Why a doctor's empathy is important for keeping patients safe

Avoiding fatal patient safety failures requires “a more empathetic and collaborative approach from doctors”, the UK’s parliamentary and health service ombudsman, Rob Behrens, recently argued in The Times.

Reporters from the Times Health Commission, which aims to highlight health sector problems and suggest solutions, also cite research finding that many of the 48,000 sepsis deaths per year are avoidable. Behrens investigated sepsis deaths in 2013 and found that the “same mistakes” are being made a decade later.

The same is true for maternity care. The 2013 Francis report into the maternity services at the Mid Staffordshire NHS Foundation Trust states that inaction in the face of death rates that were out of the ordinary probably wouldn’t have occurred if “empathy for the predicament of patients” had constantly been at the forefront of healthcare professionals’ minds.

As with sepsis, the problems pervading maternity care have persisted despite damning reports. Two reports published in 2022 regarding avoidable infant and maternal deaths at Shrewsbury and East Kent NHS hospitals also cite lack of empathy and compassion as a cause of the tragedies.

Evidence supports the idea that more empathy in hospitals and clinics – commonly taken to involve understanding and taking action – would reduce many persistent problems with patient care. As well as reducing patient complaints and medical errors, clinical trials have shown that if a healthcare professional shows empathy it can reduce pain (both chronic and acute) and post-operative morphine use, and improve immunity in post-operative patients.

Other studies have found that higher healthcare practitioner empathy is associated with lower mortality in diabetic patients.

Also, contrary to what is commonly assumed, empathy does not increase the risk of “compassion fatigue”, which is like burnout and caused by resonating with patients’ pain. Dozens of studies have shown that more empathy decreases practitioner burnout. This seems to be because empathic healthcare professionals get in touch with the wonderful work they do with patients and develop a keener sense of purpose, which builds resilience.

Medical school’s hidden curriculum

Regrettably, the extent to which patients report that their doctors are empathic varies widely. Worse, medical student empathy declines as they progress through medical school. This is due to a “hidden curriculum” that includes role models who do not display empathy, and an unduly stressful environment, inhibiting medical students’ mental health and ability to empathise.

Whereas students enter medical school with comparable levels of wellbeing to their peers, by the end it is worse, with medical students reporting higher levels of depression (39% versus 34%) and anxiety (47% versus 39%). Anxiety inhibits people’s ability to empathise.

Depressingly, the trend towards worse mental health and lower empathy continues beyond medical school, with mental illness and suicide rates worryingly high. More than one in three junior doctors in the UK experience burnout. A consequent inevitable empathy decline follows.

Traumatic medical training is bleeding into clinical practice. Junior doctors thrown into a fraught working environment look abroad for fairer working conditions. This explains why four in ten junior doctors are actively looking to leave the NHS “as soon as they can”.

Staff leaving the NHS then creates shortages, stress and a vicious cycle of poor wellbeing, low empathy and subsequent patient errors.

Good business sense

Some trials have measured the cost-effectiveness of empathy training for doctors and found it to make good business sense. Poor mental health is the main cause of absenteeism in the NHS, accounting for 2.5 days a year per employee in 2019, costing the NHS £600 million a year. If this could be reduced by just 10% through empathy training, then staff and patients would benefit.

The evidence that increased empathy benefits patients (through fewer errors and better outcomes such as reduced pain) and doctors (through higher levels of wellbeing and resilience) is clear. Efforts to implement evidence-based empathy training (sometimes taking as little as two hours) for healthcare practitioners should be encouraged, and medical schools should include empathy as a core component of their curricula.

Jeremy Howick does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.