Written by Damien Ridge, Professor of Health Studies, University of Westminster
Empathy helps ensure people receive the best quality healthcare, helps patients from all backgrounds and cultures receive care that works best for them, and helps patients feel safe about their healthcare procedures. But all too often, those working in healthcare can become burnt out – which may have a serious impact on their ability to relate to, and be empathetic, with patients.
Empathy can often be overlooked for its importance in patient care. However, being able to be empathetic can be difficult to achieve, especially since it may require staff to open themselves up to trauma and pain. Staff may not have time to nurture relationships with patients, and empathy also requires healthcare workers to be flexible in order to adapt to each patient and their unique needs, especially if a patient’s beliefs conflict with their own.
Burnout and empathy
These sorts of problems in care can also contribute to burnout, which is common in healthcare workers. Symptoms of burnout can include exhaustion, detachment, cynicism and a reduced sense of achievement, all of which makes quality patient care more difficult.
Burnout happens for a range of reasons, including high-pressure workplaces, lack of support, poor work-life balance or feeling a lack of control over, overwhelmed by, or in conflict with the work itself. Not surprisingly, research shows that as either empathy or burnout increases, the other one decreases – that is, they are negatively associated to each other.
But there’s a culture in the medical field that stigmatises mental health problems like burnout in doctors. And many GPs, for example, report not having the time to meaningfully relate to patients and colleagues. Yet being able to empathise with patients and colleagues is the very kind of nourishment they need.
Unlike some other professions, medicine also traditionally encourages practitioners to manage alone. In the NHS, where one in 12 posts remain vacant, and administration and patient loads can be “relentless”, this can be a recipe for disaster.
In a study my colleagues and I conducted exploring GPs’ experiences of workplace stress and their coping strategies, one GP told us, that they went into a stupor after coming home from work. This due to the large number of people they saw and the emotions they experienced without having time to process them. Another highlighted the constant fear GPs have of making mistakes.
Our research also shows how burnout creeps up on doctors, leaving them feeling broken and trapped. Not surprisingly, alcohol and drug dependencies are the most common medical problems for doctors after depression. Interestingly, however, we found that recovery from burnout could mean greater empathy for patients with mental health problems, as GPs might better understand the patient’s experiences.
Manageable case-loads, debriefing, peer and organisational support may all help people avoid (or recover from) burnout and low empathy. Some advice for those working in healthcare might be to set boundaries in your relationships with patients. For example, counsellors of abused children might have to remind themselves they are not the child’s parent. Healthcare professionals might also engage in self-care (such as taking time off, exercising, or meditating), and make time to regularly debrief with a colleague about difficult experiences.
But self-care can only go so far. Interestingly, the concept of “moral injury” is beginning to compete with “burnout” as a way of understanding the plight of healthcare workers. This is the idea that people can be exposed to trauma at work that violates their moral sense of right and wrong, resulting in a conflict with deeply held values and feelings like shame and betrayal.
Originally used to understand the experiences of war veterans, the term “moral injury” highlights the role of authorities in the way workers may violate their own morals, resulting in work dysfunction. An example of moral injury might be when doctors are so overworked their heads are “too full” to think straight, or when forced to choose which patient to admit into hospital first for treatment.
Cultivating empathy can be difficult for those working in the healthcare sector, especially when the stressful environment can make burnout common. But there is some research that higher empathy levels might protect against burnout.
While this link needs to be studied more, the researchers involved speculate that doctors able to better understand the perspective of their patients might feel more connected – and useful – to their patients. This could alleviate some of the stresses of the work.