When Empathy Is Not Enough

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When Empathy Is Not Enough

August 17, 2026

Understanding another person's experience is a beginning. What happens next may matter even more.

Empathy matters in health. It can help a physician understand that a diagnosis does not enter a patient's life alone. It arrives with fear, questions, family responsibilities, work, finances and uncertainty about what comes next. It can help a nurse hear the worry behind a question or a caregiver recognize when someone they love is frightened or overwhelmed. None of us can fully know what another person is experiencing through illness, uncertainty or pain. Trying to understand brings us closer to the person, beyond their diagnosis.

There is also a difference between understanding what someone is going through and being moved to help. Health should lead with empathy, and at the same time, there are moments when it needs something more: a bolus dose of compassion. Not simply more feeling, but concern that moves us toward action.

Research suggests that empathy can sometimes become emotionally exhausting. A physician, nurse or caregiver can absorb so much of another person's fear, grief or pain that it becomes difficult to remain fully present. Compassion offers another path. It allows us to care deeply about what someone is going through while retaining enough emotional space to ask a practical question: What can I do to help?

A physician cannot carry every patient's fear home at the end of the day. A daughter caring for an aging parent cannot absorb every setback without becoming depleted. Caring should not require taking another person's suffering on as your own. The goal is to remain close enough to understand what someone needs, supported enough to keep going and able to turn concern into help.

When Caring Meets Friction

That difference becomes very real when a physician knows what a patient needs, and an administrative requirement stands between the two.

A physician prescribes a treatment that sometimes requires prior authorization from an insurer. The clinical information is submitted, additional documentation is requested, and the request may be denied. The physician or practice staff then appeals or schedules a peer-to-peer review. At each step, the physician works while the patient waits.

American Medical Association survey data give some scale to that burden. Physicians reported completing an average of 40 prior authorizations each week, consuming about 13 hours of physician and staff time. Ninety-four percent said prior authorization contributes to burnout, 95 percent reported that it delays access to necessary care and 79 percent said patients sometimes abandon treatment because of authorization challenges.

For some physicians, the experience can feel like pushing a heavy rock up a hill, only to watch it roll back down. Finally, the secure the prized authorization and help one patient receive treatment. The next morning, another patient faces the same uphill challenge and the climb begins again.

The frustration is not simply the paperwork. While forms are submitted, reviewed and sometimes resubmitted, a patient waits for a treatment their physician believes they need. That delay may mean more pain, more anxiety or more time living with an untreated condition.

At some point, we need to ask why the administrative rock keeps rolling downhill.

When the Medicine Is Already Working

Non-medical switching creates a different version of the same problem.

A physician and patient may spend months finding a medication that works. Other therapies may have failed, doses may have been adjusted and side effects managed. Eventually, the patient becomes stable. Then the payer changes its formulary and the medication is no longer preferred.

That does not mean every medication switch is inappropriate. Formularies help manage costs and another therapy may provide a comparable outcome at lower expense. Cost matters because no health system has unlimited resources.

The patient, however, may hear something much simpler: The medicine that finally helped me is being taken away. Why?

That question deserves an answer.

The answer is not to put physicians and patients on one side and payers on the other. Payers have a responsibility to evaluate evidence, manage limited resources and guard against unnecessary treatment. Physicians have a responsibility to apply clinical judgment to the person they are treating. Patients live with the consequences when those viewpoints come into conflict.

That is why communication matters. A payer may have clinical and economic information the physician does not have. The physician may know that the patient already failed two alternatives or experienced serious side effects. The patient may be frightened that returning to a previous medication means returning to symptoms that once disrupted work, sleep or family life.

Those facts need to reach one another.

The people guiding the process should also be able to learn. If physicians repeatedly overturn the same denial on appeal, the criteria deserve another look. If the same kinds of exceptions are repeatedly granted, those decisions may be telling us something about the rule.

Compassion becomes practical when patients and health professionals are not forced to fight battles that experience has already taught us how to avoid.

The Caregiver at the Kitchen Table

Some of health's greatest burdens never appear on a medical chart.

The 2025 Caregiving in the U.S. report from AARP and the National Alliance for Caregiving estimates that 63 million American adults provide ongoing care to someone with an illness, disability or age-related need. Nearly one in four provides 40 or more hours of care each week, while six in ten are also employed.

Consider a daughter helping her father after hospitalization. Discharge papers cover the kitchen table beside several medication bottles. One drug appears under a brand name on one document and a generic name on another. A specialist appointment must be scheduled. A prescription has not reached the pharmacy. The insurance explanation is difficult to understand.

She begins making calls because someone must. She probably will not call herself a health navigator. She is simply a loving daughter. Yet she is coordinating appointments, sorting medications, contacting clinicians and trying to understand insurance while also worrying about her father.

Then consider the patient who has no daughter sitting at that table.

An older adult may live alone. An hourly worker may lose wages every time another phone call puts them on hold for 45 minutes. A newly diagnosed patient may be too frightened or exhausted to understand why an insurer denied a treatment or what an appeal even requires.

A compassionate health system cannot solve every problem in someone's life. It can stop placing obstacles in their path.

That may begin with something as basic as communication. Tell the family before discharge who to call with medication questions. Explain the same drug names consistently. Send the referral before the patient leaves the hospital. Tell someone that a physician is running an hour late before the patient leaves work and drives across town.

None of those actions cures disease. Each can make living with illness less difficult.

Communication is care because information can reduce fear, protect time and give people greater control at moments when illness has already taken some of that control away.

Values Matter When They Move Us

Peter Finn explores the role of values in building an organization in his book, Driven to Build, Guided by Values. Two phrases have helped define FINN Partners: "Work Hard. Play Nice." and "Make a Difference." They matter because values influence what people actually do. A statement on a wall means little if it disappears when a difficult decision arrives.

The work of FINN colleagues in the Health Policy & Impact Group offers one example. Across Africa, colleagues work with health leaders, journalists, advocates and communities on issues including immunization, nutrition and the health effects of climate change. Their work reinforces a lesson that sits at the heart of compassion: understanding begins by listening to people who know their communities best.

The 2026 Africa Health Media Trends Report, developed by colleagues working across the region, highlighted that lesson. African expertise and local context need to be central to how health challenges are understood and communicated. That work reminds us that compassionate guidance does not mean arriving with an answer. It means listening, learning and working alongside people who understand the realities of their own communities.

Communication can then become a catalyst for action. It can bring local experience into broader policy discussions, connect people who might otherwise remain in separate conversations and help those conversations lead somewhere.

The patient ambassador programs developed and led by other FINN colleagues offer another lesson. These programs create opportunities for people living with disease to describe what diagnosis, treatment and navigating the health system actually feel like. Their work has reinforced something important for me: listening matters, but the harder question comes afterward.

What frightened the patient? Where did the process break down? What information arrived too late? What burden fell on a spouse, parent or child? What might an organization change because someone trusted us enough to share what happened?

Those colleagues help bring lived experience into rooms where decisions are made. Compassionate guidance asks what should happen because of what was heard.

That same principle can take many forms in client work. It may mean helping innovators and policy leaders reconsider processes created years ago that have become obstacles today. It may mean supporting programs that train primary care physicians to use large language models so their own clinical experience can be strengthened by the composite knowledge of other health experts. It may mean telling a client that better messaging will not solve a problem when the underlying experience itself needs to change.

That is where communication becomes much more than communication. It becomes a catalyst that helps patients, caregivers, clinicians, innovators, payers, and policymakers understand one another well enough to find a better way forward. It does not guarantee agreement. It can create the conditions for decisions informed by the realities each person brings to the table.

"Make a Difference" does not require us to assume we know what is best for another person. It requires enough humility to listen, enough curiosity to understand what we may be missing and enough determination to help people act together when something clearly can be better.

When Experience Becomes Influence

Senator John McCain gave us a very human example of what can happen when a health issue becomes personal.

McCain returned to Washington in 2017 shortly after being diagnosed with brain cancer. The Senate was debating legislation that would repeal major portions of the Affordable Care Act. He was facing a life-threatening diagnosis while participating in a decision affecting the ability of millions of Americans to obtain and afford health insurance.

His vote became political history, but the human circumstances matter. McCain called for hearings, deliberation and bipartisan work on legislation affecting people's health. His cancer diagnosis did not determine what the right health policy should be. Nor does compassion belong to one political party or one view of the proper role of government.

His experience did, however, place illness very close to the policy debate.

A vote in Washington can determine whether a cancer patient can continue seeing the oncologist they trust. A coverage decision can determine what a parent is told at the pharmacy counter and whether the medication is affordable. An administrative requirement can leave a physician explaining to a patient why treatment must wait.

Policy eventually becomes personal.

Communication cannot eliminate deeply held differences about insurance, government, costs or coverage. It can ask people on all sides of the issue to confront how their decisions will be experienced by those who must live with them.

Keep the Rock at the Top

Health collects extraordinary amounts of information about costs, utilization, outcomes, readmissions and adherence. We should become equally curious about the obstacles that patients, caregivers, and health professionals repeatedly encounter.

Where are physicians filing the same appeals? Where are patients abandoning treatment because the process has become too difficult? Where are family caregivers making the same calls that hundreds of other families made the week before? Where are payers granting the same exceptions again and again?

Those are not simply complaints. They are information about where the health system is asking people to push rocks uphill.

The physician who wins an appeal, the nurse who finds a workaround, the payer representative who recognizes that an exception is warranted and the daughter who keeps calling until her father receives what he needs all deserve our respect. So do the policymaker who allows personal experience to shape a better decision and the company that brings patient ambassadors into the room, listens closely and changes course because of what it hears. Their actions remind us that compassion is not only persistence in the face of barriers. It is also the willingness to remove barriers, rethink decisions and act differently because someone else's experience has been heard.

Empathy helps us understand what they are carrying. Compassion gives us reason to lighten their load. Communication brings lived experience into the rooms where decisions are made and helps turn understanding into action.

Understanding is where we begin. What we choose to do together is where our values become visible.

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POSTED BY: Gil Bashe