Empathy: The Heartbeat of Medicine - Annals of Internal Medicine: Fresh Look Blog


Wednesday, July 19, 2023

Empathy: The Heartbeat of Medicine

Last week, I was called to the emergency department to see a new patient with a diagnosis of deep venous thrombosis. After carefully assessing the situation, I advised anticoagulation as a recommended treatment. We had a detailed shared decision-making conversation with the patient about the indications, benefits, risks, and alternatives involved. He agreed to proceed with anticoagulation.

The patient’s wife was present at the bedside. Although she remained quiet, I couldn’t help but notice the frustration on her face and intentional avoidance of eye contact with me.

I started questioning myself, “Did I do something wrong that upset her?”

I approached the patient’s wife and asked if there were any questions I could answer or if there was anything I could do to assist her. She shook her head, indicating no. Suddenly, while we were talking, she burst into tears.

She said to me, “Our daughter died 2 weeks ago due to bleeding caused by the same medicine.”

It dawned on me that her feelings weren’t directed at me, but rather, she was deeply frightened and overwhelmed, believing that she lost her beloved daughter due to the same medication I was prescribing for her husband. I sat down beside her and put my hand gently on her shoulder. At that moment, a deep bond formed between us, revealing the transformative power of empathy.

Every human being in this world has some sort of struggle, regardless of how rich or educated we are. Imagine what it is like to be a patient, a patient’s family member. Empathy is our ability to sense and understand other people’s thoughts, perspectives, and preferences. Empathy enables physicians to comprehend the nonverbal needs of patients and their families, surpassing the limitations of routine questioning. By attuning to subtle cues and unspoken concerns, physicians can cultivate a deeper understanding and forge a genuine connection to enhance the quality of health care delivery. Sir William Osler said, “A good physician treats the disease; a great physician treats the patient who has the disease.

Empathy is the true art of medicine that gives us fulfillment as physicians to make a difference in our patients’ lives along with building rewarding human connections. Physicians can become patients at any given time, and the perspective from the other side of the bed can be remarkably distinct. Sometimes, without even realizing it, we tend to overlook or ignore patients’ discomfort. In an On Being a Doctor essay, Dr. Norden shared his experience of how he became a more empathic physician after being diagnosed with metastatic renal cancer (1). His personal experience provided a profound realization that side effects can appear insignificant when we are not directly affected by them. It’s crucial to recognize and respect the fact that every patient has their own individual preferences when it comes to their treatment. Some patients may prioritize being heard and having their situations and concerns understood. By actively listening and demonstrating appreciation for their perspective, we can truly deliver patient-centered care that meets their needs. Research has shown that empathy improves both perceptions of care and clinical outcomes. One study of over 20,000 diabetic patients showed that patients of physicians with high empathy scores had significantly lower rates of metabolic complications (2).

The distinction of a single letter (u vs. a) in the words “curing” and “caring” carries substantial significance. While our aspiration as clinicians is to cure our patients through our care, the truth is that cure is not always attainable. Nevertheless, by understanding and acknowledging their needs and concerns, we can consistently provide empathic care to our patients.


  1. Norden C. I had to get cancer to become a more empathetic doctor. Ann Intern Med. 2016;165:525-526. [PMID: 27699400] doi:10.7326/M16-1243
  2. Del Canale S, Louis DZ, Maio V, et al. The relationship between physician empathy and disease complications: an empirical study of primary care physicians and their diabetic patients in Parma, Italy. Acad Med. 2012;87:1243-9. [PMID: 22836852]

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