Empathy should characterize all health care professions. Despite advancement
in medical technology, the healing relationship between physicians and patients
remains essential to quality care. We propose that physicians consider empathy
as emotional labor (ie, management of experienced and displayed emotions to
present a certain image). Since the publication of Hochschild’s The Managed Heart in 1983, researchers in management and
organization behavior have been studying emotional labor by service workers,
such as flight attendants and bill collectors. In this article, we focus on
physicians as professionals who are expected to be empathic caregivers. They
engage in such emotional labor through deep acting (ie, generating empathy-consistent
emotional and cognitive reactions before and during empathic interactions
with the patient, similar to the method-acting tradition used by some stage
and screen actors), surface acting (ie, forging empathic behaviors toward
the patient, absent of consistent emotional and cognitive reactions), or both.
Although deep acting is preferred, physicians may rely on surface acting when
immediate emotional and cognitive understanding of patients is impossible.
Overall, we contend that physicians are more effective healers—and enjoy
more professional satisfaction—when they engage in the process of empathy.
We urge physicians first to recognize that their work has an element of emotional
labor and, second, to consciously practice deep and surface acting to empathize
with their patients. Medical students and residents can benefit from long-term
regular training that includes conscious efforts to develop their empathic
abilities. This will be valuable for both physicians and patients facing the
increasingly fragmented and technological world of modern medicine.