A Narrative Review of the Interplay Between Empathy, Cognitive Dissonance, and Wellbeing Among Physicians

Abstract

Empathy is a cornerstone of effective healthcare, shaping both patient outcomes and physician wellbeing. It comprises two interrelated components: affective empathy, the capacity to share a patient’s emotional state, and cognitive empathy, the ability to understand the patient’s perspective without necessarily experiencing their emotions. Physicians often experience emotional distress in response to patients’ suffering while needing to maintain objectivity to make sound clinical decisions. This tension can give rise to cognitive dissonance, a psychological discomfort resulting from conflicting thoughts. The aim of this narrative review is to synthesise conceptual foundations, theoretical frameworks, and empirical evidence to examine the interplay between empathy, cognitive dissonance, and physician wellbeing. A targeted narrative search using PubMed, Scopus, Google Scholar, and the BMC journal platform was undertaken to identify relevant theoretical and empirical studies. This review integrates seminal works such as the Dual-Component Model of Empathy, Emotional Labour Theory, and Festinger’s Cognitive Dissonance Theory. Although cognitive dissonance has been explored among medical students, its influence on physicians’ use of empathy, particularly the distinction between affective and cognitive empathy, remains underexplored. Direct research has not yet examined whether empathy reduction may occur as a response to dissonance in this context. This review maps the conceptual relationships among these constructs and highlights the usefulness of the action-based model of cognitive dissonance in explaining empathy fluctuations. It calls for further research into how different types of empathy and dissonance management strategies influence physician wellbeing. The findings aim to inform interventions that preserve the benefits of empathy, reduce dissonance, and enhance wellbeing in clinical practice.