Letters

Empathy is important for enablement

EDITORReilly's editorial on enhancing human healing mentions the pilot work that we have done on the impact of homoeopathic consultations on patient enablement.¹ "Enablement" describes the effect of a clinical encounter on a patient's ability to cope with and understand his or her illnesses.²

We collected 200 valid questionnaires from 230 consecutive outpatients attending the Glasgow Homoeopathic Hospital, an NHS facility that integrates complementary and orthodox approaches. Measures included the patient enablement instrument,² perception of the doctor's empathy,³ and knowing the doctor well.²

The mean consultation length was 56 min for new patients (n=26) and 20 min for follow up patients (n=174). Enablement was not directly related to length of consultation but correlated with the patient's perception of the doctor's empathy (Spearman's correlation 0.371, P<0.001). The overall average enablement score (mean 4.7) was some 50% higher than the average in primary care.² Overall, 118 of the 200 patients rated the consultations at Glasgow Homoeopathic Hospital as better (n=66) or much better (n=52) than their usual consultations with their general practitioners; 99 of the 118 rated the consultations as better (n=38) or much better (n=61) than consultations with other hospital specialists.

These findings suggest that empathy is important in enabling patients; no patient reported a high enablement score with a low empathy score. Clearly the generalisability of this association needs to be established in other settings. In general practice, enablement is enhanced by longer consultations and continuity of care,² and we are currently investigating the role of empathy in this.

Empathy is often cited as a core value in the health profession, yet its lack in modern medicine seems to be widespread.⁴ The call to integrate complementary treatments into the NHS is one issue, but the organisational, structural, and personal limitations that general practitioners and hospital specialists in conventional medicine face in trying to provide holistic care is a wider one. Needing to prove that compassion is not a luxury but a fundamental requirement of a healthcare system is a damning indictment of our current ways of thinking. Yet without the scientific method and focused research, it seems certain to slide from neglect⁵ to decay.

Stewart W Mercer, health services research training fellow. 
Graham C M Watt, Norie-Miller professor. 
Department of General Practice, University of Glasgow, Glasgow G12 0RR Stewmercer{at}aol.com

David Reilly, consultant physician. 
AdHom Academic Departments, Glasgow Homoeopathic Hospital, Glasgow G12 0NR