Why physician empathy in health care delivery is so important

A patient with chronic low back pain on long-term opioid therapy visits the physician for a medication refill. The physician finds that the patient’s pain and functional status remains unchanged and questions the benefit of continuing opioid therapy.

The physician attempts to engage the patient in a discussion about opioid tapering in favor of nonpharmacological interventions or nonopioid medications. The patient replies, “I’ve tried all those things, and they don’t work. You’re saying to cut back on my pills, but I can’t even get going in the morning without them.”

The physician clarifies that opioid tapering is not an abrupt discontinuation or drastic reduction of the pain medicine, but a systematic approach to gradually diminishing opioid dosage to minimize any adverse impact on the patient’s lifestyle. The patient counters, “You said you wouldn’t decrease my pain medicine, and now you’re changing your mind.”

The physician further explains that cognitive behavioral therapy and other counseling programs are available during the tapering process, but the patient states, “You’re not listening to me. I may just have to find another doctor who cares about me.” Reluctantly, the physician refills the opioid prescription.

Unfortunately, such patient-physician encounters are not unusual. The desire for pain relief coupled with the potential harms of opioid therapy prompted the Centers for Disease Control and Prevention (CDC) to establish updated opioid prescribing guidelines in 2022. These highlight the key roles of physician empathy and shared decision-making in providing patient-centered care for chronic pain.

Studying chronic pain

My colleagues and I established the Pain Registry for Epidemiological, Clinical and Interventional Studies and Innovation (PRECISION) at the University of North Texas Health Science Center at Fort Worth to study the patient-physician relationship in chronic pain management. Physician empathy, compassion and shared decision-making are self-reported by registry participants using a digital research platform for electronic data capture throughout the contiguous United States.

A good patient-physician relationship is important when treating patients with poorly defined pain syndromes. Physician empathy enhances ongoing communication with such patients and may promote greater adherence to pain treatment recommendations. Empathy is closely intertwined with compassion. The authors of “Compassionomics,” a book that explores compassion in health care, suggest that empathy is “feeling,” and compassion is “action.” Their compiled data support the benefits of empathy and compassion in treating a variety of medical conditions.

Using PRECISION data, we reported in the Annals of Family Medicine that physician empathy was by far the strongest predictor of patient satisfaction with medical care for chronic pain. In fact, patients indicated that empathy was more important to them than their pain, their physical function outcomes or whether opioids were prescribed.

Empathy’s impact

In the April 2024 issue of JAMA Network Open, we reported that patients treated by very empathic physicians had better outcomes than those treated by physicians with less empathy. Over 12 months of follow-up, greater physician empathy was associated with less pain intensity, fewer back-related disabilities and better health-related quality of life involving physical function, anxiety and depression, sleep health and impact on social roles and activities.

Greater physician empathy was associated with better patient outcomes than costly, risky or invasive treatments such as opioid therapy or lumbar spine surgery.

Despite such benefits associated with physician empathy, some research has shown that medical students and residents may become less empathic during their education and training. This is often attributed to the ever-growing volume of information to be learned and a perceived need for objectivity in making medical decisions, ostensibly through patient detachment and reliance on technology.

However, incongruities between patient pain complaints and diagnostic test results make shared decision-making more complex.

Choices and chatbots

In the November 2024 issue of the Journal of Pain, we reported that patients who engaged in greater shared decision-making with their physician received opioid prescriptions for chronic low back pain more often over 12 months of follow-up. These surprising results should not be interpreted as evidence for abandoning shared decision-making, but rather as a clarion call for improving it through medical education and physician training.

Another study published in JAMA Internal Medicine found that responses from an artificial intelligence chatbot assistant were judged to have greater empathy than actual physician responses to patient questions posted to a social media forum. Health care practices that present challenges in providing empathic care include miscommunication, long working hours, understaffing, limited time for patients and the demands of keeping up with administrative tasks such as documentation.

Improving relationships

So, what can be done to improve the patient-physician relationship for patients with chronic pain? Although there has been a longstanding debate about whether empathy is an inborn or acquired trait, most experts believe that medical students and physicians can be trained to be more empathic. Several organizations have tested and implemented programs aimed at cultivating physician empathy.

A randomized controlled trial at the Massachusetts General Hospital and Harvard Medical School found that resident physicians became more empathic after participating in a short-term training program. New York University’s Langone Health has established the Center for Empathy in Medicine to promote empathy in the education of medical professionals. It also sponsors an empathy fellowship program that aims to develop a cadre of medical educators to be leaders in empathy curriculum development, implementation and education, both locally and nationally.

The concept of empathic health care systems has also emerged, in which organizations are structured to facilitate empathic interactions throughout their services to treat chronic pain and other medical conditions. As an example, Langone Health’s Empathy 360 is an enterprise-wide program to inspire empathy as a fundamental value and to have its 48,000 employees develop core skills through action, communication and connection.

Undoubtedly, more organizational initiatives and greater resources will be needed to enable health care professionals to develop and cultivate empathy as well as better communication skills. However, momentum is growing and initiatives to improve physician empathy and communication in health care delivery appear to be well worth the effort.

Related reading:

Compassion in medicine: It’s not just the right thing to do—it also makes the most cents

DO bridges neurology, education and the osteopathic philosophy