Empathy Meltdown? Why Burnout Busts Your Empathy Levels

Rachel Reiff Ellis

March 01, 2023

Compassion is borne out of a sense of empathy — the ability to understand and share the feelings of others. Studies on empathy show it to be crucial to quality healthcare and not just for patients.

In one study on empathy ratings among doctors, 87% of the public believe that compassion, or a clear and obvious desire to relieve suffering, is the most critical factor when choosing a doctor. In fact, it eclipses travel time, wait time, and cost on the list of sought-after physician features.

Wendie Trubow, MD, an ob/gyn in Newton, Massachusetts with over 25 years of experience in the medical field, says empathy has absolutely helped her be a better physician.

"Patients consistently mention how grateful they are that someone has listened to them and validated them," she says. "When patients feel heard and validated, they are more likely to communicate openly, and this raises the potential of being able to create treatment plans that they will actually participate in. Ultimately, it enriches patient care."

Mohammadreza Hojat, PhD, research professor of psychiatry and human behavior at the Asano-Gonnella Center for Research in Medical Education and Health Care at Thomas Jefferson University in Philadelphia, says that empirical research he and colleagues have done on empathy in health profession education and patient care over the past 20 years shows that empathic engagement in patient care is reciprocally beneficial for both clinicians and patients.

For example, Hojat notes that in one study, diabetic patients treated by empathic physicians (measured by the Jefferson Scale of Empathy) had more control over their disease when measured with laboratory test results such as hemoglobin A1c and LDL-C. In another, patients with diabetes treated by more empathic physicians had significantly lower rates of acute metabolic complications that required hospitalization.

For physicians, empathic relationships with your patients lead to fewer disputes, higher reimbursements, greater patient satisfaction, fewer malpractice lawsuits, and a more rewarding experience treating patients.

Different Types of Empathy

The importance of empathy in doctoring is evident, but Hojat says it's crucial to differentiate between clinical empathy and emotional empathy. One can enhance care, while the other, when overused, may lead to physician burnout.

In fact, he says, clinical empathy and emotional empathy have different consequences in a medical setting.

"The relationship between clinical empathy and clinical outcomes is linear, meaning that more empathic engagement leads to more positive clinical outcomes," says Hojat. "However, the relationship between emotional empathy and clinical outcomes is curvilinear, or an inverted U shape, similar to the association between anxiety and performance, meaning that limited emotional empathy or limited sympathetic engagement could be helpful, but its overabundance can hamper clinical relationships and objective clinical decision making."

The takeaway is that when physicians don't regulate their emotional empathy, it becomes an obstacle to clinical empathy, ultimately detrimental to healthcare outcomes.

When Burnout Hinders Empathy

Of course, the reverse is also true — burnout can make it harder for physicians to muster up empathy of any kind toward their patients. At least 53% of physicians show one or more symptoms of burnout, such as exhaustion, questioning the point of the work, cynicism, sarcasm, and the need to "vent" about patients or the job, according to Medscape's 'I Cry but No One Cares': Physician Burnout & Depression Report 2023.

Venting about patients can also be called "compassion fatigue," which is a sign that your ability to empathize with patients is compromised. You can still practice medicine, but you're not operating anywhere close to your optimum abilities.

"Generally, physicians who are burned out struggle with empathy since it's exactly what they're missing for themselves, and [they] often find it difficult to generate," says Trubow.

How To Manage Burnout and Boost Your Empathy

Burnout can happen for various reasons — pressure to cycle through scores of patients, too many bureaucratic tasks, less autonomy, frustration with electronic health record requirements, and too many work hours, according to the Medscape report.

A report in Family Practice Management finds there are two main goals for physicians to tackle when trying to reduce burnout symptoms: Lower your stress levels and improve your ability to recharge your energy accounts.

"For physicians experiencing burnout [and thus, a lack of empathy], the best approach to this situation is to first take a break and evaluate whether there are any structures to put in place to improve the situation; this can often improve a provider's empathy," says Trubow.

For example, physicians can look at ways to alleviate burnout by investing in leadership development, finding flexible work arrangements, reducing technological burdens, and limiting nonclinical activities.

Other strategies that can build up your reserves include connecting with colleagues, gaining a greater sense of control over your work, and having opportunities to grow and excel in your field. This requires not only a personal approach by physicians, but also a buy-in at an institutional level as well.

In Medscape's report, where 65% of physicians say burnout affects their relationships, physicians' coping methods include exercise, time with family and friends, time alone, sleep, music, and meditation.

"Clinical empathy must be placed in the realm of 'evidence-based' medicine," says Hojat. "Given our research findings that clinical empathy tends to erode as students progress through medical school, it is important that assessment and enhancement of clinical empathy be integrated into formal educational curriculum of medical schools and postgraduate training programs for professional development of physicians-in-training and in-practice."

"Burnout also leads to a large swath of physicians who aren't as empathetic toward their patients as they could be."
―  Danielle Ofri,  What Doctors Feel: How Emotions Affect the Practice of Medicine

Rachel Reiff Ellis is an Atlanta-based freelance writer and editor specializing in health and medicine. She is a regular writer for WebMD and Fortune Well, with additional work appearing in Prevention, Oprah Magazine, Women's Health and others.

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