Determinants of physician empathy during medical education: Hypothetical conclusions from an exploratory qualitative survey of practicing physicians

Florian Ahrweiler, Melanie Neumann, Hadass Goldblatt, Eckhart G. Hahn, Christian Scheffer

Research output: Contribution to journalArticlepeer-review


Empathy is an outcome-relevant physician characteristic and thus a crucial component of high-quality communication in health care. However, the factors that promote and inhibit the development of empathy during medical education have not been extensively researched. Also, currently there is no explicit research on the perspective of practicing physicians on the subject. Therefore the aim of our study was to explore physicians' views of the positive and negative influences on the development of empathy during their medical education, as well as in their everyday work as physicians. Method. We administered a written Qualitative Short Survey to 63 physicians in seven specialties. They were able to respond anonymously. Our open-ended question was: "What educational content in the course of your studies and/or your specialist training had a positive or negative effect on your empathy?" We analyzed the data using thematic content analysis following Mayring's approach. Results: Forty-two physicians took part in our survey. All together, they mentioned 68 specific factors (37 positive, 29 negative, 2 neutral) from which six themes emerged: 1. In general, medical education does not promote the development of empathy. 2. Recognizing the psycho-social dimensions of care fosters empathy. 3. Interactions with patients in medical practice promote empathy. 4. Physicians' active self-development through reflective practice helps the development of empathy. 5. Interactions with colleagues can both promote and inhibit empathy through their role modeling of empathic and non-empathic behavior. 6. Stress, time pressure, and adverse working conditions are detrimental to empathy development. Conclusions: Our results provide an overview of what might influence the development of clinical empathy, as well as hypothetical conclusions about how to promote it. Reflective practice seems to be lacking in current medical curricula and could be incorporated. Raising physicians' awareness of the psycho-social dimension of disease, and of the impact of peer influence and role modeling, seems promising in this regard, too. Stress and well-being seem to be closely related to physician empathy, and their modulation must take into account individual, social, and organizational factors. Further research should investigate whether or how these hypothetical conclusions can deepen our understanding of the determinants of physician empathy in order to help its promotion.

Original languageEnglish
Article number122
JournalBMC Medical Education
Issue number1
StatePublished - 22 Jun 2014

Bibliographical note

Funding Information:
We thank Nicole Lampe for transcribing the physicians’ responses, Janet Mowery for her valuable help with our application of the English language, Ewa Juszczyszyn for the translation of the questionnaire and the respondents’ quotations, and Adriaan Visser for his editorial advice on an early draft of the manuscript. We also thank reviewers Alicia Bergman and Kathryn Pollak for their critical and constructive comments, and Friederike Ahrweiler and Ulrich Auwärter who provided helpful feedback about the figure. The authors were funded by their institutions. The development and implementation of the survey was financially supported by the Software AG Foundation, the Mahle Foundation, and the Cultura Foundation. Part of this publication was presented at the International Conference on Communication in Healthcare 2011, held in Chicago, IL, USA, and at the Summer Academy on Integrative Medicine 2012, held in Witten, Germany.


  • Empathy
  • Health communication
  • Inhibiting factors
  • Medical education
  • Physician
  • Physician-patient relationship
  • Promoting factors

ASJC Scopus subject areas

  • Education


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