Perspective Chapter: Having Heart – The Different Facets of Empathy

Abstract

This chapter discusses the history of the various definitions of empathy and states two widely accepted current definitions for affective and cognitive empathy. The neural basis of different or overlapping cortical regions used by affective or cognitive empathy as well as sympathy/compassion are summarized, with the ventromedial prefrontal cortex as a probable common denominator for these emotions. Longitudinal studies of allopathic and osteopathic medical students confirm that women have higher affective and cognitive empathy scores than men, via the use of the Balanced Emotional Empathy Scale (BEES) and the Jefferson Scale of Empathy (JSE), respectively. During undergraduate medical education, BEES and JSE scores drop after the completion of the first basic science year and after the first year of clinical rotations. Students with higher empathy scores tend to enter primary care residencies, whereas students with lower scores are more likely to enter technical or procedure-oriented specialties. The ability to partially blunt an affective empathic response to an emotionally charged patient situation helps to ensure the health care provider can devote all their attention to the patient vs. the provider being caught up in their own emotions. Affective blunting may also be helpful in preventing burnout, especially among women health care workers.