Empathy: A critical skill for patient-centered communication

Patients highlight listening and empathy – “the ability to understand the patient’s situation, perspective, and feelings and to communicate that understanding to the patient”1 – as two of the most important qualities they look for when choosing a physician.

Despite this, studies of patient-physician communication show that physicians interrupt their patients, on average, within the first 18-30 seconds.2,3 In one study, where physician interactions with lung cancer patients were audio recorded, physicians responded empathically to statements of distress only 10 percent of the time.4
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The good news is that physicians, medical students and staff – and even people who say they are not empathic by nature – can improve their empathic listening skills. Like any other skill, empathic listening can be learned and practiced with a health communication specialist.

During practice sessions, participants discuss how to identify patients in distress (because the patient won’t always explicitly express how they’re coping), and what types of statements patients identify as helpful versus which can be harmful to the patient-provider relationship. For instance, take a simple example like this:

A patient is talking with their physician about shoulder pain after a recent injury.

Patient: “I can’t concentrate at work; I haven’t been to the gym in weeks; and sleeping is close to impossible.”

Physician: “On a scale of 1 to 10, how bad is the pain?”

While this question might be useful to the physician, it does not show the patient that the physician is directly listening. In general, questions are not empathic. An empathic response will acknowledge or explore the patient’s concern. Two options here would be to either echo or explore the statement more. For example:

Echoing response:  “So, it sounds like the pain is keeping you from your daily activities.”

Exploring response:  “Can you tell me more about this experience?”

While there are numerous acceptable ways to respond to a patient’s concerns, an empathic response is one that acknowledges or explores the patient’s feelings. Both examples above show the patient that the physician recognizes their feelings. If this opportunity is missed, especially in the first few minutes of the interaction, the patient’s trust could be lost.

To learn more about empathic listening and responding, contact Health Communication and Training Specialist Mychal Voorhees at 314-362-4734 or mychal.voorhees@wustl.edu. Mychal offers individual and small-group consultations as well as presentations for groups and departments, all free of charge.


Here are a few of Mychal’s favorite resources to start with:

“Attending: Medicine, Mindfulness, and Humanity” by Ronald Epstein, M.D. (book)

Schwartz Center for Compassionate Healthcare

“There is No Good Card for This” by Emily McDowell & Kelsey Crowe (book)



  1. Coulehan, et al. (2001). “Let me see if I have this right…”:Words that build empathy. Annals of Internal Medicine, 135(3): 221-7.
  2. Smith, et al. (1995).  A strategy for improving patient satisfaction by the intensive training of residents in psychosocial medicine: a controlled, randomized study. Academic Medicine, 70(8): 729-32.
  3. Joshi, N. (2015, Jan 4). Doctor, shut up and listen. The New York Times. Retrieved from https://www.nytimes.com/2015/01/05/opinion/doctor-shut-up-and-listen.html
  4. Morse, D.S., Edwardsen, E.A., and Gordon, H.S. (2008). Missed opportunities for interval empathy in lung cancer communication. Archives of Internal Medicine, 168(17): 1853–1858.