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Background: Empathy — the ability to recognize others’ emotions, understand their feelings and situations, and respond in a helpful way — is a fundamental component of the patient–doctor relationship. It is associated with several positive outcomes in patient care. However, numerous quantitative studies suggest that empathy tends to decline during medical education and as doctors progress through clinical training. This thesis adopts a qualitative approach to explore the prerequisites for, and potential challenges to, empathy in healthcare, through the perspectives and lived experiences of medical students, doctors, and patients.

Method: This thesis is based on empirical material from four different interview studies, all of which employed a qualitative analysis, inspired by qualitative content analysis and constructivist grounded theory.

Findings and reflections: Junior doctors describe empathy as contextual and influenced by, for example time constraints and workplace culture. Additionally, senior colleagues were seen as particularly important role models in developing and maintaining empathic abilities. Senior doctors reported a daily balancing act, navigating challenges between individual and structural conditions that may affect empathy. Medical students experienced clashes between theoretical teachings and clinical reality regarding empathy, and they made efforts to develop and sustain empathy during their education. Patients expressed a longing for a more personal connection with healthcare personnel. They described inequities in the patient-doctor relationship, which could be partly bridged through empathy.

Conclusions: Both doctors and patients consider empathy crucial in the patient – doctor relationship. However, there are challenges related to empathy both in individual interactions and at a structural level in clinical and educational contexts. To maintain and further develop empathy, doctors need working conditions that allow for collegial reflection and conversations that promote empathy. This approach would also benefit medical students, who are influenced by teachers and clinical doctors as role models for empathy.