Compassion Versus Empathy
By Karen Forshaw
GP Doncaster (Yorkshire & the Humber)
By Chrisssie Mowbray
Chartered Physiotherapist (Yorkshire)
When talking to patients, clinicians can sometimes feel overwhelmed by emotion. This may manifest as feeling low, sad or even as if you are going to cry. This can be an odd experience. It happens because we have, in effect, absorbed the other person’s emotion. This absorption is what is often referred to as “Empathy.”
The dictionary definition of empathy is as follows: The ability to understand and share the feelings of another.
Empathy is encouraged in medical education and seen as something to aspire to. We would like you to consider whether it is actually helpful to clinicians or indeed patients. Imagined events produce similar body chemicals to actual events, and so stepping into other people’s pain and misery multiple times every day, triggers stress hormone release within us and will eventually have an impact on our physical and mental health. Persistently high levels of cortisol and adrenaline lead to gastrointestinal symptoms, headaches, poor sleep and impaired memory and cognition. We can often go home drained and feel we have nothing left for our own families. Over time, this leads to burnout.
This is a high price to pay for connection with patients and in fact, we cannot truly know what another person is feeling. We each view the world through a unique lens, we each have different neural networks and we have each most definitely had different experiences. When we are being empathic, are we not, in fact, guessing how the other person is feeling? At best this will be based on our experience of seeing lots of other people who have been in the same situation but most likely it will be a projection of how we think we would feel if we were them. Even when we have had a similar experience, how it affects us and what we feel about the situation will be vastly different.
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Patients like empathic doctors but is it truly useful to them? Does it encourage them to give up responsibility for their health decisions to us? Does it, in fact, disempower them and encourage a paternalistic style of consulting?
Consider also that our patients deserve a professional who is fully functioning and clear headed. A clinician who is able to share knowledge in a clear way, helping them to understand what is happening and navigate the best course with them. When we are upset, we are less likely to make rational decisions and we can even fall into the trap of bias. We are also more likely to make mistakes.
What if rather than indulging in empathy we look instead to compassion.
The dictionary definition of compassion is as follows: ‘A strong feeing of sympathy and sadness for the suffering or bad luck of others and a wish to help them.’
In teaching about empathy, ‘sympathy’ is shown in a bad light. Feeling sorry for someone rather than feeling what they are feeling is frowned upon and we agree that feeling pity with no real concern is poor practice. Our definition of compassion, however, includes recognition of the impact of the problem on the patient and caring about it. This calls for a more intimate knowledge of the patient and also encourages their contribution to the consultation. It does involve emotion but in the form of deep concern, however, the clinician themself is not hampered by the sometimes crippling effects of pain, grief and fear, and is therefore able to be more helpful to the patient. We would argue that this approach encourages us to feel for someone not with them and to act in their best interests with a clear head.
A study of palliative patients who were asked to choose between sympathy, empathy and compassion, preferred compassion in their clinicians. They liked empathy but felt their doctors were more effective when they were compassionate.
To avoid burnout and to provide what your patients really need, be aware of the difference between empathy and compassion and consider protecting yourself from absorbing emotions that are not your own. Start to recognise when it is happening and ask yourself if this is the best approach for all involved.
The link below takes you to a meditative exercise to help protect you from external influences:
Here is a link to a wellbeing article on the importance of being careful with empathy:
 Sinclair S, Beamer K, Hack TF, et al. Sympathy, empathy, and compassion: A grounded theory study of palliative care patients’ understandings, experiences, and preferences. Palliat Med. 2017;31(5):437-447.