11606_2019_5188_Article 1967..1967


Physician Empathy and Diabetes Outcomes
Alexander Chaitoff, MD, MPH1, Michael B. Rothberg, MD, MPH2, and Kathryn
A. Martinez, PhD, MPH2

1Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, USA; 2Center for Value-Based Care Research ,
Cleveland Clinic, Cleveland, OH, USA.

J Gen Intern Med 34(10):1967

DOI: 10.1007/s11606-019-05188-z

© Society of General Internal Medicine 2019

W e appreciate the response from Hojat and colleaguesregarding our study. In our manuscript, we extensively
outlined reasons why we might not have been able to replicate
the original study’s findings. Those that the authors proposed
in their letter, however, are unlikely causes.
They propose our findings may have differed due to the

mandatory communication trainings at Cleveland Clinic. Yet
our methods stated the Jefferson Scale of Empathy (JSE)
scores used in our study were collected prior to training
exposure. It’s true we had a larger proportion of Internal versus
Family Medicine physicians and a moderately different case
mix of patients, but our finding of no association between
empathy and diabetes outcomes was consistent in all multi-
variable and sensitivity analyses. Whether using their empathy
cut points, analyzing scores continuously to maximize statis-
tical power, or looking at subsets of patients with poorly
controlled diabetes, we found no relationship between JSE
and outcomes.
As described in detail in our paper, our inability to repro-

duce the original study’s conclusions is not unusual—research
findings are often reversed.1 This is why it’s important to
replicate studies. It may be true that empathy was associated
with diabetic control among patients of 29 Family Medicine
physicians at Thomas Jefferson > 10 years ago, but their
conclusion that “physician empathy is an important factor
associated with clinical competence and patient outcomes” is
not true now, at least not at the Cleveland Clinic.
Finally, the authors cite our “error in judgment” for acknowl-

edging that the two studies that found correlations between
empathy and diabetes outcomes were conducted by the same
group. We fear they felt we were impugning their integrity,

which is not the case. Research shows even when studying
the same data, different researchers often come to different
conclusions,2 highlighting the benefit of having multiple groups
independently study similar topics. Additionally, financial in-
terests have been shown to lead to unconscious biases,3 and
investigators that are professionally invested in a specific field
may be more likely to see associations in data than impartial
methodologists.4 These implicit phenomena are reasons that
authors are required to disclose financial conflicts of interest,
and less commonly, professional ones. We have no specific
stake in the outcome of this study. We hope that others will also
attempt to replicate this work and add to our knowledge about
the impact of empathy on patient outcomes.

Corresponding Author: Kathryn A. Martinez, PhD, MPH; Center for
Value-Based Care Research Cleveland Clinic, Cleveland, OH, USA
(e-mail: MARTINK12@ccf.org).

Compliance with Ethical Standards:

Conflict of Interest: The authors declare that they do not have a
conflict of interest.

REFERENCES
1. Ioannidis JPA, Chen J, Kodell R, Haug C, Hoey J. Why Most Published

Research Findings Are False. PLoS Med. 2005;2(8):e124. https://doi.org/
10.1371/journal.pmed.0020124.

2. Silberzahn R, Uhlmann EL, Martin DP, et al. Many analysts, one data
set: Making transparent how variations in analytic choices affect results.
Adv Methods Pract Psychol Sci. 2018;1(3):337–356.

3. Dana J. Conflict of Interest in Medical Research, Education, and Practice.
Vol (Field MJ, Lo B, eds.). Washington DC: National Academies Press;
2009.

4. Panagiotou OA, Ioannidis JPA. Primary study authors of significant
studies are more likely to believe that a strong association exists in a
heterogeneous meta-analysis compared with methodologists. J Clin
Epidemiol. 2012;65(7):740–747.

Publisher’s Note Springer Nature remains neutral with regard to
jurisdictional claims in published maps and institutional affiliations.

Published online July 24, 2019

1967

http://dx.doi.org/10.1371/journal.pmed.0020124
http://dx.doi.org/10.1371/journal.pmed.0020124
http://crossmark.crossref.org/dialog/?doi=10.1007/s11606-019-05188-z&domain=pdf

	Physician Empathy and Diabetes Outcomes
	References