Empathy in the Physician-Patient Relationship: Definition, Trainability and Ethical Challenges

Sammanfattning

The aim of this study was to examine (1) how clinical empathy is defined and conceptualised in the medical literature, (2) what evidence supports clinical empathy as a trainable clinical competence, and (3) whether the development of clinical empathy is associated with an increased risk of ethical stress for physicians. A hermeneutic literature review was conducted, drawing on peer-reviewed empirical studies and relevant professional debate articles. Searches were performed in PubMed, PsycInfo, and Web of Science, complemented by targeted hand searches in Läkartidningen. The findings highlight diverse definitions of clinical empathy, with some authors emphasising affective engagement and others viewing it as a predominantly cognitive capacity involving perspective-taking, communication, and an intention to help. This lack of consensus complicates education and assessment. Evidence suggests that clinical empathy can be trained, especially as a cognitive skill, but sustained effects appear to require ongoing reinforcement. While affective engagement may support the recognition and interpretation of patients’ emotional states, excessive affective involvement may increase vulnerability to emotional exhaustion and ethical stress, whereas cognitive empathy is generally associated with lower vulnerability to such outcomes. The unclear distinction between cognitive and affective empathy makes it difficult to fully address the consequences of either. In conclusion, clinical empathy remains essential yet conceptually unclear. A predominantly cognitive definition appears more teachable, sustainable, and compatible with clinical practice, while the affective component may contribute to the understanding and appropriate expression of empathy in the physician-patient encounter. Clarifying professional standards for clinical empathy is therefore important to support both patient care and physician wellbeing.