The Role of Empathy in Therapeutic Relationships

I couldn’t help but roll my eyes. I was at a mandatory “training session” on patient communication for all clinicians at my institution. There, I was being coached on how to properly talk to patients. In theory, this isn’t a bad thing—we all need more education on how to facilitate inclusive and equitable conversations with patients.¹ But here, I couldn’t help but feel a sense that I was being manipulated by the institution to improve patient satisfaction numbers by giving an affect of empathy. And this training is not just at my institution; these sessions are becoming increasingly commonplace in hospitals and clinics throughout the U.S. and the world.

Anyway, five long hours later—full of mandatory reflections, fun role-playing skits and team-building activities—I left with a greater curiosity about the patient-clinician relationship and the role of empathy in fostering it. Although it wasn’t the intended message, the one thing I learned during my five hours is that the American healthcare system is prompting us to commoditize empathy to improve revenue and profits. This is, needless to say, a very dangerous development.

So how can we, as clinicians, maintain and build our therapeutic alliances with patients based on the core principles of compassion and empathy? Let’s rheuminate.

Empathy vs. Sympathy

A lot has been written about empathy—and just like any other literature, there is a lot of rigorous evidence and theory, and there is a lot of less than high-quality literature.² Studying a concept like empathy, which is enormously subjective, from a scientific standpoint becomes a slippery slope.³ Worse yet is that empathy is often confused for other, related concepts, such as sympathy and compassion. Sympathy reflects “feelings of pity and sorrow for someone’s misfortune,” whereas empathy is “the ability to understand and share the feelings of another.”^4,5

With respect to rheumatology, sympathy can come in many forms. A recognition of the impact of pain or disability may drive a sense of sympathy. But this sympathy can be paternalistic and misguided. After all, the experience of chronic illness is not really a misfortune—the term is stigmatizing and disempowering. Sympathy may also compel us to do things that are not in the patients’ interest, in earnest but potentially harmful attempts to remove that sense of misfortune and make ourselves—but not necessarily the patient—feel better.

This is in contrast to empathy, which doesn’t have that normative aspect of pity or sorrow. As rheumatologists, we can empathize with our patients’ sense of pain and disability as well as with their sense of determination and connectedness to the world. True empathy is much more difficult to experience because it rests on an effort to communicate for understanding. It’s a skill that requires dedicated practice and self-reflection. Empathy is also much more likely to be bidirectional—in that, once we truly empathize with patients, our patients can start to truly empathize with us. In short, empathy is at the heart of a healthy patient-clinician relationship.