“I understand how you feel.”
It is probably one of the most frequently taught phrases in healthcare communication.
It is also one of the easiest to use badly.
A patient has just been told that their surgery needs to be postponed. Another is frightened about a test result. Someone has been living with pain for months and feels that nobody has taken them seriously. A parent is worried about a child.
The healthcare professional responds:
“I understand how you feel.”
And immediately continues:
“Now, regarding your medication…”
The words are empathetic.
The conversation may not be.
This is where empathy in healthcare becomes more interesting than a collection of compassionate phrases. Genuine empathy involves recognising what another person may be experiencing, showing that their response has been noticed, and allowing that understanding to influence what happens next in the conversation.
Sometimes that requires words.
Sometimes it requires a question.
And sometimes the most empathetic response is to stop speaking for a moment.
Empathy in Healthcare Communication
Empathy Is Not the Same as Being Nice
Healthcare professionals are often described as needing to be caring, kind or compassionate. All are worthwhile qualities, but empathy has a more specific communication function.
Imagine a patient saying:
“I’ve been waiting for this appointment for four months. Now you’re telling me I need another scan before anybody can decide what to do. I’m exhausted.”
A pleasant but ineffective response might be:
“Don’t worry. I’m sure everything will be okay.”
The intention is reassuring. But the patient’s frustration has effectively been bypassed.
Compare:
“You’ve already waited a long time, and hearing that there is another step before you get an answer sounds understandably frustrating.”
The second response does not solve the delay.
It does something important before trying to solve anything: it acknowledges the patient’s experience.
That is often where empathy begins.
“I Understand” Can Sometimes Sound Like the Opposite
There is nothing inherently wrong with saying “I understand”.
The difficulty arises when we claim more understanding than the conversation supports.
Consider a young healthcare professional speaking to a patient whose spouse has just died.
“I understand exactly how you feel.”
Do they?
Perhaps they have experienced a similar loss. Perhaps they have not.
Either way, the word exactly creates an unnecessary claim. Even two people who have experienced the same kind of loss do not necessarily experience it in the same way.
A more careful response might be:
“I can only imagine how difficult this must be for you.”
Or perhaps:
“You’ve been through an enormous amount.”
Or simply:
“I’m very sorry.”
Empathy does not require us to prove that we have experienced the same thing.
It requires us to make room for the other person’s experience.
Listen for the Emotion Behind the Information
Patients rarely announce their emotions in clinically convenient language.
They do not always say:
“I am frightened.”
Instead, they may say:
“Are you sure this is nothing serious?”
They do not necessarily say:
“I feel that nobody is listening to me.”
They may say:
“I’ve already explained this three times.”
A patient worried about losing independence might say:
“How long before I’m allowed to drive again?”
The literal question concerns driving.
The emotional concern may involve work, independence, family responsibilities or fear of becoming dependent on others.
This is one reason active listening in healthcare is so closely connected with empathy.
A healthcare professional needs to hear both the information being given and the possibility that something else is being communicated underneath it.
Instead of answering immediately:
“You won’t be able to drive for six weeks.”
there may be value in adding:
“Is not being able to drive going to cause particular difficulties for you?”
Now the conversation has somewhere useful to go.
Patient Cues Are Invitations, Not Interruptions
One of the clearest differences between formulaic and patient-centred communication appears when a patient offers an emotional cue.
Imagine:
Nurse: “Have you been managing the dressing at home?”
Patient: “Yes, but my daughter usually helps me. She’s moving away next week.”
A task-focused communicator may continue:
“And have you noticed any discharge from the wound?”
The clinical question is perfectly reasonable.
But the patient has offered something else.
Her daughter is leaving.
That may affect practical care. It may also matter emotionally.
An empathetic response might simply be:
“It sounds as though her moving away is going to make things harder for you.”
Then allow the patient to respond.
This does not mean every emotional cue requires a lengthy counselling conversation.
It means we should notice when the patient has handed us information that may matter.
Empathy often starts with not rushing past it.
Sometimes Empathy Is a Question
Healthcare professionals preparing for communication assessments often look for “empathetic phrases”.
That is understandable. A phrase feels concrete. You can memorise it.
But some of the most empathetic communication does not look like an empathy phrase at all.
A patient says:
“I don’t want another operation.”
Instead of immediately reassuring or persuading:
“Why do you feel that way?”
may reveal far more.
Perhaps the previous operation was painful.
Perhaps the patient is frightened of anaesthesia.
Perhaps they are the sole carer for someone at home.
Perhaps they misunderstood what has been proposed.
The healthcare professional cannot respond meaningfully to a concern until they know what the concern actually is.
So empathy is not only:
“That sounds difficult.”
It may also be:
“What worries you most about having another operation?”
The acknowledgement and the exploration work together.
Empathy Should Change What You Do Next
This is perhaps the most useful test.
If you acknowledge a patient’s emotion and then continue exactly as if they had never expressed it, the empathy may have become decorative.
Consider:
Patient: “My sister died from breast cancer. That’s why I’ve been terrified since I found the lump.”
Healthcare professional: “I understand. So, when did you first notice the lump?”
The next question is clinically relevant.
But the emotional disclosure deserves more than a verbal tick before returning to history-taking.
Compare:
“That must make finding a lump particularly frightening for you.”
Pause.
“We’ll talk through what happens next. Before we do, can I ask when you first noticed it?”
The clinical task still gets done.
The difference is that the patient’s emotional reality has been incorporated into the consultation rather than briefly acknowledged and discarded.
Empathy does not compete with efficiency.
Often, it makes the conversation more coherent.
Silence Can Be an Empathetic Response
Silence makes many healthcare professionals uncomfortable.
We are trained to gather information, explain, reassure, advise and act. When somebody becomes emotional, the instinct can be to fill the gap.
Yet immediately speaking can sometimes take the moment away from the patient.
Imagine telling someone that an investigation has shown something unexpected.
They become quiet.
Their eyes fill with tears.
The healthcare professional immediately says:
“But there are treatments available and the specialist will discuss everything and you shouldn’t worry because…”
The urge to help is understandable.
But the patient may not yet be ready for the next piece of information.
A short silence, accompanied by attentive presence, may communicate something that another paragraph cannot:
I have noticed. You do not need to recover from this news quickly for my convenience.
Silence should not become awkward withdrawal. The healthcare professional remains present.
But empathy does not always need to be verbal.
Reassurance and Empathy Are Not the Same Thing
Healthcare professionals understandably want to reduce anxiety.
That can lead to premature reassurance:
“There’s nothing to worry about.”
“You’ll be fine.”
“I’m sure it’s not serious.”
These statements may be intended as kindness, but they can create two problems.
First, the healthcare professional may be offering certainty that the clinical situation does not justify.
Second, reassurance can shut down the patient’s opportunity to explain what they are worried about.
Imagine:
Patient: “I’m frightened this pain means the cancer has returned.”
Healthcare professional: “Don’t worry. I’m sure it hasn’t.”
Compare that with:
“I can see why that possibility is frightening you. We don’t know the cause of the pain yet, so we’ll need to assess it properly.”
The second response combines empathy with clinical honesty.
Good empathy does not require us to make uncertainty disappear.
Sometimes it helps the patient tolerate uncertainty while we deal with it properly.
Validation Does Not Mean Agreement
This becomes particularly important when dealing with frustrated, angry or “difficult” patients.
Suppose a patient says:
“I’ve been completely ignored by this hospital.”
The healthcare professional may disagree. Perhaps several people have tried to help.
Empathy does not require saying:
“Yes, the hospital has treated you terribly.”
Instead:
“You’ve had to repeat the same concern several times, and I can see why you’re frustrated.”
You can acknowledge the experience without endorsing every conclusion the patient has drawn from it.
This distinction is useful far beyond complaints.
A patient can be frightened without the feared outcome being likely.
They can be angry even if the healthcare professional did nothing wrong.
They can feel dismissed even if nobody intended to dismiss them.
Feelings can be acknowledged without every interpretation being accepted as fact.
That is an important professional boundary.
Empathy Can Coexist With Firmness
Another misconception is that being empathetic means continually agreeing, apologising or giving the patient what they want.
It does not.
Consider a patient demanding an action that the healthcare professional cannot appropriately provide.
A weak response may swing in one of two directions.
Too soft:
“I understand, I’ll see what I can do.”
even when the request cannot be fulfilled.
Or unnecessarily confrontational:
“I’ve already told you we can’t do that.”
An empathetic but boundaried response might be:
“I can see that you’re frustrated because you were expecting this to be resolved today. I can’t authorise that treatment, but I can explain what I am able to do and who needs to review you next.”
The emotion has been acknowledged.
The boundary remains intact.
Healthcare professionals sometimes need to be both empathetic and firm. Those qualities are not opposites.
Tone Can Undo the Perfect Sentence
Imagine hearing:
“I’m sorry to hear that.”
Now imagine it said while someone is typing, looking away and already reaching for the next form.
The words have not changed.
Their meaning has.
Healthcare communication skills involve far more than vocabulary. Tone, pace, facial expression, posture, eye contact and attention all influence whether an empathetic response feels genuine.
This matters particularly for internationally qualified healthcare professionals because a phrase learned correctly may still sound quite different depending on how it is delivered.
There is no need to manufacture an exaggerated “caring voice”.
The aim is congruence.
If the words communicate concern but the rest of your behaviour communicates impatience, patients are likely to notice the contradiction.
Empathy Must Be Individual, Not Assumed
There is another danger in phrases beginning:
“You must feel…”
Sometimes they are wonderfully accurate.
Sometimes they are not.
Consider:
“You must be devastated.”
The patient might be.
Or they may be relieved, angry, numb or simply unsure what they feel.
A useful alternative is to leave room for correction:
“That sounds as though it has been very difficult.”
Or:
“How has all of this been for you?”
Empathy is not mind-reading.
The healthcare professional forms an understanding and then remains willing to discover that the patient experiences the situation differently.
That becomes especially important across cultures.
People differ in how openly they express emotion, how comfortable they are discussing personal concerns and what kinds of support they expect from healthcare professionals.
The safest approach is rarely to assume that a particular patient should respond in a particular way.
Empathy Is Different With Different Patients
An anxious child does not necessarily need the same communication as an anxious adult.
An angry patient does not require the same response as a withdrawn patient.
Someone receiving unexpected bad news needs something different from a person frustrated by a delayed appointment.
Yet the underlying principles remain recognisable:
Notice. Acknowledge. Explore when necessary. Respond appropriately.
With a child, empathy may involve acknowledging fear and explaining what will happen in simple, reassuring language.
With an angry patient, it may involve allowing them to explain the problem before trying to correct the facts.
With someone who has become withdrawn, it may require gentle questions and more silence.
With a distressed relative, empathy may mean recognising that their anger is partly fear.
The phrase changes because the person and the situation change.
That is precisely why memorisation alone cannot produce good patient communication skills.
Why Empathy Can Become Formulaic in OET Preparation
OET Speaking understandably brings empathy into sharp focus.
Candidates learn that the patient in the role-play may be worried, reluctant, frustrated or upset. They therefore prepare language such as:
“I understand your concern.”
The problem arises when the phrase becomes a reflex rather than a response.
Patient:
“I can’t sleep because I’m worried my condition is getting worse.”
Candidate:
“I understand your concern. Have you been taking your medications regularly?”
The candidate has said empathy without necessarily doing empathy.
A stronger response might be:
“It sounds as though this has been worrying you quite a lot, especially if it’s affecting your sleep. What makes you feel the condition may be getting worse?”
Now empathy has served a purpose.
It has acknowledged emotion and opened the conversation.
This is an important distinction for OET communication skills training. Candidates benefit far more from learning how to recognise a cue and respond naturally than from memorising a bank of empathetic sentences.
And the benefit survives long after the examination.
Internationally Qualified Healthcare Professionals May Need to Recalibrate Empathy
Moving into another healthcare system involves learning more than terminology.
Different workplaces may have different expectations around patient autonomy, emotional disclosure, shared decision-making, personal space, eye contact and how directly concerns are discussed.
A phrase that sounds warm in one setting can sound overly familiar in another.
A professional who has been trained in a more hierarchical model of healthcare may also be accustomed to moving relatively quickly from diagnosis to advice. In a more explicitly patient-centred environment, greater attention may be placed on the patient’s perspective before recommendations are made.
That does not mean one country possesses empathy and another does not.
It means professional communication has a cultural context.
International healthcare professionals benefit from observing how experienced colleagues acknowledge emotion, manage silence, discuss uncertainty and preserve boundaries in the system where they are working.
The goal is not imitation.
It is adaptation without losing authenticity.
Empathy Is a Skill, Not a Personality Test
Some people are naturally warm.
Others are quieter.
Some healthcare professionals find emotional conversations easy. Others feel unsure about what to say.
None of this automatically determines whether someone can communicate empathy professionally.
Empathy in healthcare can be developed through specific behaviours:
noticing verbal and non-verbal cues;
allowing the patient to finish expressing a concern;
acknowledging emotion rather than immediately changing the subject;
exploring the concern when its meaning is unclear;
using silence comfortably;
avoiding premature reassurance;
validating feelings without necessarily agreeing with conclusions;
adapting language and tone to the person and situation;
maintaining professional boundaries while remaining supportive.
These behaviours can be observed, practised and refined.
That matters because healthcare professionals should not be left with the impression that they either “are empathetic people” or they are not.
Professional empathy is something we can work on.
A Better Question Than “What Empathy Phrase Should I Use?”
Healthcare communication training often becomes much stronger when we replace:
“What should I say?”
with:
“What does this person need from me at this point in the conversation?”
Perhaps they need acknowledgement.
Perhaps clarification.
Perhaps reassurance based on facts.
Perhaps permission to express anger.
Perhaps an explanation.
Perhaps practical support.
Or perhaps they need ten seconds in which nobody tries to make the moment better.
Once that becomes the starting point, empathy stops sounding like something inserted into the consultation.
It becomes part of how the consultation works.
Frequently Asked Questions
Why is empathy important in healthcare communication?
Empathy helps healthcare professionals recognise and respond to the patient’s emotional experience rather than focusing only on clinical information. It can support rapport, encourage patients to express concerns and make communication more patient-centred.
What is an example of empathy in healthcare?
If a patient says, “I’ve been waiting months for this appointment and now I need another test,” an empathetic response might be: “You’ve already waited a long time, so I can understand why hearing that there is another step feels frustrating.” The response acknowledges the patient’s specific experience rather than using a generic phrase.
What should healthcare professionals say instead of “I understand”?
There is no single replacement. Depending on the situation, phrases such as “That sounds very difficult,” “I can see why that has worried you,” or “You’ve been through a lot” may be appropriate. Sometimes asking the patient to explain more is more useful than making an empathetic statement.
Can healthcare professionals show empathy without agreeing with a patient?
Yes. A healthcare professional can acknowledge that a patient feels frightened, angry or frustrated without agreeing with every interpretation or request. Empathy recognises the person’s experience; it does not remove professional judgement or boundaries.
How can nurses improve empathy and patient communication skills?
Practise recognising emotional cues rather than concentrating only on phrases. Pay attention to what the patient says, how they say it and what they may be trying to communicate. Role-play, feedback and reflection on real clinical interactions can help make empathetic communication more natural and responsive.
Empathy Is What Happens After You Notice
Perhaps the easiest way to misunderstand empathy is to treat it as a sentence.
It is not.
A healthcare professional may say all the right words and still leave the patient feeling unheard.
Another may use very few words and communicate enormous understanding because they noticed the hesitation, allowed the silence, asked the right follow-up question and did not rush to reassure.
That is why empathy belongs within healthcare communication skills, rather than beside them as an optional display of kindness.
It influences how we listen.
How we question.
How we explain.
How we respond when someone is frightened, angry, embarrassed or overwhelmed.
And for internationally qualified healthcare professionals preparing for examinations or clinical practice abroad, this may be one of the most useful distinctions to learn:
You do not demonstrate empathy by proving that you know an empathetic phrase.
You demonstrate it by showing the patient that what they have just said has changed the way you respond.
To learn more about how our structured courses prepare you for every OET sub-test, visit Khaira Education.