Physician Assertiveness and Empathy: Strangers in the Night?

By Tiffany Parnell
Monday, October 2, 2017

A Journal of Contemporary Medical Education study reveals that pediatric and med-peds residents generally have higher emotional intelligence (EI) scores than members of the general population. As residents progress through their training, however, scores for key subcategories, such as empathy and assertiveness, start to change.

Technical competence isn’t the only characteristic of a highly skilled physician. EI — described in the Journal of Contemporary Medical Education study as “the ability to recognize and understand emotions in yourself and others, and the ability to use this awareness to manage your behavior and relationships” — is directly linked to the quality of the physician-patient relationship.

“There are studies out there that show [EI] correlates with better patient follow-up, better rapport with patients, better patient satisfaction and even better adherence to physician recommendations,” says study first author Ramzan Shahid, MD, FAAP, Loyola Medicine pediatrician and Division Director of General Pediatrics, Residency Program Director of Pediatrics, and Associate Professor in the Department of Pediatrics at Loyola University Chicago’s Stritch School of Medicine. “There’s more recent literature suggesting that physicians who have higher EI levels are at decreased risk for burnout because they’re able to deal with emotionally charged situations in a more constructive way.”

Indicators of Future Success

The goal of the study was to establish baseline EI scores for pediatric and med-peds residents and identify areas where further development may be needed. The research team used the EQ-i 2.0 survey tool to administer an online, 133-item self-assessment to 31 pediatric and 16 med-peds residents. Results revealed the residents’ median EI score was 110 — 10 points higher than the general population’s average score.

“The areas that our residents [scored] highest in included ... intrapersonal skills, empathy and impulse control,” Dr. Shahid says. “Their lower scores were in the areas of assertiveness, independence and flexibility.”

Certain scores seemed dependent upon the number of years of training residents had completed. When researchers compared the scores of residents in their first and second years of training with those of residents in their third and fourth years, they found variations in assertiveness and empathy. Junior residents had a higher median composite empathy score, 116, and lower assertiveness score, 100, than more senior residents, who had scores of 110 and 109, respectively.

Contradictory Characteristics?

The discrepancy in empathy and assertiveness scores may lead some to assume that as assertiveness increases, empathy naturally decreases. The authors note that this particular hypothesis has not been studied, indicating an avenue for further research. At this point, Dr. Shahid believes it is difficult to say whether or not there’s a direct correlation between increases in assertiveness and decreases in empathy, but he does not believe the traits are contradictory. Rather, he feels rising assertiveness scores make sense because senior residents have more confidence in their abilities. Decreases in empathy, he says, could be a coping mechanism physicians develop as they take on greater responsibility for patient care.

Burnout may also play a role in declining empathy levels. A 2017 study published in Cureus that sought to determine a baseline EI score for Indian postgraduate medical students found that overall EI scores decrease as physicians’ workloads increase.

“A statistically significant difference was observed between postgraduate students who worked around 48 hours per week and those who worked more than 96 hours per [week],” says Rajkrishna Ravikumar, MD (Community Medicine), who was involved in the Cureus study and practices at the University College of Medical Sciences and GTB Hospital in Delhi. “Similar results were observed between residents who had night duty hours and emergency duty hours.”

Workload modifications that give physicians more time to spend with their families and participate in recreational activities may play a key role in helping them manage their emotions. Participating in workshops and other activities designed to improve EI (see “Incorporating Emotional Intelligence into Medical Training” above) may also enhance patient care and minimize physician burnout.

“EI is a skill that can be developed and improved,” Dr. Shahid says. “I think starting to improve and develop those skills early in medical education at the medical student or residency level is very important, so that when physicians leave training and start practicing in the real world and start interacting with patients and other providers, they have these skills that allow them to work well and effectively within [their] teams.”