Exploring how surgeons employ empathy in clinical practice: a qualitative study

Emotions are key factors in surgical disease and treatment, both in the surgeon and in the patient. Despite the recognition of the value of clinician empathy (Michalec and Hafferty, Soc Theory Health STH 20: 1–19, 2021), quantitative studies have shown that surgeons have lower empathy scores than other specialities (Walocha, et al., Folia Med Cracov 53:35–42, 2013, Hojat, Med Educ 52:456–7, 2018, Tariq, et al., J Coll Physicians Surg--Pak JCPSP 58:310–3, 2018). The reason for this is unclear, and little is known about how surgeons manage emotions in clinical settings. This study explored the role of empathy in surgical treatment and how surgeons respond to patient emotions, with the aim of creating a theory to explain this clinical process. We used an exploratory qualitative study in the Constructivist Grounded Theory tradition, utilising online individual semi-structured interviews with fourteen general surgeons. Surgeons described multiple discrete approaches to patients’ emotions. Participants were conscious of modulating their emotional response to patients depending on need, and systemic factors like urgency and setting. General approaches to patient emotions included emotion-facing and emotion-avoidant strategies. While the approach used was often tailored to the situation, surgeons usually had a preferred style. The degree of emotional engagement was particularly influenced by time available, and urgency. Participants described some techniques to influence the degree of emotional involvement, primarily by altering consultation times. The management of emotions by surgeons is nuanced and affected by contextual factors. Management is not entirely automatic or subconscious, but opportunities can be created or limited by the surgeon as required to facilitate effective treatment. The results offer a new perspective on surgeon empathy in the context of the limited existing literature.