“The Weight of the Pager on My Hip”: Lightening the Load of Empathy on Critical Care Physicians by Understanding its Limitations, A Qualitative Study

Abstract

Introduction: Empathy improves patient outcomes and increases perception of physician competence. However, empathy may contribute to biased decision-making and provider burnout. To help providers harness the benefits of empathy without the pitfalls, comprehensive knowledge about the practice of empathy is needed – particularly in high-stress contexts, such as in critical care. This qualitative study explores how critical care physicians experience empathy in intensive care units and how this might inform the medical education of critical care physicians throughout their training. Methods: Working from a constructivist orientation, we engaged in thematic analysis of semi-structured interviews with critical care physicians. We asked participants to describe their personal experiences of empathy including how they handled events requiring empathy, managed empathic distress, and reframed their understanding of empathy over time. Data analysis followed the six steps of thematic analysis and used Hoffman’s Theory of Empathy to further inform our understanding of the data. Results: We identified limitations of empathy in the intensivist experience, which were consistent with Hoffman’s theory of empathy. This theory describes arousal, habituation, and bias which were prevalent in the data. Further, intensivists altered their behavior due to these limitations and to manage empathic distress. Additionally, burnout as a consequence of empathy was identified, though interviewees discussed prevention methods and the development of resilience. Discussion: Empathy and empathic distress among intensivists have been understudied in the literature thus far. Our study reveals that critical care physicians acutely experience limitations of empathy to include over-arousal, habituation, and bias—all of which impact interactions with patients, physician stress, and physician burnout. The knowledge that fully trained intensivists struggle with the limitations of empathy has implications to all stages of physician education from medical student through continuing medical education for attendings since all must learn and practice the empathic skills required to optimize patient care and maintain their own wellness.