Inpatients’ Perceptions of Physicians’ Empathy and Their Level of Satisfaction Regarding Medical Care Measured by Jefferson Scale of Patient’s Perceptions of Physician Empathy

Document Type: Original article


1 Department of Public Health, Faculty of Health, Zanjan University of Medical Sciences, Zanjan, Iran

2 Social Determinants of Health Research Center, Zanjan University of Medical Sciences, Zanjan,Iran


Background: Physician empathy toward patient is an important factor and humanistic aspect of patient -centered cares and effective therapeutic consultation. The aim of the present study was to evaluate inpatients perceptions of physician empathy and their level of satisfaction regarding medical care besides evaluating the association of the variables with the decision of the inpatients in recommending physician to friends and relatives.
Methods: This cross-sectional study was carried out at teaching hospitals of Zanjan city in 2018. The participants included 285 inpatients. The Jefferson Scale of Patient’s Perceptions of Physician Empathy (JSPPPE) was used for the data collection. Data analysis was performed using descriptive statistics and multivariate analyses to describe empathy relations with personal characteristics. Pearson correlation coefficient was used to examine the relationship between inpatients’ satisfaction and perception of empathy with the decision of recommending physician to their relatives.
Results: The factor analysis on five items of JSPPPE led to one prominent factor. Items-total empathy score correlations ranged from 0.7 to 0.81. Correlation coefficient between JSPPPE scores with inpatients’ satisfaction was statistically significant (r=0.69, p<0.001). Overall score of the JSPPPE was strongly correlated with recommendation of physician to relatives and friends (r=0.56, p<0.001). More than half of inpatients (57.1%) were satisfied with medical care and consultations. Only a quarter of inpatients said that they knew their physicians well beforehand. Observed difference in mean scores of the overall satisfaction and personal trust to physician and recommending physician to relatives was statistically significant on the base of age characteristic (p<0.5).
Conclusion: The results of the study showed that there is significant positive association between perceptions of physician empathy with patient’s satisfaction and recommending physician to relatives and friends.


1. Hojat M, DeSantis J, Gonnella JS. Patient perceptions of clinician’s empathy: measurement and psychometrics. J Patient Exp 2017;4(2):78-83.
2. Mercer SW, Reynolds WJ. Empathy and quality of care. Br J Gen Pract 2002;52(Suppl):S9-S12.
3. Hojat M, Louis DZ, Maxwell K, Markham F, Wender R, Gonnella JS. Patient perceptions of physician empathy, satisfaction with physician, interpersonal trust, and compliance. Int J Med Educ 2010;1:83-7.
4. Tsai SL, Chai S, Wang HH. Patient-perceived empathy from nurses in Taiwan acute care settings. Open J Nurs 2013;03(08):532-8.
5. Babar MG, Hasan SS, Yong WM, Mitha S, Al-Waeli HA. Patients’ perceptions of dental students’ empathic, person-centered care in a dental school clinic in Malaysia. J Dent Educ 2017;81(4):404-12.
6. Mirani SH, Shaikh NA, Tahir A. Assessment of clinical empathy among medical students using the Jefferson Scale of Empathy-Student Version. Cureus 2019;11(2):e4160.
7. Naseer M, Zahidie A, Shaikh BT. Determinants of patient’s satisfaction with health care system in Pakistan: A critical review. Pak J Public Health 2012;2(2):56-63.
8. Welch SJ. Twenty years of patient satisfaction research applied to the emergency department: a qualitative review. Am J Med Qual 2010;25(1):64-72.
9. Hanževački M, Jakovina T, Bajić Z, Tomac A, Mercer S. Reliability and validity of the Croatian version of Consultation and Relational Empathy (CARE) Measure in primary care setting. Croat Med J 2015;56(1):50-6.
10. Mercer SW, Hatch DJ, Murray A, Murphy DJ, Eva KW. Capturing patients’ views on communication with anesthetists: the CARE Measure. Clin Govern Int J 2008;13(2):128-37.
11. Bikker AP, Fitzpatrick B, Murphy D, Mercer SW. Measuring empathic, personcentred communication in primary care nurses: validity and reliability of the Consultation and Relational Empathy (CARE) Measure. BMC Fam Pract 2015;16:149.
12. Uddin MJ, Ashrafun L and Kubra TJ. Patient satisfaction with doctors’ care in Bangladesh: A case of government hospital. J Fam Med 2017;4(6):1-6 .
13. Berg K, Blatt B, Lopreiato J, Jung J, Schaeffer A, Heil D, et al. Standardized patient assessment of medical student empathy: ethnicity and gender effects in a multi-institutional study. Acad Med 2015;90:105-11.
14. Berg K, Majdan JF, Berg D, Veloski J, Hojat M. A comparison of medical students’ self-reported empathy with simulated patients ‘assessments of the students’ empathy. Med Teach 2011;33:388-91.
15. Kane GC, Gotto JL, Mangione S, West S, Hojat, M. Jefferson scale of patient’s perceptions of physician empathy: Preliminary psychometric data. Croat Med J 2007;48(1):81-6.
16. Glaser K, Markham FW, Adler HM, McManus PR, Hojat M. Relationship between scores on the Jefferson Scale of Physician Empathy, patient perceptions of physician empathy, and humanistic approaches to patient care: a validity study. Med Sci Monit 2007;13(7):291-4.
17. Hojat M, Louis D Z, Maxwell K, Markham F, Wender R, Gonnella JS. A brief instrument to measure patients’ overall satisfaction with primary care physicians. Fam Med 2011;43(6):412-7.
18. Steiber S, Krowinski W. Measuring patient satisfaction. Chicago: American Hospital Publishing Inc; 1996.
19. Mostafa A, Hoque R, Mostafa M, Rana MM, Mostafa F. Empathy in undergraduate medical students of Bangladesh: Psychometric analysis and differences by gender, academic year, and specialty preferences. ISRN Psychiatry 2014 Apr 7;2014:375439.
20. Hogarty K, Hines CV, Kromrey JD, Ferron JM, Mumford KR. 2005. The quality of factor solutions in exploratory factor analysis: The influence of sample size, communality, and over determination. Educ Psychol Meas 2005;65:202-26.
21. Nunnally CJ. Psychometric Methods. New York: Harper and Row; 1978.
22. Aomatsu M, Abe H, Abe K, Yasui H, Suzuki T, Sato J, et al. Validity and reliability of the Japanese version of the CARE Measure in a general medicine outpatient setting. Fam Pract 2014;31(1):118-26.
23. Place M A, Murphy J, Duncan E AS, Reid J M, Mercer S W. A preliminary evaluation of the Visual CARE Measure for use by allied health professionals with children and their parents. J Child Health Care 2014;1-13.
24. Şahin BB, Görpelioğlu S, Hülya Yıkılkan H, Akbıyık D, Aypak C. Reliability and validity of Turkish version of scale of patient overall satisfaction with primary care physicians. Turk J Family Med Prim Care 2017;11(3):159-63.  Turkish, English.
25. Mukhtar F, Anjum A, Bajwa MA, Shahzad S, Hamid S, Masood Z, et al. Patient satisfaction; OPD services in a Tertiary Care Hospital of Lahore. Professional Med J 2013;20(6):973-80.
26. Williams B, Brown T, McKenna L, Palermo C, Morgan P, Nestel D, et al. Student empathy levels across 12 medical and health professions: an interventional study. J Compassionate Health Care 2015;2(4):7-12.
27. Soncini F, Silvestrini G, Poscia A, Ciorba V, Conti A, et al. Public health physicians and empathy. Are we really empathic? The Jefferson Scale applied to Italian resident doctors in Public Health. Eur J Public Health 2013;23(1):13-6.