title: Managing barriers to empathy in the clinical encounter: a qualitative interview study with GPs.
abstract: Current daily general practice has become increasingly technical and somatically oriented (where attention to patients' feelings is decreased) due to an increase in protocol-based guidelines. Priorities in GP-patient communication have shifted from a focus on listening and empathy to task-oriented communication.
  
  
  
  To explore what barriers GPs experience when applying empathy in daily practice, and how these barriers are managed.
  
  
  
  Thirty Dutch GPs with sufficient heterogeneity in sex, age, type of practice, and rural or urban setting were interviewed.
  
  
  
  The consolidated criteria for reporting qualitative research (COREQ) were applied. The verbatim transcripts were then analysed.
  
  
  
  According to participating GPs, the current emphasis on protocol-driven care can be a significant barrier to genuineness in communication. Other potential barriers mentioned were time pressures and constraints, and dealing with patients displaying 'unruly behaviour' or those with personality disorders. GPs indicated that it can be difficult to balance emotional involvement and professional distance. Longer consulting times, smaller practice populations, and efficient practice organisation were described as practical solutions. In order to focus on a patient-as-person approach, GPs strongly suggested that deviating from guidelines should be possible when necessary as an element of good-quality care. Joining intercollegiate counselling groups was also discussed.
  
  
  
  In addition to practical solutions for barriers to behaving empathically, GPs indicated that they needed more freedom to balance working with protocols and guidelines, as well as a patient-as-person and patient-as-partner approach. This balance is necessary to remain connected with patients and to deliver care that is truly personal.
authors.affiliation: Department of Primary and Community Care, Gender and Women's Health, Radboudumc, Nijmegen, the Netherlands.
authors.forename: Frans Awm
authors.initials: FA
authors.lastname: Derksen
authors.affiliation: Department of Primary and Community Care, Radboudumc, Nijmegen, the Netherlands.
authors.forename: Tim C
authors.initials: TC
authors.lastname: Olde Hartman
authors.affiliation: Department of Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, NIVEL, Netherlands Institute for Health Services Research, the Netherlands.
authors.forename: Jozien M
authors.initials: JM
authors.lastname: Bensing
authors.affiliation: Department of Primary and Community Care, Gender and Women's Health, Radboudumc, Nijmegen, the Netherlands.
authors.forename: Antoine Lm
authors.initials: AL
authors.lastname: Lagro-Janssen
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003142:Communication; D004645:Empathy; D005260:Female; D058006:General Practice; D058005:General Practitioners / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010817:Physician-Patient Relations / Q000941:ethics; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D036301:Qualitative Research
keywords: empathic behaviour; empathy; patient-centred care; primary health care; protocol-driven care; shared responsibility