“When empathy is recognition rather than absorption, it nourishes instead of depletes. It becomes sustainable.” Eva Minkoff shares this thought in our collaborative book, White Coats, Human Hearts, featuring the stories of 11 physicians, two physician spouses, and two patients. Eva has spent her life entrenched in health care, as a chronic patient, physician spouse, and now leadership coach for health care professionals and leaders. Reading those words was an “aha!” moment for me, so I asked Eva to elaborate on this insight.

Imagine you are sitting across from a parent who just lost a child. As they speak, your mind does what minds naturally do. It leaps forward: What would this be like if this were my child? The intention behind that instinct is empathy. But it may also be one of the quiet drivers of physician burnout. Doctors are often taught to empathize by imagining themselves in the patient’s position. Imagine yourself losing a child. Think about hearing a doctor say, “You have cancer.” Picture yourself as if you were the mother.

The intention is good. The outcome is not. Because this is where many clinicians quietly unravel. When you imagine yourself inside a patient’s situation, your nervous system does not treat it as hypothetical. It treats it as a threat. You begin to simulate the loss, fear, and devastation. When this happens repeatedly, room after room, year after year, it has a cost. Physicians do not burn out because they care too much. They burn out because they unknowingly turn someone else’s story into their own.

There is a cleaner way to understand empathy in medicine. It begins with a simple distinction: story versus feeling. The story is the situation, such as the diagnosis, details, narrative, and the mental movie that begins with, “What would this be like if this were me?” The feeling is something else entirely: grief, fear, anger, sadness, and uncertainty. You may not share the same stories as your patients. But you do share the same emotional capacity. Empathy does not require narrative identification. It requires emotional recognition and validation.

When clinicians step into the story, several things happen. You begin future-casting, mentally simulating the loss, experiencing personal threat, and carrying emotional residue into the next room. This is not compassion. It is self-referential processing under the banner of empathy. When clinicians stay with the feeling instead, something different happens. You notice grief, recognize fear, and attune to anger. You can remain steady because you are responding to an emotion, not inserting yourself into the circumstances that produced it. From this simpler place, connection increases and emotional exhaustion decreases. This is not detachment. It is a disciplined way of connecting.

Importantly, this does not mean the story a patient shares is irrelevant. History, context, and narrative matter for diagnosis and treatment. But emotional attunement does not require inserting yourself into that narrative. Research supports the impact of this kind of empathic communication. When patients perceive their physician as empathic, they are more likely to adhere to treatment plans and disclose important information (Zolnierek and DiMatteo, Medical Care; Derksen et al., BMC Medical Education). Higher physician empathy has also been associated with improved outcomes in conditions such as diabetes (Hojat et al., Academic Medicine).

But there is another side to this conversation. Research also distinguishes empathic distress, self-focused emotional overwhelm, from regulated compassion. When empathy becomes personal identification, it increases stress and emotional exhaustion. Training that helps clinicians regulate empathy and communication has been shown to reduce burnout symptoms (Krasner et al., JAMA). The issue is not that physicians feel too much. It is that they were never taught how to regulate empathy in the first place. Consider a few common scenarios.

• A cancer diagnosis: If you imagine this happening to you, you may feel panic. If you stay with the patient’s fear, you can slow down and say, “I can sense that this feels overwhelming. We will take this one step at a time.”
• A patient angry about a delay in care: If you imagine being blamed unfairly, you may become defensive. If you stay with the anger underneath, you can say, “I can hear how upsetting this has been,” even if you do not agree with why they are angry.
• A miscarriage: If you project your own imagined fertility journey into the room, you may feel destabilized. If you stay with the grief present, you can say, “I understand this is a real loss.”

The difference is subtle but powerful. Stories consume. Feelings connect. Many clinicians are not burning out because they lack empathy. They are burning out because they have never been taught how to regulate it. Doctors are trained in anatomy, pharmacology, and pathophysiology. They are not trained in how to keep their nervous systems steady in the presence of suffering. So it is natural to do what seems intuitive: Imagine yourself inside the tragedy, and pay for it later. A simple question can interrupt this pattern in real time: What is the feeling here, not the story? That shift changes the emotional load of the encounter. It allows you to remain human without collapsing. It allows you to care without carrying every story home. It allows you to sit in rooms that would otherwise feel unbearable.

The good news is that this shift can be learned. This distinction can be applied at the bedside through a simple three-step approach: Recognize. Distinguish. Address. Recognize that emotion is present. Distinguish the patient’s feeling from the story and from your own reaction to it. Address the feeling within your scope before moving into the medicine. Sometimes that means explaining something confusing or frightening. Sometimes it means acknowledging frustration. Sometimes it means simply slowing down.

Emotion first. Medicine second. Empathy in medicine does not require physicians to experience every patient’s pain as their own. It requires recognizing pain, honoring it, and responding to it wisely. The goal is not to feel less. The goal is to feel in a way that is effective for you and for the patient. Because medicine does not need physicians who shut down. It also does not need physicians who are drowning. It needs physicians who can stay. Recognize. Distinguish. Address.

Eva Minkoff is a health care executive. Kim Downey is a physician advocate and physical therapist.