Understanding why empathy is hard to maintain in clinical practice

Empathy is often seen as a natural and essential part of the patient encounter - but reality tends to look quite different. In a new doctoral thesis from Umeå University, doctors describe how not only time pressure, but also the structure of medical education and the culture of the workplace, can make it difficult to live up to the ideal.

In her thesis, Johanna von Knorring interviewed medical students, practicing doctors, and patients about how they experience and understand empathy in healthcare. The results show that empathy is relational and constantly changing - and that it is influenced by far more than an individual doctor's will or personality.

Participants in the study describe empathy as difficult to define, yet a natural part of a good healthcare encounter. It involves being present, listening actively and meeting the patient as a whole person - not just as a diagnosis. For patients, an empathetic approach can help create safety, trust and greater involvement in their own care.

Although empathy is considered an ideal, the study highlights how difficult it can be to achieve in everyday practice. Medical students say that empathy is given attention in the early stages of their education, but once they enter the clinical environment, they face a reality shaped by time constraints, documentation demands and a strong focus on technical and medical efficiency - all of which make it harder to remain empathetically present.

There is a clash between what you've been taught to strive for and what you're actually able to do in your daily work."

Johanna von Knorring, doctoral student, Department of Clinical Sciences and the Industrial Doctoral School at Umeå University

Experienced doctors also describe how their empathy is negatively affected by the work environment, organisational conditions and a workplace culture that often prioritises efficiency over relational care. Many hope to serve as role models for younger colleagues - but find that there is limited space for reflection and discussion on patient interaction. At the same time, they emphasise that empathy does not disappear, but that it requires ongoing effort and support to be maintained.

Patients in the study show great understanding of the challenges faced by healthcare professionals but still call for a more person-centered approach - to be seen, heard and taken seriously. For them, empathy is not a bonus but a fundamental part of quality care.

In summary, the thesis shows that empathy does not simply emerge in the encounter between two individuals. It is shaped by the design of medical education, workplace cultures and the values embedded in the healthcare system.

"We need to understand empathy as something shaped and reshaped by its context. Creating better conditions for doctors to maintain and develop their empathy is a shared responsibility - one that rests with individuals, educational institutions and healthcare organisations," says Johanna von Knorring.