Empathy The Jefferson Scale of Physician Empathy: Preliminary Psychometrics and Group Comparisons in Italian Physicians Mariangela Di Lillo, MD, MHS, Americo Cicchetti, PhD, Alessandra Lo Scalzo, PhD, Francesco Taroni, MD, and Mohammadreza Hojat, PhD Abstract Purpose To examine the psychometrics of the Jefferson Scale of Physician Empathy (JSPE) among a sample of Italian physicians. Method The JSPE was translated into Italian using back-translation procedures to ensure the accuracy of the translation. The translated JSPE was administered to 778 physicians at three hospitals in Rome, Italy in 2002. Individual empathy scores were calculated, as well as descriptive statistics at the item and scale level. Group comparisons of empathy scores were also made among men and women, physicians practicing in medical or surgical specialties, physicians working in different hospitals, and at physicians at various levels of career rank. Results Results are reported for 289 participants who completed the JSPE. Item-total score correlations were all positive and statistically significant. The prominent component of “perspective taking,” which is the most important underlying construct of the scale, emerged in the factor analysis of the JSPE and was similar in both Italian and American samples. However, more factors appeared among Italian physicians, indicating that the underlying construct of empathy may be more complex among Italians. Cronbach coefficient alpha was .85. None of the group differences observed among physicians classified by gender, hospital of practice, specialty, or level of career rank reached statistical significance. Conclusions Findings generally provide support for the construct validity and reliability of the Italian version of the JSPE. Further research is needed to determine whether the lack of statistically significant differences in empathy by gender and specialty is related to cultural peculiarities, the translation of the scale, or sampling. Acad Med. 2009; 84:1198–1202. Editor’s Note: Commentaries on this article appear on pages 1174 and 1177. “The art of medicine,” according to Hippocrates, “has three elements: the disease, the patient and the physician … and the patient must cooperate with the physician in combating the disease.” 1 The patient–physician relationship is a symbiotic alliance in which each party contributes to its effectiveness. But what is the secret ingredient that really forms this encounter between two different human beings into a successful interaction? Empathic engagement in patient care can lead intuitively to a more meaningful interpersonal relationship and, in turn, to more optimal care. No wonder empathy is the most frequently mentioned humanistic dimension of patient care. 2 The word “empathy” comes from the Greek word “empatheia,” which means appreciation of another person’s feelings. The English term “empathy” was coined in 1909 by psychologist Edward Bradner Titchener as a translation of the German word “einfu ¨ hlung,” used for the first time in 1873 by Robert Vischer, an art historian and philosopher who used this word to describe an observer’s feeling elicited by works of art. In 1915 Titchener used the term empathy to convey “understanding” of other human beings, but not until 1918 did Southard describe the significance of empathy in the relationship between a clinician and a patient for facilitating diagnostic outcomes. 3 Empathy within the context of medical practice has been defined in many ways. For example, empathy in patient care has been characterized as arising “out of a natural desire to care about others.” 4 According to Gianakos, 5 empathy is “the ability of physicians to imagine that they are the patient who has come to them for help,” and for Greenson 6 empathy is “letting a part of you becoming the patient and going through her experience as if you were the patient.” Considering these descriptions and the role of empathy in patient care, as well as a review of relevant literature, the physician empathy research team at Jefferson Medical College proposed the following definition of empathy in the context of patient care: “Empathy is a predominantly cognitive (rather than an emotional) attribute that involves an understanding (rather than feeling) of experiences, concerns and perspectives of the patient, combined with a capacity to communicate this understanding.” 7–9 Cognition, understanding, and Dr. Di Lillo is a specialist in internal medicine and visiting research fellow, Center for Research in Medical Education and Health Care, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania. Dr. Cicchetti is professor of health economics, Universita’ Cattolica Sacro Cuore, Faculty of Economics, Rome, Italy. Dr. Lo Scalzo is a researcher, Agenzia Nazionale per i Servizi Sanitari Regionali, Rome, Italy. Dr. Taroni is associate professor of medicine and health policy, Universita’ di Bologna, Department of Medicine and Public Health, Bologna, Italy. Dr. Hojat is research professor of psychiatry and human behavior and director, Jefferson Longitudinal Study, Center for Research in Medical Education and Health Care, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania. Correspondence should be addressed to Dr. Di Lillo, Jefferson Medical College of Thomas Jefferson University, 1025 Walnut Street, Philadelphia, PA 19107; telephone: (215) 955-9459; fax: (215) 923- 6939; e-mail: (Mariangela.DiLillo@jefferson.edu). Academic Medicine, Vol. 84, No. 9 / September 2009 1198