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Clinician views on optimism and empathy in primary care consultations: a qualitative interview study

Hughes, S; Vennik, JL; Smith, KA; Bostock, J; Howick, J; Mallen, C; Little, P; Ratnapalan, M; Lyness, E; Bishop, FL; Leydon, GM; Dambha-Miller, H; Morrison, L; Everitt, HA

Clinician views on optimism and empathy in primary care consultations: a qualitative interview study Thumbnail


S Hughes

JL Vennik

KA Smith

J Bostock

J Howick

P Little

M Ratnapalan

E Lyness

FL Bishop

GM Leydon

H Dambha-Miller

L Morrison

HA Everitt


Background: Practitioner expressions of optimism and empathy may improve treatment engagement, adherence, and patient satisfaction but are not delivered consistently amid the challenges of everyday clinical practice.

Aim: To explore primary care practitioner (PCP) views about optimistic and empathic communication in consultations; and to identify behavioural, attitudinal, and/or contextual issues likely to encourage or deter PCPs from practising such communication.

Design & setting: Qualitative interview study with 20 PCPs (GPs, practice nurses, and primary care physiotherapists).

Method: Semi-structured telephone interviews with 20 PCPs. Data were analysed thematically.

Results: A conceptual mismatch between optimism and patient expectations became apparent; when asked how PCPs communicate about the likely effects of a treatment, answers were focussed around managing patient expectations. When prompted, it became clear PCPs were open to communicating optimistically with patients, but emphasised the need for realism. Concerns arose that patients may not be receptive to optimistic messages, especially when holding negative expectations. PCPs felt that expressing empathy is fundamental to all clinical consultations, noting that it can be challenging. Some PCPs worried that increasing expressions of empathy might increase their risk of clinician burnout and felt guilty about (appropriately) communicating empathy while maintaining some emotional distance.

Conclusion: PCPs agreed expressing realistic optimism during consultations could aid communication and would constitute a novel change to practice. PCPs strive for clinical empathy but can struggle to manage emotional self-protection. Specific training to help PCPs express realistic optimism and empathy, and better utilise efficient non-verbal skills could help these issues.


Hughes, S., Vennik, J., Smith, K., Bostock, J., Howick, J., Mallen, C., …Everitt, H. (2022). Clinician views on optimism and empathy in primary care consultations: a qualitative interview study. British Journal of General Practice Open (BJGP Open), 6(3), Article 0221.

Journal Article Type Article
Acceptance Date Mar 30, 2022
Publication Date Apr 4, 2022
Publicly Available Date May 30, 2023
Journal BJGP Open
Print ISSN 2398-3795
Electronic ISSN 2398-3795
Publisher Royal College of General Practitioners
Peer Reviewed Peer Reviewed
Volume 6
Issue 3
Article Number 0221
Keywords empathy; optimism; Primary Health Care; qualitative research; clinician-patient relationships
Publisher URL