How to DO empathy
I’ve written previously about empathy and compassion, but a recent experience highlighted just how much is misunderstood on how to do empathy. Empathy is, to start with, an individually experienced feeling, however it is also expressed through conversation. Advice often focuses on either higher level strategies, e.g. ‘make the patient feel heard’, or, if it does focus on the how of a strategy, it is often amorphous concepts like ‘active listening’ or set turns of phrase that, when deployed as one off statements, aren’t necessarily in keeping with how the rest of the conversation has progressed.
Three months ago I had surgery. It was a big surgery and it hurt. Following a period of patient controlled analgesia, I was switched to oral pain medications. For a procedure a few years prior I had been prescribed the same medication and it really didn’t agree with me. I felt wildly spacey and just plain off. So a member of the pain team came to visit. Luckily, this person was a pain specialist and explained to me that I must be the one in five people who don’t do well on that medication. He switched me to another medication and everything seemed like it would go smoothly for pain management.
The next day, however, I received different information about managing pain post-discharge from the nursing staff, based on what the pain team that morning had told them. This was along with other issues in the discharge information overall. The doctor from the pain team that morning was different and I was prescribed much less pain relief for discharge. He had not seen me, so I requested a consultation. Apparently two of the team had been around already, but unfortunately their rounding involved chatting outside my room, which I had heard, rather than to me personally. Needless to say, they were less than pleased at being asked to return.
That conversation was quite different from the one the day before. It was patronising throughout and ended with the doctor tilting his head, smiling softly, and saying to me “but I think you’re doing a great job”. This was so at odds with the conversation that had just occurred that it added to how patronised I had felt. The statement was so obviously trying to tack empathy onto the end.
But genuine empathy doesn’t work like that. A just released systematic review of research into empathy in real healthcare consultations found that empathy can, instead, be used to within consultations to facilitate not just the relational agenda but the clinical one too. This is similar to how we found that social talk can be used. Across the reviewed studies, the authors identified eight different empathy communication practices, also showing that displays of empathy need not always be affiliative with patients’ perspectives to be effective.
When empathy is integrated across consultations, it does not lengthen them. In identifying how empathy is used in practice and that it is not consultation-lengthening as often feared, the authors state, this “supports the notion that empathy is not an optional addition to care but a core component that can contribute to better health outcomes, adherence to treatment, and overall patient satisfaction.”
Doing empathy effectively in practice involves engaging with the complexity of social interaction and the need to use strategies in context sensitive ways. That is, clinicians need to consider when and how they will demonstrate empathy in real time as the conversation unfolds. This can be supported through engagement with real consultations, which I also argue for here.
“Far from distracting from clinical goals, empathy can enhance patient engagement, facilitate emotional expression, support problem-solving, and help reconcile differing patient and HCP perspectives, making it an essential element of care.” (Ta et al 2026).
Looking forward to hearing your thoughts on this great review.
Sarah
p.s. if you’re wondering what I said in reply to “but I think you’re doing a great job”, it was a flat but firm “yes I am”, which took him by surprise to that he promptly took his leave.