The case for empathy

While not everyone agrees, empathic healthcare is a fundamental ingredient of professionalism. 

What a delight to open my Irish Times recently to discover a feature article/ book review of a new publication: Ionbhá, The Empathy Book for Ireland. Co-edited by actor Cillian Murphy and Prof Pat Dolan, of the University of Galway, it is a ground-breaking project aimed at getting empathy taught in Irish schools. 

Why is a famous actor campaigning for empathy? 

“The most important tool that you have as an actor is empathy. Not just for your character. Unless you’re connected with that other person and truly listening and truly engaged with them, the scene falls flat. It doesn’t work,” Murphy says. 

Both he and Dolan, who has been researching this area for years, says there is a compelling case to introduce empathy education in schools, and across wider society, based on the positive findings of a growing body of research. 

The results of years of research and practice by Dolan, a 12-week secondary school programme – Activating Social Empathy – has been shown to promote “pro-social behaviour”, or the willingness to do good, and boosting young people’s level of “cognitive empathy” (they were better able to understand other people’s perspectives), and affective empathy (they were more willing to share the emotions/feelings of others). 

What has this got to do with medicine, you may well ask? 

I have taught narrative-based medicine to medical students and to postgraduates for almost 15 years. A major part of that teaching focuses on practising the twin skills of attentive listening and empathy during patient consultations. 

Narrative competence and narrative awareness have been shown to feed empathy during a consultation. Rather than taking a history from a patient, you build a history with that person. Having listened actively you then reflect the story back to the patient to include factual content, but also an acknowledgement of the emotions the person has expressed. 

Empathic care is a fundamental ingredient of professionalism. It is highly valued by patients and their families and has been associated with patient trust and adherence to treatment, as well as being linked to “hard” health outcomes (especially in chronic disease), such as improved blood pressure and blood sugar readings. In addition, substantial evidence supports associated benefits for the healthcare practitioner. 

For various reasons empathy in medicine has faced new barriers and challenges in recent decades with significant evidence of an increasing decline in physicians’ empathy, endangering a fundamental asset of patient care. 

What are these barriers? Undoubtedly a major factor has been appearance of the computer and electronic health record as a ubiquitous third party in clinical encounters. Doctors can become so immersed in the screen with its endless information and demands, they have less time for eye contact, being tuned in to patients’ cues, and empathy. Time constraints, which have worsened as patient complexity and physicians’ obligations increased, mean harassed practitioners may drop empathy, seeing it as another time-consuming chore. And with burnout being so common, a depersonalised doctor will struggle to provide empathic care. 

There has also been something of an anti-empathy uprising in recent years. The book Against Empathy: The Case for Rational Compassion by Paul Bloom makes a case against empathy as an inherent force for good. He takes a closer look at what empathy is (and is not), how empathy works in our brains, and how we can improve our ability to have a positive impact by strengthening our intelligence, compassion, self-control, and ability to reason. 

Bloom is an implacable opponent of what he calls ‘emotional empathy’. But there is another form of empathy that Bloom wants us to be aware of and consider more benignly. It relates to our ability to understand what is going on in the minds of others. Bloom refers to this form as ‘cognitive empathy’. 

From Bloom’s perspective, cognitive empathy is “…a useful and necessary tool for anyone who wishes to be a good person, but it is morally neutral”. On the other hand, Bloom believes that emotional empathy is “morally corrosive”. 

The notion of empathy being a force for harm in patient care is strongly held by some senior medical figures – for reasons I fail to understand. It leaves me wondering if colleagues who attack empathy, struggle professionally with the almost constant uncertainty that is chronic disease care? And such is their vigorous opposition, one might even wonder, is it possible their intolerance reflects some unacknowledged emotional issues in their own lives?