Why empathy is an upside-down concept

Empathy, according to the definition favoured by Howick et al., comprises three components.¹ The first is to understand another person’s situation, essentially putting oneself in another’s shoes. Next is to communicate that understanding and check its accuracy. The final step is to act on that understanding in a helpful way.

While this sequence of behaviour might seem obvious, it proves hard to incorporate into modern clinical encounters. When clinicians had few treatment options, more time was available to sympathise, if not empathise, with a patient’s plight. The proliferation of diagnostic tests and treatments that marks the era of modern medicine shifted focus away from the person to the problem. Evidence-based medicine added another layer of depersonalisation to clinical care.

The challenge then, as we increasingly acknowledge the limits of modern medicine, is to seamlessly integrate the principles of empathy into day-to-day clinical care. In their commentary, Howick et al. deconstruct empathy, explaining it from first principles, and call for a paradigm shift in clinical practice to ensure that empathy is central in the work of all clinicians. The modern era demands this of us at the very least.

Other authors call for a radical redesign of NHS service delivery.² The command and control model currently favoured to run the NHS presents several problems, two to which are that it lends itself to political interference and disenfranchises frontline staff. A better way would be to hand power to the people at the coalface of service delivery, the clinical staff. This is a model employed by some successful businesses, such as Timpsons, and the authors propose an ‘upside-down’ approach to running the NHS.

Call it ‘upside-down’ or ‘bottom-up’ but it seems logical that any NHS reform, for example to ensure that empathy is central to clinical practice, is best led by clinicians. Each month, our articles from the James Lind Library remind us of past times when clinicians and researchers led advances in clinical care and medical science. Not all was rosy then, of course, but empowering staff is a more likely, empathic route to success than exerting power over them.