons yang menunjukkan perilaku yang empatik. Aspek
kognitif, kemampuan untuk mengerti apa yang sedang orang lain rasakan,
bersifat terpisah dari aspek afektif.(7)

• Afective component
berhubungan dengan emosi, dalam hal ini termasuk
simpati dan penularan perasaan emosional. Kelebihan aspek
afektif, yang dapat dialami oleh seorang calon dokter yang
kurang terlatih, dapat menyebabkan timbulnya stres.
PROSES EMPATI SECARA NEUROBIOLOGIS
Penelitian neurologis pertama terfokus pada mirror neuron, yaitu sekelompok
neuron yang terspesialisasi, menghubungan neuron pada korteks premotorik
dengan korteks parietalis inferior.
korteks cingulata bagian dorsal dan
Penelitian lanjutan membuktikan bahwa
genual terlihat meningkat aktifitasnya pada proses afektif dan bioregulatory,
berperan dalam respons simpatetik yang diperlukan untuk menimbulkan kondisi
fisiologis tertentu yang sesuai dengan tuntutan emosional. Pemeriksaan MRI
fungsional menunjukkan area nyeri tereksitasi seluruhnya saat kita
mengalami nyeri, dan tereksitasi sebagian saat kita melihat orang lain
mengalami nyeri, hal ini menunjukkan bahwa secara neuroanatomis kita
dapat merasakan nyeri orang lain dalam skala tertentu. Kemampuan
kita merasakan nyeri orang lain menimbulkan respons empati. Namun
besarnya atenuasi perasaan tersebut harus dibatasi sehingga tidak berlebihan dan
menimbulkan stres emosional.
 Communicating with empathy
• I and Thou theory • Rapport: introducing
ourselves, accepting the the
• Equality: among
person we are
humans, no such thing communicating with
as social “ranks”, • “Tuning in” with the person
gender, etc we are communicating
• Eye contact
• Active listening
• Responding
• Reflection:
 The importance of empathy
Empathic behavior may lead to
• patients’ reporting more about their symptoms and concerns, 7–11
• physicians’ increased diagnostic accuracy,9,10,12,13
• patients’ receiving more illness-specific information, 14–16
• patients’ increased participation and education 6,16,17
• patients’ increased compliance and satisfaction , 16,18–20
• patients’ greater enablement,17,21–23 and
• patients’ reduced emotional distress and increased QOL 15

• Neumann,M PhD, Edelhäuser F, Tauschel D, Fischer MR, Wirtz M, PhD, Woopen C Haramati A,
Scheffer : Empathy Decline and Its Reasons: A Systematic Review of Studies With Medical
Students and Residents 996 Academic Medicine, Vol. 86, No. 8 / August 2011 996-1009
 Sympathy and empathy
• Empathy, feeling inside the other, is often
taken as synonymous or nearly synonymous
with the attitude of sympathy, compassion,
benevolence and care.
• Sympathy involves one’s emotion, meaning that
we involve our own emotion in sharing the
emotion of the people we are symphatizing.
• The result of the two situation maybe completely
different.
• There is also a second, derived, meaning of
sympathy that should be even more clearly
distinguished from empathy: sympathy as a
positive, warm feeling for another person.
• Understanding, even fully understanding the
feelings of another, does not necessarily imply
liking this person or these feelings.
Understanding does not imply approving.
Sympathizing does.
Nightingale SD, Yarnold PR, Greenberg MS: Sympathy, empathy,
and physician resource utilization. J Gen Intern Med 1991;
6:420–423

• Empathetic physicians share

the understanding with patients,
sympathetic physicians share their emotions
with their patients (9).
• The two concepts do not, however, function
independently.
• Empathy leads to a professional solution
• Sympathy may lead to an emotional involvement
Gambar 1. Skala EM Hogan
Gambar 2. Skala CARE
Nightingale SD, Yarnold PR, Greenberg MS: Sympathy, empathy,
and physician resource utilization. J Gen Intern Med 1991;
6:420–423

• Empathetic physicians share

the understanding with patients,
sympathetic physicians share their emotions
with their patients (9).
• The two concepts do not, however, function
independently.
• Empathy leads to a professional solution
• Sympathy may lead to an emotional involvement
 INTERVENSI UNTUK
MENINGKATKAN EMPATI
1. Pelatihan wawancara pasien
2. Pelatihan keterampilan komunikasi dan
interpersonal
3. Ekspos seni
4. Bermain drama atau Role Play
5. Memasukkan unsur keterampilan empati dan
komunikasi dalam Problem-Based Learning (PBL)
6. Manajemen stres
 Conclusion
• Empathy is the ability of a person to understand the
perspectives (way of feeling, thingking, emotion) of
other people regardless of age, gender, position in
society
• Empathy in communication enhances the change of
information between people and good relation
• In medical profession, empathy makes better
doctor –patient relation, more complete information,
better compliance of the patients, better diagnosis ,
thus leading to more professional solution to the
patient’s problems.