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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
Abstract
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.
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“Empathy skills of healthcare providers have been shown to positively influence patient outcomes.38”
From Artificial intelligence: opportunities and implications for the health workforce (2020) · cites this paper as [38]
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“The use of the JSE as indicator of this professional ability to predict clinical and patient outcomes in adult patients with diabetes was proved in two studies (Hojat et al., 2011b; Del Canale et al., 2012).”
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“Studies have evidenced that empathic engagement in patient care leads to improved patient satisfaction and clinical outcomes (Kim et al., 2004; Hojat et al., 2011; Del Canale et al., 2012).”
Does empathy change during undergraduate medical education? – A meta-analysis*
Spatoula, V., Panagopoulou, E. P., & Montgomery, A. (2019) · Medical Teacher · doi:10.1080/0142159x.2019.1584275 · Cited by 58
“High levels of empathy in nursing and medical practice have been associated with enhanced diagnostic accuracy, and favorable patient outcomes, such as reduced psychological stress, and fewer complication rates (Beckman and Frankel 1984; ReesLewis 1994; Hojat et al. 2011; Del Canale et al. 2012).”
BackgroundMilanese, G., Silva, M., Bruno, L., Goldoni, M., Benedetti, G., Rossi, E., Ferrari, C., Grutta, L. L., Maffei, E., Toia, P., et al. (2019) · Diagnostic and Interventional Radiology · doi:10.5152/dir.2018.18037 · Cited by 57
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Assessment of Burnout and its Factors Among Doctors Using the Abbreviated Maslach Burnout Inventory
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Stansfield, R. B., Schwartz, A., O’Brien, C. L., Dekhtyar, M., Dunham, L. N., & Quirk, M. E. (2015) · Advances in Health Sciences Education · doi:10.1007/s10459-015-9605-1 · Cited by 52
“Self-reported clinical empathy is gaining interest because of findings that closely and positively associate it with medical outcomes (Del Canale et al. 2012; Hojat et al. 2011).”
BackgroundMethodYang, N., Xiao, H., Wang, W., Li, S., Yan, H., & Wang, Y. (2018) · Patient Preference and Adherence · doi:10.2147/ppa.s166460 · Cited by 53
Burnout Status of Italian Healthcare Workers during the First COVID-19 Pandemic Peak Period
Conti, C. M., Fontanesi, L., Lanzara, R., Rosa, I., Doyle, R., & Porcelli, P. (2021) · Healthcare · doi:10.3390/healthcare9050510 · Cited by 61
Student empathy levels across 12 medical and health professions: an interventional study
Williams, B. A., Brown, T., McKenna, L., Palermo, C. E., Morgan, P. E., Nestel, D., Brightwell, R. F., Gilbert‐Hunt, S., Stagnitti, K. E., Olaussen, A., et al. (2015) · Journal of Compassionate Health Care · doi:10.1186/s40639-015-0013-4 · Cited by 52
“Del Canale S, Louis DZ, Maio V, Wang X, Rossi G, Hojat M, et al. The relationship between physician empathy and disease complications: an empirical study of primary care physicians and their diabetic patients in Parma, Italy.”
InfluentialModi, A., Fascelli, M., Daitch, Z. E., & Hojat, M. (2016) · Journal of Primary Care & Community Health · doi:10.1177/2150131916685199 · Cited by 52
Will Artificial Intelligence Replace the Human Echocardiographer?: Clinical Considerations
Sengupta, P. P., & Adjeroh, D. A. (2018) · Circulation · doi:10.1161/circulationaha.118.037095 · Cited by 50
Yang, C., Zhu, Y.-L., Xia, B.-Y., Li, Y.-W., & Zhang, J. (2019) · Nurse Education Today · doi:10.1016/j.nedt.2019.104296 · Cited by 57
Balint groups and narrative medicine compared to a control condition in promoting students’ empathy
Lemogne, C., du Vaure, C. B., Hoertel, N., Catu-Pinault, A., Limosin, F., Ghasarossian, C., Jeunne, C. L., & Jaury, P. (2020) · BMC Medical Education · doi:10.1186/s12909-020-02316-w · Cited by 50
Hojat, M., & Gonnella, J. S. (2016) · Academic Medicine · doi:10.1097/acm.0000000000001424 · Cited by 50
Association Between Empathy and Burnout Among Emergency Medicine Physicians
Wolfshohl, J. A., Bradley, K., Bell, C., Bell, S., Hodges, C., Knowles, H. C., Chaudhari, B. R., Kirby, R., Kline, J. A., & Wang, H. (2019) · Journal of Clinical Medicine Research · doi:10.14740/jocmr3878 · Cited by 49
Hoffstädt, H. E., Stouthard, J. M., Meijers, M. C., Westendorp, J., Henselmans, I., Spreeuwenberg, P. M. M., de Jong, P., van Dulmen, S., & van Vliet, L. M. (2020) · Palliative Medicine Reports · doi:10.1089/pmr.2020.0052 · Cited by 49
Kompetenzorientiert prüfen im Staatsexamen Medizin
Jünger, J. (2018) · Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz · doi:10.1007/s00103-017-2668-9 · Cited by 47
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“Empathy has likewise been shown to improve the therapeutic alliance and improve clinical outcomes on the side of the patient (Canale et al., 2012; Hojat, 2016; Hojat et al., 2011), as well as reduce professional stress and burnout on the side of the clinician (Thirioux et al., 2016).”
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“Numerous studies have found that better patient outcomes are associated with personcentered care, as well as greater provider empathy and patient–provider trust (Del Canale et al., 2012; Derksen, Bensing, & Lagro-Janssen, 2013; Farin, Gramm, & Schmidt, 2013; Hojat et al., 2011).”
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Psychosocial burden in medical students and specific prevention strategies
Bugaj, T., Cranz, A., Junne, F., Erschens, R., Herzog, W., & Nikendei, C. (2016) · Mental Health & Prevention · doi:10.1016/j.mhp.2015.12.003 · Cited by 47
Metadata
- Authors
- Canale, S. D., Louis, D. Z., Maio, V., Wang, X., Rossi, G., Hojat, M., & Gonnella, J. S.
- Affiliations
- Thomas Jefferson University (US)
- Corresponding author
- Louis, Daniel Z.
- Venue
- Academic Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2012-09
- Volume
- 87
- Issue
- 9
- Pages
- 1243-1249
- ISSN
- 1040-2446 (ISSN-L)
- OpenAlex
- W2114067207
- Cited by
- 512
- References
- 46
- Citations by year
- 2026: 9 · 2025: 31 · 2024: 33 · 2023: 38 · 2022: 44 · 2021: 53 · 2020: 46 · 2019: 51 · 2018: 45 · 2017: 34 · 2016: 47 · 2015: 25 · 2014: 31 · 2013: 21 · 2012: 1
- FWCI
- 17.76
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Academic Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Empathy and Medical Education
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Keywords
- physician empathy, diabetes mellitus, diabetic ketoacidosis, hyperosmolar hyperglycemic state, diabetic coma, Jefferson Scale of Physician Empathy, clinical outcomes, primary care physicians, elderly patients, clinical competence
- MeSH terms
- Age Factors, Aged, Diabetes Mellitus, Empathy, Female, Hospitalization, Humans, Italy, Male, Physician-Patient Relations, Retrospective Studies, Logistic Models, Diabetes Complications, Physicians, Primary Care
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