Flexible empathy – the key to resilience?

It’s such a simple idea – but hugely useful in day to day practice.

Empathy has long been recognised as a critical component of good nursing or medical practice but in talking with healthcare audiences we often hear confused ideas. What’s the difference between empathy and compassion? Does too much empathy lead to burnout? How does empathy relate to the technical knowledge and skill that’s also so important in healthcare? Can we measure how empathetic a health professional is?

New research is clarifying these questions, as we heard during the ‘Compassion Week’ in San Francisco in November – a whole week of conferences about the science of compassion, compassion in healthcare, and compassion in the workplace and community.

Health professionals with high degrees of empathy feel the pain of their patients – literally. And empathy alone can increase the risk of burnout because the practitioner may develop what’s called “anxious empathy” – a painful state of suffering with the patient but not able to do anything about the suffering.

That’s where compassion come in. Compassion is the humane quality of understanding suffering (empathy) plus the motivation to relieve that suffering. Compassion is more a motive than a feeling. Unlike empathy alone – which causes a negative affect – compassion engenders a positive affect, a warm feeling of love and caring that benefits the giver as much as the receiver. Researchers have shown that training in empathy alone increases negative feelings but that subsequent compassion training reverses this effect, restoring positive feelings and increasing pro-social behaviour.

So what is “flexible empathy”?

Researchers have documented that the measured level of empathy of physicians correlates with patient outcomes. For instance a large study of insulin-dependent diabetics who rated their doctors for empathy showed a large reduction in emergency hospital admissions in those patient who rated their doctor as having ‘high empathy’. These kinds of studies reinforce the notion that doctors either have, or don’t have, empathy – as if this is some kine of fixed quality. The idea of flexible empathy is that mindful practitioners have the ability to turn their empathy on and off, sensitive to the context.

I work as an anaesthetic specialist in the operating room, in the ICU, and in the resuscitation bay of the emergency department. Much of my work is highly technical and my patients are often unconscious. Sometimes I have to act very swiftly to save a life in the drama of a sudden emergency. I need to be highly focused on the task, situationally aware, and acting with swift precision. There’s no room for my emotions. If I stopped to think about the human consequences of my actions, I might be paralysed with fear, or overcome with the tragedy of the event. That’s the time to turn off empathy.

Half an hour later, I might need to meet with the traumatised family of an accident victim. I know from personal experience that being the loved one of a critically injured patient is a place of exquisite vulnerability – the empathy and compassion of hospital staff makes a world of difference when you feel so frightened and helpless. So in responding to this situation as an anaesthetist, having turned off my empathy in the resuscitation room, I now need to turn it back on to offer compassion to the fearful family members. This is flexible empathy in action. It combines the best of clinical detachment with deep compassion.

Researchers have shown that subjects with the ability to modulate their empathy – flexible empathy – are more resilient. It lets health workers know it’s OK to be detached during technical care but also OK to show their softer sides when it’s time to offer emotional support to patients and families.

It’s such a useful concept, we think it should be widely taught in undergraduate training for all health professionals. What do you think?


One Response to “Flexible empathy – the key to resilience?”

  1. Birute Macys says:

    From a patient’s family perspective l believe flexible empathy is the foundation of what makes a great Doctor & Hospital. A Mission Statement on the wall or brochures mean nothing if staff do not back up the words with their actions. My Father used to say a good Doctor is a Human being first, Doctor second. He based that on those who had flexible empathy.I have spent over 40yrs in different Hospitals,met many Drs, Nurses,Hospitals & there is clearly a big difference between those eho believe in flexible empathy & those who do not. Not only do the patients feel safer in the hands of their Drs & medical staff but the families can leave the Hospital knowing their loved ones are receiving the best care possible. I understand there’s a fine line between combining Professional and Empathy but l know it’s not impossible.

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