An Investigation on Turkish Specialist and Practitioner Doctors’ Empathy and Cognitive Flexibility Levels and Interpersonal Relationship Styles

Findings revealed specialists’ empathy and cognitive flexibility scores were generally higher than practitioners’, yet the only statistically significant dimension was cognitive flexibility-alternatives in specialists.

In interpersonal relations, significant differences in terms of open, respectful, and condescending communication styles demonstrated that, compared to practitioners, specialist physicians were again more competent in these areas.

These findings do not corroborate our tentative assumption when undertaking the study, namely that due to familiarity and longer interactions with their patients, practitioners should exhibit higher empathy, cognitive flexibility, and communication competence. Our particular pattern may have stemmed from various factors: First, with respect to cognitive flexibility, due to certain preexisting cognitive skills, individuals who become specialists may be predisposed to more competently assess alternatives in particular situations and problems. Indeed, Spiro and Jehng (1990) proposed that the predominant characteristic of experts is the ability to manipulate versatile mental representations, which in turn enables them to adapt better to environmental changes and use their knowledge more efficiently among different tasks. Alternatively, one may consider the effect of specialists’ education in terms of both different cognitive skills acquired and being exposed to courses on patient-doctor interactions. It is conceivable that different specialist branches, the cultures of hospitals and medical schools, socioeconomic status, or even cities of residence may play a role in augmenting or hindering cognitive flexibility, empathy, and interpersonal relationship style. In this regard, future studies may include these variables to determine both their unique and interactive effects for various professionals in the medical field.

Although not displaying a statistically significant difference, higher empathy levels and interpersonal relations competence of specialists may be linked to particular predicaments of the medical system in Turkey. In Turkey, practitioners regularly receive a burdensome number of registered patients. In this sense, it is reasonable to suggest that practitioners may have developed certain emotive strategies to mitigate the emotional burden that accompanies personal interactions with their patients. Alternatively, the mundane and repetitive tasks of referrals to specialists and renewing prescriptions may also hamper the tendency to develop a genuinely empathetic understanding of patients’ problems and emotional states.

Conversely, specialists in Turkey accept additional patients in return for extra income, which offers them an opportunity to control the overburden they experience. These points highlight the importance of considering the significant role that the nature of healthcare systems may play in determining the quality of interpersonal communication and empathetic interaction. It is particularly telling that both specialist and practitioner empathy scores in Turkey are well below those reported by international studies, which lends support to the idea that predicaments in healthcare systems may greatly compromise cognitive flexibility and empathy. As compared to our scores of 101.30 for specialists and 97.63 for practitioners, Kataoka et al. reported international physicians’ empathy levels in human-centered and technology-centered specialty fields as 112.9 and 106.9, respectively. Average physician empathy levels were found to be 120 in the United States (Hojat et al., 2001, p. 349), 115.1 in Italy (Di Lillo, 2009, p. 1198), 122 in Spain (Alcorta-Garza et al., 2016, p. 1), 98.2 in South Korea (Suh et al., 2012, p. 464), 110 in Iran (Shariat et al., 2010, p. 417), 113.06 in Poland (Kliszcz et al., 2006, p. 219), and 102.85 in the Czech Republic (Kožený & Tišanská, 2013, p. 521).

In another major finding, in a practitioner sample within group analyses, the present study substantiated empathy’s significant relation to cognitive flexibility and interpersonal relations. These findings resonate with a prior study on Turkish university students (Hasta & Güler, 2013, p. 64) in which, as in this study too, empathy was found to be positively associated with open and respectful styles and negatively linked to condescending styles. Since in our study, empathy in specialists was not correlated to cognitive flexibility or communication style, one may consider the idea that, for specialists, the more intermittent and impersonal nature of doctor-patient interactions in the Turkish healthcare system enables the acquisition of satisfactory communication skills mainly via cognitive skills. Conversely, for health professionals such as practitioners and nurses who interact more closely with patients, communication skills may be induced mainly along the path of empathy.

Notwithstanding fields or branches among health professionals, the present study can be considered a noteworthy contribution to international research that investigates questions regarding empathy, cognitive skills, communication, and patient outcomes for healthcare professionals and workers at large. Indeed, a recent upsurge in international studies started to increasingly point to relations of these kinds. To give a few examples, prior research found a positive relationship between empathy and interpersonal relations in nursing students (Chung, 2014, p. 332; Kim, 2018, p. 229), and similarly posited positive relationships among empathy, perspective-taking, nurturing care, and friendly-harmonious relationship types in medical students (Jordan & Foster, 2016, p. 1009). Recently a strong relationship was suggested between empathic thinking and perspective-taking (Song & Shi, 2017, p. 1). Hence, the present study lends support to the idea that the empathic and communicational skills of medical professionals should be one of the major avenues of research for promoting patient outcomes.

This study offers ideas as to why training intervention is needed to improve communication and interpersonal relationships, and also includes suggestions about what the training program should cover.

Some limitations should also be noted. The rather small sample sizes, including 30 participants for each group, and non-random, voluntary sampling procedures in this study should be considered caveats preventing satisfactory representativeness and generalizations around the globe. Additionally, variables such as doctors’ and patients’ personality traits and cultural and socioeconomic backgrounds were excluded from analyses. Lastly, our measuring instruments relied on self-report scales and are thus subject to biases rooted in the conveyance of subjective experience. These points should be taken into account by researchers while drawing cautious inferences for future research studies.