Defining Empathy to Better Teach, Measure, and Understand Its Impact.

No consensus on the definition of empathy exists. Empathy has been described as emotional and spontaneous, cognitive and deliberate, or some combination of the two. Attentive nonverbal reactions, feeling reflections, reassurance, sympathy, and compassion all have been conflated with empathy, making it impossible to differentiate empathy from other communication skills. This confusion over the definition of empathy has affected its measurement. For example, the authors of the Interpersonal Reactivity Index see empathy as multidimensional, involving both emotional and cognitive aspects, while the authors of the Jefferson Scale of Physician Empathy see empathy as a predominately cognitive process. Researchers, such as Yamada and colleagues in their study in this issue, then must straddle these conceptualizations, which is a limitation to their work.To address this problem, the author of this Invited Commentary proposes adopting the cognitive definition of empathy, noting that it allows physicians to distinguish between empathy and other communication skills and is the most consistent with counseling psychology descriptions. The author defines cognitive empathy as a conscious, strenuous, mental effort to clarify a patient's muddy expression of her experience using a soft interpretation of her story. Accurate empathic responses are unadulterated by a physician's reactions to a patient and the patient's experience. The author describes four aspects of empathy that are rarely noted in the medical literature but that are fundamental to understanding its practice: the "as if" condition, the use of soft interpretation, the primacy of cognition, and the relevance of reflection.