Association Between Physician Empathy and Difficult Patient Encounters: a Cross-Sectional Study

Hiroki Tamura, Kiyoshi Shikino, Daichi Sogai, Daiki Yokokawa, Shun Uchida, Yu Li, Yasutaka Yanagita, Yosuke Yamauchi, Jumpei Kojima, Kosuke Ishizuka, Tomoko Tsukamoto, Kazukata Noda, Takanori Uehara, Takahiro Imaizumi, Hitomi Kataoka, Masatomi Ikusaka

Research output: Contribution to journalArticlepeer-review


Background: Physicians frequently experience patients as difficult. Our study explores whether more empathetic physicians experience fewer patient encounters as difficult. Objective: To investigate the association between physician empathy and difficult patient encounters (DPEs). Design: Cross-sectional study. Participants: Participants were 18 generalist physicians with 3–8 years of experience. The investigation was conducted from August–September 2018 and April–May 2019 at six healthcare facilities. Main Measures: Based on the Jefferson Scale of Empathy (JSE) scores, we classified physicians into low and high empathy groups. The physicians completed the Difficult Doctor-Patient Relationship Questionnaire-10 (DDPRQ-10) after each patient visit. Scores ≥ 31 on the DDPRQ-10 indicated DPEs. We implemented multilevel mixed-effects logistic regression models to examine the association between physicians’ empathy and DPE, adjusting for patient-level covariates (age, sex, history of mental disorders) and with physician-level clustering. Key Results: The median JSE score was 114 (range: 96–126), and physicians with JSE scores 96–113 and 114–126 were assigned to low and high empathy groups, respectively (n = 8 and 10 each); 240 and 344 patients were examined by physicians in the low and high empathy groups, respectively. Among low empathy physicians, 23% of encounters were considered difficulty, compared to 11% among high empathy groups (OR: 0.37; 95% CI = 0.19–0.72, p = 0.004). JSE scores and DDPRQ-10 scores were negatively correlated (r = −0.22, p < 0.01). Conclusion: Empathetic physicians were less likely to experience encounters as difficult. Empathy appears to be an important component of physician perception of encounter difficulty.

Original languageEnglish
JournalJournal of General Internal Medicine
Publication statusAccepted/In press - 2022


  • DPE
  • Empathy
  • Physician-patient relations

ASJC Scopus subject areas

  • Internal Medicine


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