The process of empathy: insights from John Berger's A Fortunate Man.

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A Fortunate Man: The Story of a Country Doctor , by John Berger and illustrated by Jean Mohr’s photographs, was published almost 50 years ago but has recently been reissued.1,2 Berger describes the work of Dr John Sassall, a rural GP in the Forest of Dean. Studying the book provides insights into the process of empathy. There is agreement that we need more of it in medical care, although conflicting evidence suggests that medical students experience a decline in their empathy levels during training.3–6 A Fortunate Man also warns of the dangers of going beyond empathy and becoming overwhelmed by the patients’ suffering.2 An interpretivist approach has been used to explore the text of Berger’s book through a phenomenological lens.7 This involves a double hermeneutic: the reader is interpreting Berger’s interpretation of Sassall’s views and experience of a 6-week period of his practice. Berger acknowledges the subjectivity of his observations and yet from a phenomenological perspective his insights resonate with the problems facing GPs today. The aim of this analysis is to identify themes relating to the process of empathy in the book and stimulate debate about empathic relationships in general practice today. Empathy is a complex, multifaceted construct that has been defined in many different ways.8 For some doctors empathy has been defined in narrow cognitive terms leading to a form of ‘detached concern’.4 This study adopts a broader approach highlighting empathy’s cognitive, affective, behavioural, and moral aspects.9,10 Berger is struck by Sassall’s connection with patients, seeing empathy as a relational process rather than a personal attribute. Sassall begins by spending time with the patient, appreciating the importance of the first contact and learning about the person before considering their illness:2 ‘“The door opens,” he …