Clarifying empathy: the first step to more humane clinical care.

Abstract

Currently, empathy and the ‘humanisation’ of medical care are of particular concern in the wake of high-profile reports. These include the Mid Staffordshire NHS Foundation Trust public inquiry; Dying Without Dignity , a report by the Health Service Ombudsman into end-of-life-care; and the Leadership Alliance for the Care of Dying People report, One Chance to Get it Right .1–3 These reports all pointed to an empathy deficit in clinical care. A disheartening aspect of the current situation is that empathy deficit is not a new phenomenon. In 1927, in a seminal study Peabody wrote: ‘One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient.’ 4 Twenty years ago, Weatherall argued that many of the ills of the medical profession reflect a lack of ‘whole person understanding’.5 More recently, Spiro observed that doctors who used to listen to patients now looked at a screen. He wrote: ‘Empathy has always been and will always be among the physician’s most essential tools of practice.’ 6 Spiro argues that physicians must have the time to listen to patients.7 However, medicine’s positivist view prioritises technical progress, evidence-based medicine, targets, and efficiency, so risking a view of patients solely as objects of intellectual interest.8 Mattingly suggests that, because the medical culture does not consistently support the practice of empathy, it becomes easy for doctors to see empathy as ‘nice’ but not an essential part of practice.9 Doctors have always struggled to achieve a balance in their relationship with patients between connection and distance. Doctors can choose between a narrow technical approach based on their competence, or a broader humanistic approach that is more ambiguous and less reductionist.10 The way in which …