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(Howick + 2017)

Overthrowing barriers to empathy in healthcare: empathy in the age of the Internet
Authors: J Howick, S Rees

Empathy-based medicine re-establishes relationship as the heart of healthcare. Practitioners often complain that their capacity to practise empathically is undermined by ‘tyrannical guidelines’,1 insufficient time and an ever-increasing burden of paperwork.2 Clinicians often see this system as lacking empathy – uninterested in practitioners’ perspectives, health or welfare. Within this context, it is unsurprising that NHS staff have significant work-related stress and ill health.3  As a result, patients suffer, claiming clinicians do not communicate adequately, often leaving their needs and concerns insufficiently addressed.4"


"A growing number of trials show that enhanced practitioner empathy can
  • reduce pain and 
  • anxiety,
  • together with several other health outcomes,6,7 
  • while improving general quality of care.8 
  • Empathic care also increases patient satisfaction, and can benefit the growing number of multimorbid patients,9 
  • increase practitioner wellbeing while reducing stress and burnout,10 and diminish medico-legal risks.11"
  • "Empathy-based medicine promises to improve patient outcomes, reduce practitioner burnout and save money"
"The new paradigm: celebrating the therapeutic benefits of empathy
In this new paradigm the heart of the consultation is the human relationship, and the following are fundamental:"


  • Role modelling
  • Exploiting existing technology
  • Training and development


1.Greenhalgh THowick JMaskrey N. Evidence Based Medicine Renaissance Group. Evidence based medicine: a movement in crisis? BMJ 2014; 348: g3725g3725Google Scholar CrossRefMedline
2.GP Magazine. Quarter of GPs spend half their time on paperwork. GP Online, Haymarket Media Group Limited, 2012.
3.National Institute for Health and Care Excellence. NHS Employers: National Key Finding Scores 2011–2015, LondonDepartment of Health2016Google Scholar
4.Parker SMClayton JMHancock K, . A systematic review of prognostic/end-of-life communication with adults in the advanced stages of a life-limiting illness: patient/caregiver preferences for the content, style, and timing of information. J Pain Symptom Manage 2007; 34: 8193Google ScholarCrossRefMedline
5.Tanaka H. Putting Patient Experience at the Centre of Clinical Practice, LondonThe King’s Fund2013Google Scholar
6.Howick JFanshawe TRMebius A, . Effects of changing practitioner empathy and patient expectations in healthcare consultations. Cochrane Database Syst Rev 2015; Issue 11. Art. No.: CD011934. Google Scholar CrossRef
7.Kelley JMGordon K-TLidia SJoe KHelen RThe influence of the patient-clinician relationship on healthcare outcomes: A systematic review and meta-analysis of randomized controlled trials. PLoS One 2014; 9: e94207e94207Google Scholar CrossRefMedline
8.Crawford MJRutter DManley C, . Systematic review of involving patients in the planning and development of health care. BMJ 2002; 325: 12631263Google Scholar CrossRefMedline
9.Mercer SWFitzpatrick BGuthrie B, . The CARE Plus study – a whole-system intervention to improve quality of life of primary care patients with multimorbidity in areas of high socioeconomic deprivation: exploratory cluster randomised controlled trial and cost-utility analysis. BMC Med 2016; 14: 8888Google Scholar CrossRefMedline
10.Thomas MRDyrbye LNHuntington JL, . How do distress and well-being relate to medical student empathy? A multicenter study. J Gen Int Med 2007; 22: 177183Google Scholar CrossRefMedline
11.Moore PJAdler NERobertson PAMedical malpractice: the effect of doctor-patient relations on medical patient perceptions and malpractice intentions. West J Med 2000; 173: 244250Google Scholar CrossRefMedline
12.Chassany OBoureau FLiard F, . Effects of training on general practitioners’ management of pain in osteoarthritis: a randomized multicenter study. J Rheumatol 2006; 33: 18271834Google Scholar Medline
13.Chaparro LEFurlan ADDeshpande AMailis-Gagnon AAtlas STurk DCOpioids compared with placebo or other treatments for chronic low back pain: an update of the Cochrane Review. Spine (Phila Pa 1976) 2014; 39: 556563Google Scholar CrossRefMedline
14.Pappas Y, Wei I, Car J, Majeed A and Sheikh A. Computer-assisted versus oral-and-written family history taking for identifying people with elevated risk of type 2 diabetes mellitus. Cochrane Database Syst Rev 2011. Issue 12, Art. No.: CD008489.
15.Rakel DPHoeft TJBarrett BPChewning BACraig BMNiu MPractitioner empathy and the duration of the common cold. Fam Med 2009; 41: 494501Google Scholar Medline
16.Mercer SWHiggins MBikker AM, . General practitioners’ empathy and health outcomes: a prospective observational study of consultations in areas of high and low deprivation. Ann Fam Med 2016; 14: 117124Google Scholar CrossRefMedline
17.McLean GGuthrie BMercer SWWatt GCGeneral practice funding underpins the persistence of the inverse care law: cross-sectional study in Scotland. Br J Gen Pract 2015; 65: e799e805Google Scholar CrossRefMedline
18.Painkillers cost NHS £442m, with north of England spend greatest, analysis reveals. Pharm J 2011.
19.Riess HThe impact of clinical empathy on patients and clinicians: understanding empathy’s side effects. Am J Bioeth Neurosci 2015; 6: 5153Google Scholar
20.Aronson JK. When I use a word… Empathy—fact and fiction. When I use a word Empathy—fact and fiction. BMJ Blogs, 2016.
21.Aronson JKJeffrey Aronson: When I use a word… A word about empathy. BMJ Blogs 2016; Google Scholar
22.Aronson JKJeffrey Aronson: When I use a word… Empathy and compassion. BMJ Blogs 2016; Scholar
23.Mercer SWReynolds WJEmpathy and quality of care. Br J Gen Pract 2002; 52: S9S12Google Scholar Medline
24.Hojat MGonnella JSNasca TJMangione SVeloksi JJMagee MThe Jefferson Scale of Physician Empathy: further psychometric data and differences by gender and specialty at item level. Acad Med 2002; 77: S58S60Google Scholar CrossRefMedline
25.Hordern JWhat’s wrong with ‘compassion’? Towards a political, philosophicaland theological context. Clin Ethics 2013; 8: 9197Google Scholar Link
26.Berwick DMEra 3 for medicine and health care. JAMA 2016; 315: 13291330Google Scholar CrossRefMedline
27.Ioannidis JPEvidence-based medicine has been hijacked: a report to David Sackett. J Clin Epidemiol 2016; 73: 82–8682–86Google Scholar CrossRef
28.Howick J, Steinkopf L, Ulyte A, Roberts AN and Meissner K. How empathetic is your doctor? A systematic review and meta-analysis of patient surveys. forthcoming 2017.
29.Black ADCar JPagliari C, . The impact of eHealth on the quality and safety of health care: a systematic overview. PLoS Med 2011; 8: e1000387e1000387Google Scholar CrossRefMedline
30.Susskind RSusskind D. The Future of the Professions: How Technology Will Transform the Work of Human Experts, OxfordOxford University Press2015Google Scholar
31.Bikker APMercer SWCotton PConnecting, Assessing, Responding and Empowering (CARE): a universal approach to person-centred, empathic healthcare encounters. Educ Prim Care 2012; 23: 454457Google Scholar Medline
32.Fitzgerald NHeywood SBikker AMercer SEnhancing empathy in healthcare: mixed-method evaluation of a pilot project implementing the CARE Approach in primary and community care settings in Scotland. J Compassionate Health Care 2014; 1. Google Scholar CrossRefMedline
33.Mistiaen Pvan Osch Mvan Vliet L, . The effect of patient-practitioner communication on pain: a systematic review. Eur J Pain 2015; 20: 675–688675–688Google Scholar
34.Riess HKelley JMBailey RWDunn EJPhillips MEmpathy training for resident physicians: a randomized controlled trial of a neuroscience-informed curriculum. J Gen Intern Med 2012; 27: 12801286Google Scholar CrossRefMedline