The field of medicine is facing a dilemma when it comes to empathy. On one hand, research has found that receiving empathy from caregivers—feeling understood and accepted—is critical for patient satisfaction, a key aspect of hospital reimbursement. On the other hand, over 60 percent of health care providers are experiencing burnout across professions, making now a harder time than ever to prioritize additional training.

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Will our health care system be able to embrace empathy as a core value going forward?

I recently spent an evening in front of a live audience in conversation with author, doctor, and empathy researcher Helen Riess to discuss her new book, The Empathy Effect. Riess—who has been a mentor and friend to me over several years—is an assistant professor of medicine and the director of the Empathy and Relational Science Program at Harvard Medical School and founder and chief scientific officer at Empathetics, which offers empathy training across industries. Her research suggests that empathy is a skill that can be taught—not something we just have or we don’t—and further research has found that empathic doctors have patients with greater adherence to medications, improved trust (fewer malpractice suits), and even reduced symptoms.

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How can health care providers learn skills to help others with an open heart when they already feel overworked, emotionally depleted, and cynical? In our conversation below, Riess and I address this difficult question, as well as other barriers to empathy, and explore how empathy can promote more meaningful work and greater compassion.

Eve Ekman: I want to start with a simple question: Why did you write this book and why now?

Dr. Helen Riess

Helen Riess: This topic has been very near and dear to me throughout my psychiatry training, and then it has become more and more critical as I’ve worked in the health care world, where I have seen a dramatic drop in empathy. Through my own clinical practice, I have heard many patients complain bitterly about a lack of empathy. They describe how little contact they actually have with their caregivers and how they’re treated like a number. Medical care has become so focused on getting people in and out of doctor’s offices that they are missing out on the true healing in a relationship that is so vital.

I started this book for the medical profession, but in my empathy training work, I get calls from every industry—from the law, to parenting, to business, and leadership. I’m confident that if everybody were given a choice, they would prefer a more empathic interaction than a less empathic interaction, and yet it’s still such an obstacle. We need training.

EE: I often hear people concerned that if they increase their empathy, they will be overwhelmed: “The world is so painful and stressful; how am I going to manage all of that?” What are your thoughts on the relationship between burnout and empathy?

HR: As you said, some people think that if they open their hearts to too many more people, they’re just going to be flooded with everyone’s burdens, and they’re going to be crushed by the needs and the emotional weight of connecting. Actually, I think that’s absolutely a risk, but I also think that the secret is learning self-regulation skills, such as meditating, learning how to name and identify emotions, how to manage them, and self-care.

Self-care practices are needed to simply “fill the tank.” I think what contributes to burnout is when the tank is empty and we don’t take time to fill it with what truly nourishes and soothes us. We keep trying to be a certain way (like compassionate) when we haven’t filled ourselves up adequately for the task. So I think empathy and self-care are really intricately interdependent.

Empathy can make us burn out if we don’t tend to ourselves, but empathy can also actually enliven and invigorate us. One author in the Journal of the American Medical Association, Michael Kearney, wrote about the concept of “exquisite empathy.” He used that phrase to refer to that magical moment when a person feels thoroughly cared about; it enlivens and quickens the relationship not just for the patient but also for the caregiver.

EE: There is a provocative viral video making the rounds among health care professionals suggesting that burnout is the wrong term and we should call it moral injury—the result of being asked to work in an environment that is toxic and untenable. Beyond not filling our own tanks, are there more systemic causes of burnout, whether it’s in a hospital or a company?

HR: Burnout is an interesting word, because I think it implies to the burned-out person that it’s their fault—that they’re not resilient, not tough, or that they’re weak. Statistics in the last ten years show that up to 60 percent of physicians are showing symptoms of burnout, with equal numbers of nurses. It can’t be that all of a sudden 60 percent of the workforce is unable to cope. Something’s happening within the whole system of health care. The disconnection in these systems is that the people making decisions about how medicine is practiced are not the ones in the frontlines.

Leaders who have never been doctors or nurses view health care as a business. In the last few decades, there’s been this “lean six sigma” approach to health care that has nearly dropped the humanity out of it and brought in the spirit of a Toyota factory, where you try to make the parts as cheaply as possible and get the workers to work as quickly as possible. We have kind of lost the magic of what a health care profession can offer. It really is the system that’s burning people out; it’s not that people have become somehow weak.

I think it’s a real challenge to figure out how health care workers can approach their leadership teams and help them to recognize that the organizations they lead are not going to get the outcomes that they want—which are happy, satisfied, and well-cared-for patients—if the providers working with them are emotionally and physically exhausted and deriving very little pleasure from their work.

EE: What other challenges do health care providers face when trying to be empathic?

The Empathy Effect: Seven Neuroscience-Based Keys for Transforming the Way We Live, Love, Work, and Connect Across Differences (Sounds True, 2018, 248 pages)

HR: I developed some training around how we maintain empathy even in the most challenging situations. It’s very easy to have empathy if a patient is nice and grateful. However, one example of a challenge is if patients are not so happy with whatever you prescribe—maybe it’s not working and they’re still having symptoms, and they’re calling you frequently because nothing is quite satisfying—that can become challenging merely because it can make physicians and caregivers feel helpless. And when they feel helpless, they don’t like that feeling. They may decide they don’t really like the patient that much and empathy is challenged.

What we were trying to do is help health caregivers see the vulnerability that the patient is feeling, and not dismiss them because they’re having an emotion, but actually figure out what’s going on so we help them with their specific needs. These skills also help with parenting and other important relationships. I wish I had known some of these empathy skills when I was raising my children. I’ve learned a lot along the way.

EE: One of the emotions that gets in the way of these beautiful reflections is a feeling of fear, like when we want to give money or a meal to a person living on the street who’s clearly in need, but feel fearful to engage because they appear mentally ill. How can we work with fear, when we feel threatened personally but actually want empathy to arise?

HR: Empathy is the antidote to fear. When we live in a state of fear, we close off our heart defensively, whereas empathy opens our hearts. As a society, we are living in a state of massive fear exaggeration right now, and it is really closing a lot of hearts and minds. We are all wired to recognize threats, and we recognize threats much more quickly than we recognize gratitude and opportunity. A large percentage of what we perceive as threatening we’re actually projecting out onto others.

So much of the tone that’s been set in medicine has been about rushing into getting the most out of everybody and acting as if there is such a scarcity in everything, which is a kind of fear. I think one of the biggest myths is to have everyone feel as if there’s just “not enough.” If we just flipped that around and said, “There’s enough for everyone,” I think we could ease up on everything. That abundance has to come from our leaders, but also from within.

I would love to see everyone in a leadership position learn about the value of valuing the people who work with you. To recognize that the more you invest in the people, the more you’re going to get out of your bottom line—and the more you use people and treat them like objects and want them to be a cog in the wheel, the more impoverished your organization is going to be. This applies to health care leaders, business leaders, and deans and presidents of all kinds of institutions of education.

EE: How do we train empathy in a way that leads to showing compassion and actually taking action to relieve suffering?

HR: Opening our perceptions of what’s going on in other people typically leads to empathic concern, but the concern doesn’t always lead to action. That transition to compassion has to come from a more reflective life, where you don’t just pass by a homeless person and think, “Oh, I should help,” but never do. We can reflect on the abundance we live with, about humanity as a brotherhood, and the possibility of joining with other people in the journey to have a more compassionate society. The fact that things aren’t this way can embolden us to do more.

EE: In your book, I was really struck by your sharing of your painful personal experiences and how that made you more open to empathy. If people got in touch with their own struggles, would this help them be more present, open, and caring to others?

HR: We know that when people have struggled, they’re much more able to relate to people who have similar struggles. Let’s work toward the end of our conversation with a quote by Carl Jung, who said that “the sole purpose of life is to kindle the light in the darkness of mere being.” And when you think about empathy, I think of it as a light that we’re able to put forth into the world. That just puts a little light into someone’s experience. It doesn’t have to be a heavy lift; it could be a kind word or a knowing look or a nice smile at somebody. But if we think that the sole purpose of life is to kindle the light in the darkness of mere being, there is a lot of darkness in life. We all can make the life of others lighter.

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