In Reply to Quinn and Zelenski

In their remarks about our Invited Commentary, Drs. Quinn and Zelenski misinterpreted our views on empathy in patient care. They overlooked the following points we made and suggested that we subscribe to the notion that “the emotional domains of empathy are irrelevant,” which is not true. We made a distinction between clinical empathy (predominantly a cognitive attribute to understand patients’ pain and suffering), and emotional empathy (predominant ly an affective reaction in feeling patients’ pain and suffering, synon ymous with sympathy in our view). We pointed out that cognition (in clinical empathy) and affect (in emotional empathy) are two different entities involving different mental processing—namely, “understanding” and “feeling,” respectively. We noted that the aforementioned distinctions (cognition vs. emotion; understanding vs. feeling) could have different consequences in patient care, where cognition or understanding is always beneficial. Their abundance can strengthen the patient–clinician relationship and contribute to positive clinical outcomes. On the contrary, emotional involvement and feeling another’s pain and suffering in excess can be overwhelming and, thus, detrimental to both the clinician (leading to exhaustion and burnout) as well as the patient (leading to affective dependency). To avoid burnout, overpowering emotion, and unregulated emotion that impede a clinician’s performance, objective clinical decisions, accurate diagnosis, and treatment adherence, we suggested that, in empathic engagement in patient care, emotion should be regulated. We never endorsed the notion that emotion is “irrelevant.” In our view, the relationship between cognitively defined clinical empathy and clinical outcomes is likely to be linear, meaning the more empathic the engagement, the better the patient outcomes.1(p14) However, the relationship between the degree of emotional involvement and clinical outcomes is likely to be curvilinear (an inverted U shape), meaning that emotion, up to a certain point, can be beneficial; above that point, emotion can become an impediment to patient–clinician relationships.1(p14) Accordingly, we defined “compassion” as an overlap between cognitive empathy and regulated degree of emotion. While we recognize the distinction between cognitively defined clinical empathy and emotional empathy in their conceptualization and consequences in patient care, we nonetheless maintain that the two cannot be entirely independent.1(p13) In conclusion, we suggest that clinical empathy binds patients and clinicians together, but emotion, in excess, blinds them to objectivity, which is an essential component of patient care. Thus, understanding and emotions are relevant in patient care; however, for optimal patient outcomes, understanding must be maximized, and emotion must be restrained and regulated. Mohammadreza Hojat, PhDResearch professor of psychiatry and human behavior and director of the Jefferson Longitudinal Study of Medical Education, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; [email protected]Joseph S. Gonnella, MDDistinguished professor of medicine, emeritus dean, and founder, Center for Research in Medical Education and Health Care, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania.