John Goldie is a retired GP and medical educator
Empathy requires time and continuity — resources increasingly scarce in today’s general practice. In Scotland’s most deprived communities, these pressures are felt most acutely. Towards the end of my career, our practice became involved in the Deep End Project,¹ which supports GPs working in such settings. With additional funding, we were able to experiment with longer consultations, targeting patients who frequently use GP services in an attempt to establish if and where there was a problem meeting their needs.
Those appointments became some of the most disorienting and humbling encounters of my professional life. Patients I had known for years told me stories I had never heard. Their pasts — often painful, often hidden — surfaced in ways that left me feeling out of my depth. Yet these conversations opened a door into a different way of practising.
Our guiding philosophy was simple: we are all in the process of becoming. Martin Buber’s idea of Confirming the Other captures this.² When we meet a patient as someone fixed — shaped and limited by their past — we deny their potential. When we meet them as someone becoming, we help make their possibilities real.
Those appointments became some of the most disorienting and humbling encounters of my professional life.
Longer consultations made this visible. They reminded me that empathy is not a technique but a way of being. It is often blurred with sympathy or compassion. As Brené Brown notes, sympathy, feeling for someone, creates distance; empathy, feeling with someone, creates connection.³ Carl Rogers’ definition⁴ remains the clearest: to perceive another’s internal world ‘as if’ it were your own, without losing the sense that it is theirs, and to reflect it back without judgement. Howick and colleagues’ recent synthesis echoes this: empathy is an active, relational process, not a static trait.⁵
Crucially, empathy must be learned in an empathic environment. General Practice rarely provides this. We are expected to be empathic without the reflective space, feedback, or emotional scaffolding that makes empathy possible.
In the consultation, empathy develops between two people, each in flux. When the patient’s world becomes clear to the GP, we can move within it more freely, naming meanings the patient may only dimly sense. Even a small amount of empathic understanding can be transformative.
But empathy requires inner work. It asks the GP to be congruent — aware of their own feelings rather than hiding behind the professional distance instilled by the hidden curriculum of biomedical training. It asks us to allow ourselves positive feelings such as warmth, liking, or respect, even though we often fear these will lead to dependency or disappointment.4 When we retreat behind early diagnostic formulations, we risk objectifying the patient and freezing them in place.
Empathy also requires separateness. To sense a patient’s fear, anger, or despair ‘as if’ it were our own — yet without being engulfed by it — demands confidence in our boundaries. If we can remain ourselves in the presence of another’s distress, we can go deeper in understanding and acceptance.
And empathy requires allowing patients to be who they are — despairing or hopeful, infantile or self assured — without selectively approving or disapproving of their feelings. Often our disapproval arises from our own discomfort.⁴ When we try to mould patients into what we think they should be, or keep them dependent on our advice, we undermine their capacity to grow.
Empathy is not a luxury. It is the ground on which healing relationships are built — and the ground on which we remain whole.
A relationship free from judgement helps patients recognise that the centre of responsibility lies within themselves. This is not indulgence; it is the foundation of therapeutic change.
When the funding ended, we returned to shorter consultations — the reality of modern practice. Yet the experience stayed with me. A more empathic approach improves outcomes, increases satisfaction, and protects clinicians from burnout. But it requires time, support, and investment.
Sustaining empathy also requires deliberate practice. Clinicians can nurture it by:
• Protecting regular reflective time focused on how consultations unfolded.
• Attending to patient narratives rather than scores.
• Offering occasional longer appointments for patients with complex, unresolved distress.
• Normalising discussion of difficult clinician emotions within peer or supervisory relationships.
• Strengthening informal mentorship and peer support, especially in deprived settings.
• Joining Balint groups, where available.
These steps do not remove pressure, but they help preserve the relational conditions in which empathy can arise.
Empathy is not a luxury. It is the ground on which healing relationships are built — and the ground on which we remain whole. Every act of empathic attention confirms the patient’s capacity to become — and reminds us that we, too, are still becoming.
References
1. Watt G et al. General Practitioners at the Deep End: The experience and views of general practitioners working in the most severely deprived areas of Scotland. Occas Pap R Coll Gen Pract. 2012 Apr;(89):i-40.
2. Buber M, Rogers C. The Martin Buber–Carl Rogers Dialogue: A New Transcript with Commentary, edited by Rob Anderson and Kenneth N. Cissna. State University of New York Press. 1997
3. Brown B. I thought it was just me (but it isn’t): making the journey from “what will people think?” to “I am enough”. New York: Avery. 2008.
4. Rogers C. The Carl Rogers Reader. Eds H. Kirschenbaum, V L Henderson. Boston: Houghton Mifflin. 1989.
5. Howick J, Bennett-Weston A, Dudko M, Eva K. Uncovering the components of therapeutic empathy through thematic analysis of existing definitions. Patient Educ Couns 2024; 131: 108596.
Featured image: by Krystian Tambur on Unsplash
