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      Association between low empathy and high burnout among primary care physicians and nurses in Lleida, Spain

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          Abstract

          Background: Burnout is a growing problem among healthcare professionals and may be mitigated and even prevented by measures designed to promote empathy and resilience.

          Objectives: We studied the association between burnout and empathy in primary care practitioners in Lleida, Spain and investigated possible differences according to age, sex, profession, and place of practice (urban versus rural).

          Methods: All general practitioners (GPs) and family nurses in the health district of Lleida (population 366 000) were asked by email to anonymously complete the Maslach Burnout Inventory (MBI) and the Jefferson Scale of Physician Empathy (JSPE) between May and July 2014. Tool consistency was evaluated by Cronbach’s α, the association between empathy and burnout by Spearman’s correlation coefficient, and the association between burnout and empathy and sociodemographic variables by the χ 2 test.

          Results: One hundred and thirty-six GPs and 131 nurses (52.7% response rate) from six urban and 16 rural practices participated (78.3% women); 33.3% of respondents had low empathy, while 3.7% had high burnout. The MBI and JSPE were correlated ( P < .001) and low burnout was associated with high empathy ( P < .05). Age and sex had no influence on burnout or empathy.

          Conclusion: Although burnout was relatively uncommon in our sample, it was associated with low levels of empathy. This finding and our observation of lower empathy levels in rural settings require further investigation.

          KEY MESSAGES
          • More empathic primary care practitioners have lower burnout scores.

          • Practitioners working in rural areas have significantly lower levels of empathy than their urban counterparts have.

          • Interventions designed to foster attributes and skills such as empathy, resilience, and doctor–patient communication may help to reduce and prevent burnout.

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          Most cited references23

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          Empathy in Clinical Practice: How Individual Dispositions, Gender, and Experience Moderate Empathic Concern, Burnout, and Emotional Distress in Physicians

          To better understand clinical empathy and what factors can undermine its experience and outcome in care-giving settings, a large-scale study was conducted with 7,584 board certified practicing physicians. Online validated instruments assessing different aspects of empathy, distress, burnout, altruistic behavior, emotional awareness, and well-being were used. Compassion satisfaction was strongly associated with empathic concern, perspective taking and altruism, while compassion fatigue (burnout and secondary traumatic stress) was more closely related to personal distress and alexithymia. Gender had a highly selective effect on empathic concern, with women displaying higher values, which led to a wide array of negative and devalued feelings. Years of experience did not influence dispositional measures per se after controlling for the effect of age and gender. Participants who experienced compassion fatigue with little to no compassion satisfaction showed the highest scores on personal distress and alexithymia as well as the strongest indicators of compassion fatigue. Physicians who have difficulty regulating their negative arousal and describing and identifying emotions seem to be more prone to emotional exhaustion, detachment, and a low sense of accomplishment. On the contrary, the ability to engage in self-other awareness and regulate one’s emotions and the tendency to help others, seem to contribute to the sense of compassion that comes from assisting patients in clinical practice.
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            Relationships between medical student burnout, empathy, and professionalism climate.

            Medical student burnout is prevalent, and there has been much discussion about burnout and professionalism in medical education and the clinical learning environment. Yet, few studies have attempted to explore relationships between those issues using validated instruments. Medical students were surveyed at the beginning of their fourth year using the Maslach Burnout Inventory, the Jefferson Scale of Physician Empathy-Student Version, and the Professionalism Climate Instrument. The data were analyzed using Statistical Package for the Social Sciences, and Spearman correlation analysis was performed. Scores indicative of higher medical student burnout were associated with lower medical student empathy scores and with lower professionalism climate scores observed in medical students, residents, and faculty. Investigators observed relationships between medical student burnout, empathy, and professionalism climate. These findings may have implications for the design of curriculum interventions to promote student well-being and professionalism.
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              The patient-doctor relationship: a synthesis of the qualitative literature on patients' perspectives.

              The patient-doctor relationship is an important but poorly defined topic. In order to comprehensively assess its significance for patient care, a clearer understanding of the concept is required. To derive a conceptual framework of the factors that define patient-doctor relationships from the perspective of patients. Systematic review and thematic synthesis of qualitative studies. Medline, EMBASE, PsychINFO and Web of Science databases were searched. Studies were screened for relevance and appraised for quality. The findings were synthesised using a thematic approach. From 1985 abstracts, 11 studies from four countries were included in the final synthesis. They examined the patient-doctor relationship generally (n = 3), or in terms of loyalty (n = 3), personal care (n = 2), trust (n = 2), and continuity (n = 1). Longitudinal care (seeing the same doctor) and consultation experiences (patients' encounters with the doctor) were found to be the main processes by which patient-doctor relationships are promoted. The resulting depth of patient-doctor relationship comprises four main elements: knowledge, trust, loyalty, and regard. These elements have doctor and patient aspects to them, which may be reciprocally related. A framework is proposed that distinguishes between dynamic factors that develop or maintain the relationship, and characteristics that constitute an ongoing depth of relationship. Having identified the different elements involved, future research should examine for associations between longitudinal care, consultation experiences, and depth of patient-doctor relationship, and, in turn, their significance for patient care.
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                Author and article information

                Journal
                Eur J Gen Pract
                Eur J Gen Pract
                IGEN
                igen20
                The European Journal of General Practice
                Taylor & Francis
                1381-4788
                1751-1402
                2017
                10 October 2016
                : 23
                : 1
                : 4-10
                Affiliations
                [ a ] Primary Care, Lleida Health Region Spain
                [ b ] Support Unit, Primary Care Research Institute (IDIAP) Jordi Gol. Autonomous University of Barcelona Lleida CataloniaSpain
                [ c ] Epidemiology unit, University Hospital Vall d’Hebron Barcelona CataloniaSpain
                [ d ] Borja institute of Bioethics BarcelonaSpain
                [ e ] School of Medicine, University of Lleida Spain
                [ f ] Platform for Bioethics and Medical Education, La Rioja Biomedical Research Center Logroño (CIBIR)Spain
                Author notes
                CONTACT Oriol Yuguero oriol.yuguero@ 123456gmail.com Av. Rovira Roure 80 25198 LleidaSpain
                Article
                1233173
                10.1080/13814788.2016.1233173
                5774288
                27723375
                b7ee1f34-664b-41e5-a158-5ce166579b7e
                © 2016 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/Licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 27 December 2015
                : 18 August 2016
                : 19 August 2016
                Page count
                Pages: 7
                Funding
                Funded by: Sociedad Española de Medicina Familiar y Comunitaria
                Award ID: 3000 €
                Sociedad Española de Medicina Familiar y Comunitaria [3000 €]
                Categories
                Article
                Original Article

                Medicine
                communication,empathy,primary care,family medicine,professionalism
                Medicine
                communication, empathy, primary care, family medicine, professionalism

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