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We all prefer a doctor who listens to our concerns and expresses compassion for our suffering. But does physician empathy actually have a lasting impact on a patient’s health?
Empathy appears to decline among some medical students over the duration of their medical school training, and doctors often miss opportunities to offer it due to time constraints. Physicians also seem to show less empathy toward patients in lower socioeconomic groups and from non-white races. But they might be missing an important therapeutic tool.
A new study in JAMA finds that “very empathetic” doctors are associated with greater pain relief, better daily functioning, and higher quality life among people with chronic back pain compared with “slightly” empathetic doctors. Physician empathy was even more strongly associated with good outcomes on these measures than opioids, surgical interventions, and other non-drug treatments, such as exercise. The effect sizes were small, but clinically relevant, according to the researchers, and extended across a full year of follow-up.
It can be hard to exude empathy when you’ve got five minutes with somebody.
The power of this dynamic does not lie in metaphysical woo, says Subhash Aryal, a professor at Johns Hopkins School of Nursing and one of the authors of the study. “Empathy most likely facilitates more open communication between patients and physicians, so providers can tailor treatment plans based upon patient feedback and experience,” he writes over email. When patients feel like their experiences are taken into account, they may also adhere to treatment plans better, he adds. The results align with findings from his ongoing research on empathy and patient experience, but it was the first time his team tested the impacts of empathy on pain over a period longer than a few months. “Our goal is to lessen the burden” of chronic pain, says Aryal.
Aryal and his colleagues followed more than 1,400 chronic back pain patients, 75 percent of whom were women. Using patient surveys that asked about physicians’ listening, understanding, and compassion, the researchers categorized doctors as more or less empathetic. Patients answered survey questions five times over a year-long period to rate their pain, daily functionality, and quality of life—including anxiety, fatigue, depression, and sleep disturbance.
The average differences in pain levels found in the study were likely too small to make a difference in a patient’s day-to-day experience, says Vitaly Napadow, a pain researcher at Massachusetts General Hospital who was not involved in the study. That’s true even though empathy had a greater impact than other treatments, including opioids and spinal surgeries, he says. “It speaks to how little difference those other things make, unfortunately,” he says.
Over the past decade, evidence has begun to accumulate that a physician who is empathetic may not only help to relieve a patients’ pain, but also improve clinical outcomes, in terms of both physical and mental health. Empathy may matter because patients often need help opening up about what they’re experiencing, says Jodi Halpern, a psychiatrist at the University of California, Berkeley, whose research spans medical ethics and decision-making.
“We know that patients don’t just tell physicians what’s bothering them,” says. “They listen for little clues,” she says, that the doctor wants to hear more. “We are social animals,” Halpern adds. With more information, doctors can also find a more fitting diagnosis and build more of an alliance with the patient, which can help them follow through on treatment—even when it’s arduous, such as exercise for chronic pain.
Physician empathy was stronger than opioids, surgical interventions, and other non-drug treatments.
Studying something as nebulous as empathy brings its own challenges. For one, it can be difficult to define, particularly in the context of a brief, clinical interaction in a doctor’s office. Patient perceptions of empathy are also influenced by many factors, says Claire Ashton-James, a social psychologist at the University of Sydney who studies the interpersonal aspects of health care and pain. The numerical scores gathered on patient surveys, like the ones used in the new study, look simple, but they’re actually complex: They’re subjective snapshots taken after an interaction that can be difficult. A patient’s own expectations, personality, and pain levels all affect their ratings of doctors, complicating study results. “That’s not to say it’s not important. A small effect size suggests that there’s something worth investigating.”
Ashton-James, whose work involves empathy training for health care workers, targets barriers to empathy. Stigma, in particular, can get in the way, she says. “We all know how to be empathic, and we’re all naturally empathic towards certain groups,” she says. “The training of empathy shouldn’t be about behaviors, but about digging into their emotional response to patient groups,” particularly ones that are different from the doctor’s own, such as racial, ethnic, socioeconomic, or gender identity.
For doctors, empathy is a lot of work, says Napadow. It’s hard to be an empathetic doctor amid physician shortages and high rates of burnout. “There’s a crisis in this country,” he says, which only accelerated during the pandemic as health care workers left the industry. “It can be really hard to really exude empathy when you know you’ve got five minutes with somebody and then you’ve got to move on to the next patient.”
Empathy takes time, something many doctors lack. But Aryal and his colleagues say their striking findings suggest doctors should be encouraged to make the effort. 
Lead image: Alphavector / Shutterstock
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