Open Access Highly Accessed Research article

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

Florian Ahrweiler12*, Melanie Neumann3, Hadass Goldblatt4, Eckhart G Hahn5 and Christian Scheffer16

Author Affiliations

1 Integrated Curriculum for Anthroposophic Medicine, Institute for Integrative Medicine, School of Medicine, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany

2 Medizinische Klinik, Augusta-Kranken-Anstalt, Bergstraße 26, 44791 Bochum, Germany

3 Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany

4 Department of Nursing, Faculty of Social Welfare & Health Sciences, University of Haifa, Mount Carmel, 3498838 Haifa, Israel

5 Gesellschaft für Berufliche Fortbildung, Forschung und Entwicklung an der Medizinischen Klinik 1, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany

6 Center for Educational Research, School of Medicine, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany

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BMC Medical Education 2014, 14:122  doi:10.1186/1472-6920-14-122

Published: 22 June 2014



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.


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.


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.


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.

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