For decades, medical schools and hospital systems have warned physicians about “compassion fatigue” — the idea that caring deeply for patients eventually drains you. But a growing body of research challenges that assumption. Compassion may not be the problem at all. It may be the antidote.

“When you open up the literature, it’s a Pandora’s box,” said Shane Sinclair, PhD, director of the nationally funded Compassion Research Lab and a professor at the University of Calgary in Calgary, Alberta, Canada. “There are thousands of articles. Most assume compassion is tiring — that it’s synonymous with burnout and workplace stress. But there’s minimal to no evidence that compassion is inherently fatiguing.”

Yet many physicians experience exactly that. From primary care and oncology to emergency medicine and maternal-fetal medicine, doctors report some of the highest levels of compassion fatigue. In a 2025 Physicians Foundation survey, up to 57% of US doctors reported warning signs, such as debilitating stress, hopelessness, and social withdrawal. The crisis is global: A 2024 UK poll found 70% of physicians grapple with the mix of burnout and emotional exhaustion often labeled as compassion fatigue.

Many worry these feelings erode their ability to connect with patients, a concern backed by research that consistently shows patient trust depends on the perception that clinicians genuinely care. In an era of rising medical skepticism, this trust is the bedrock of the clinical relationship; when a physician appears emotionally depleted, the patient often perceives a lack of competence or investment, causing that essential bond to fracture before the exam even begins. Studies of patient experience suggest moments of compassion are what build that trust. When patients feel their physician understands them and is motivated to help, confidence in their care grows — suggesting that the “fatigue” doctors feel is creating a secondary crisis of confidence in medicine itself.

Still, for all its importance — not to mention three decades of research and more than 2500 published papers — compassion fatigue remains a point of fundamental disagreement. The traditional view describes compassion fatigue as the “cost of caring” — the depletion of an internal reserve of compassion, often likened to an empty cup. But emerging neuroscience and large clinician surveys suggest a different explanation: The fatigue is real, but compassion is not the source.

Compassion Fatigue or Empathic Distress?

In pivotal research described in several papers, neuroscientists at the Max Planck Institute for Human Cognitive and Brain Sciences in Leipzig, Germany, had volunteers watch short video clips of people in pain — accident and natural disaster victims, including children. The clips lasted 10-18 seconds, just long enough to trigger a powerful emotional response.

As the participants watched, functional MRI showed activity in regions associated with empathic pain — the anterior insula and anterior cingulate cortex. Participants reported feeling distressed and stressed and wanting to withdraw.

The researchers had trained these volunteers to amplify empathy, defined as resonating with another person’s emotions so that you feel their suffering.

Then the scientists tried something different. They trained the participants to strengthen compassion instead — defined as recognizing another person’s suffering, while also feeling motivated to help.

This time when the volunteers watched similar videos, a different brain network lit up, including the medial orbitofrontal cortex and ventral striatum. Instead of distress, participants reported warmth, concern, and connection.

“Compassion is feeling for and not feeling with the other,” researchers Tania Singer and Olga M. Klimecki wrote in a 2014 review of their work.

Too much empathy, they said, can lead to “empathic distress” — a state marked by negative emotions and a desire to distance oneself from suffering. Over time, chronic empathic distress may contribute to burnout and other negative health outcomes. Compassion, by contrast, activates positive, other-focused emotions and prosocial motivation. From this perspective, what many call “compassion fatigue” is actually empathic distress.

The distinction may be particularly important in healthcare.

“Empathy is informed by our feelings — it fluctuates,” Sinclair said. “But compassion is a human virtue, connected to understanding an individual and their unique needs. It’s more constant and doesn’t drain you. Finding a way to act, small or large, provides a pressure valve that reduces distress.”

Inside the Compassion Lab

Compassion can benefit not only clinicians but also patients. In a 2017 study of 53 people with advanced cancer, Sinclair and colleagues asked participants what they most wanted from their doctors. Many said they preferred compassion over either sympathy or empathy.

“When you empathize with people…you’ve crawled right into their moccasins,” one participant said. “Sympathy is…‘jeez, I hope you feel better,’” another said. “Compassion is running over and getting a barf bag.”

This distinction between empathy and action is what Sinclair’s team studies in real-world clinical settings. For Sinclair, compassion has been a central research focus for more than a decade. In a 2017 review of compassion fatigue studies, he and colleagues described the term as an “iconic euphemism” for the many daily stresses of working in healthcare.

At the nationally funded Compassion Research Lab at the University of Calgary, Sinclair’s team develops tools to track how these compassionate actions translate into clinical outcomes. One is the validated Sinclair Compassion Questionnaire, which assesses patients’ perceptions of compassion. The lab also created and tested a 1-day compassion training program that teaches clinicians to recognize patient needs, communicate clearly, and respond effectively — practical skills that help rebuild the doctor-patient bond.

Early results suggest those skills can be learned. In a 2024 study of the program, 26 trainees reported lower burnout and higher compassion competence and professional fulfillment. A larger clinical trial — currently under review — also found that it improved patient ratings, Sinclair said.

“If compassion is action, it needs to trickle down to the bedside — to a difference in care,” he said. “Even trainees who come in with relatively high levels of compassion find they can cultivate new skills.”

A Self-Fulfilling Prophecy?

Believing compassion runs out — and fearing it will drain you — may shape how clinicians respond to patients, said psychologist Nathan Consedine, PhD, professor at the University of Auckland in Auckland, New Zealand.

In a 2024 study of nearly 900 healthcare professionals in New Zealand, Consedine first measured participants’ beliefs about compassion. He then showed them a video vignette featuring a “difficult” patient and asked how they would respond.

Clinicians who believed compassion was emotionally draining scored lower when rating how much they cared about the patient and how motivated they were to help. Those who viewed compassion as important and sustainable expressed a stronger desire to help.

“Thinking about compassion as inherently fatiguing is deeply problematic,” Consedine said. “There is no reservoir to get depleted. If you look at the neuroscience evidence, brain activation in compassionate states had nothing to do with stress and fatigue and everything to do with pleasure. It’s pleasurable to care for others.”

Other observational research points in the same direction. Showing compassion has been linked to greater well-being, job satisfaction, and self-rated job performance among healthcare professionals, he said.

In a 2025 survey, Consedine found that clinicians used a range of strategies to support their capacity for compassion. Some focused on reducing stress — limiting work hours, maintaining work-life balance, exercising, and spending time with family and friends.

But many also described reinforcing compassion through their patient interactions: getting to know them, being fully present, spending more time with them, showing kindness, and treating them like family. These behaviors are also widely recognized as core ingredients of patient trust.

‘The Reasons You Struggle Aren’t All Inside You’

Strengthening compassion while addressing burnout may require a two-pronged approach, Consedine said. But simply urging clinicians to refill their own “compassion cup” through self-care risks overlooking structural pressures. In a 2018 study of 800 nurses, he and colleagues found that burnout was linked with more barriers to showing compassion — such as stress, fatigue, interruptions during care, a big workload, and challenging patients — even among those with stronger self-compassion.

“What I’m saying is: I know you’re tired,” Consedine said. “Healthcare providers are tired of everything. They’re burnt out. That affects absolutely everything about how they work, including the motivation to keep showing compassion. The reasons you struggle to care aren’t all inside you.”

That broader exhaustion may help explain why “compassion fatigue” is reported across medicine and beyond.

Nurses, mental health professionals, disaster and emergency personnel, radiology technicians, dental hygienists, and aides in long-term care centers report it. Religious leaders, teachers, police officers, and veterinarians do too.

Trauma psychologist Charles Figley, PhD, emeritus professor at Tulane University in New Orleans and a pioneer in compassion fatigue research in the mid-1990s, said talking with others who share the same challenges with compassion is helpful.

“Whenever you see compassion fatigue, you’re seeing hard work and sacrifice — someone in a highly stressful position in healthcare who’s taking care of patients traumatized and distressed by illness, severe pain, a disaster, or an accident,” Figley said. “You reach your limit. You can’t cope. People need help.”

The experts cited in this article had no relevant disclosures.

This article is part of an ongoing, year-long Medscape series examining the decline of public trust in medicine. More content is available here.