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Synergistic effects of emergency physician empathy and burnout on patient satisfaction: a prospective observational study
  1. Jennifer Byrd1,
  2. Heidi Knowles1,
  3. Sephonie Moore1,
  4. Victoria Acker1,
  5. Sarah Bell1,
  6. Naomi Alanis1,
  7. Yuan Zhou2,
  8. James P d'Etienne1,
  9. Jeffrey A Kline3,
  10. Hao Wang4,5
  1. 1 -, Fort Worth, Fort Worth, USA
  2. 2 -, Arlington, Texas, USA
  3. 3 Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
  4. 4 Emergency Medicine, JPS Health Network, Fort Worth, Texas, USA
  5. 5 JPS Health Network, Fort Worth, Texas, USA
  1. Correspondence to Dr Hao Wang, Emergency Medicine, JPS Health Network, Fort Worth, TX 76104, USA; hwang{at}


Background Physician empathy and burnout have been shown to be independently associated with patient satisfaction. However, their correlations were uncertain in previous studies. We aimed to determine correlations among empathy, burnout, and patient satisfaction, and further analyse interactions among these factors.

Method A single centre prospective observational study was conducted from December 2018 to August 2019 at JPS Health Network, USA. Emergency physician (EP) self-assessed empathy and burnout were measured by the Jefferson Scale of Empathy (JSE) and the Copenhagen Burnout Inventory (CBI) separately. We assessed patient perception of physician empathy and patient satisfaction with their treating physician by the Jefferson Scale of Patient Perception of Physician Empathy and a patient assessed satisfaction survey. Spearman’s correlation was used to determine associations among JSE, patient assessed physician empathy, CBI and patient satisfaction. Additionally, JSE, patient assessed physician empathy and CBI predictive of patient satisfaction were measured by multivariate logistic regression analysis.

Results A total of 28 EPs and 423 patients were enrolled. Patient satisfaction had a weak correlation with JSE (ρ=0.11) but showed a strong correlation with patient assessed physician empathy (ρ=0.60). CBI showed no correlation with patient satisfaction (ρ<0.1). However, when JSE, patient assessed physician empathy and CBI were analysed together in relation to patient satisfaction, adjusted odds ratios (AOR) was 3.85 (95% CI 1.36 to 10.88) with high patient assessed physician empathy alone; AOR was 7.17 (2.62–19.67) when high patient assessed physician empathy was combined with low CBI; and AOR was 8.37 (3.07–22.83) when high patient assessed physician empathy, low CBI and high JSE were combined.

Conclusion Patient assessed physician empathy had a strong positive correlation with patient satisfaction. Moreover, higher patient satisfaction was achieved from EPs of high patient assessed physician empathy, low CBI and high JSE, indicating a positive synergistic effect. These findings suggest different interventions might be applied to EPs of different wellness features to maximise patient satisfaction.

  • emergency department

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  • Handling editor Richard Body

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  • Contributors JB, HK, YZ, JAK and HW conceived the research and designed the study. SM, VA, SB and NA performed the data collection. YZ, HK, JAK and HW performed the analysis. JB, HK, NA, YZ, JPD, JAK and HW drafted the manuscript. JB, HK, YZ, JPD, JAK and HW contributed to data interpretation, critical review and revisions of the manuscript for important intellectual content. All authors approved the final version of the submitted manuscript and agree to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the University of North Texas Health Science Center regional institutional review board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. Patient deidentified data are available upon reasonable request through John Peter Smith Health Network clinical research office. Please contact Dr Melissa Acosta (

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.