Greater empathy reduces problems with patient care

Professor Jeremy Howick

Greater levels of compassion from hospital and clinical staff can reduce persistent problems with patient care says a University expert in empathy.

Professor Jeremy Howick is Director of the Stoneygate Centre for Excellence in Empathic Healthcare, which officially opened last year. 

The centre is embedding a new approach to medical education and training with empathy at its very heart through ground-breaking research, a revolutionary new medical curriculum and professional development training across the wider healthcare sector. 

Professor Howick’s comments echo those of Rob Behrens, the UK’s parliamentary and health service ombudsman, who recently commented in The Times that avoiding fatal patient safety failures required a more “empathetic and collaborative approach from doctors.”

Professor Howick said: “Reporters from the Times Health Commission, which aims to highlight health sector problems and suggest solutions, have also cited research that states many of the 48,000 sepsis deaths per year are avoidable. Behrens investigated sepsis deaths in 2013 and found that the “same mistakes” are being made a decade later.

“The same is true for maternity care. The 2013 Francis report into maternity services at the Mid Staffordshire NHS Foundation Trust stated that inaction in the face of death rates that were out of the ordinary probably wouldn’t have occurred if “empathy for the predicament of patients” had constantly been at the forefront of healthcare professionals’ minds.

“As with sepsis, the problems pervading maternity care have persisted despite damning reports. Two reports published in 2022 regarding avoidable infant and maternal deaths at Shrewsbury and East Kent NHS hospitals also cite lack of empathy and compassion as a cause of the tragedies.

“Evidence supports the idea that more empathy in hospitals and clinics – commonly taken to involve understanding and taking action – would reduce many persistent problems with patient care. As well as reducing patient complaints and medical errors, clinical trials have shown that if a healthcare professional shows empathy it can reduce pain (both chronic and acute) and post-operative morphine use, and improve immunity in post-operative patients.”

Other studies have also found that higher healthcare practitioner empathy is associated with lower mortality in diabetic patients.

Professor Howick added that contrary to common assumption, empathy did not increase the risk of “compassion fatigue”, akin to burnout and caused by resonating with patients’ pain

He said: “Dozens of studies have shown that in fact greater empathy decreases practitioner burnout

“This seems to be because empathic healthcare professionals get in touch with the wonderful work they do with patients and develop a keener sense of purpose, which builds resilience.”

Regrettably, studies demonstrate that the extent to which patients report that their doctors are empathic varies widely. 

“Worse, medical student empathy declines as they progress through medical school. This is due to a “hidden curriculum” that includes role models who do not display empathy, and an unduly stressful environment, inhibiting medical students’ mental health and ability to empathise,” he said.

The decline of empathy is accompanied by a decline in wellbeing

“Whereas students enter medical school with comparable levels of wellbeing to their peers, by the end it is worse, with medical students reporting higher levels of depression (39% versus 34%) and anxiety (47% versus 39%). Anxiety inhibits people’s ability to empathise.

“Depressingly, the trend towards worse mental health and lower empathy continues beyond medical school, with mental illness and suicide rates worryingly high. More than one in three junior doctors in the UK experience burnout with inevitable empathy decline a consequence of this.

“Traumatic medical training is bleeding into clinical practice. Junior doctors thrown into a fraught working environment look abroad for fairer working conditions. This explains why four in ten junior doctors are actively looking to leave the NHS “as soon as they can.”

“Staff leaving the NHS creates shortages, stress and a vicious cycle of poor wellbeing, low empathy and subsequent patient errors.”

Professor Howick said that some trials measuring the cost-effectiveness of empathy training for doctors found it made good business sense because poor mental health was the main cause of absenteeism in the NHS – costing the NHS around £600 million a year. 

He said: “If this could be reduced by just 10% through empathy training, staff and patients would benefit.

“The evidence that increased empathy benefits patients (through fewer errors and better outcomes such as reduced pain) and doctors (through higher levels of wellbeing and resilience) is clear. Efforts to implement evidence-based empathy training for healthcare practitioners should be encouraged, and medical schools should include empathy as a core component of their curricula.

“That’s exactly what the Stoneygate Centre for Excellence in Empathic Healthcare is doing so that medical and healthcare students at the University receive the best training possible during their time here in a manner which benefits both them and patients in the long run too.”