To the Editor: I congratulate Haslam on his excellent overview of the role of empathy in medicine.1 He rightly reminds us that empathy is not vague or ill defined; rather, its presence improves clinical outcomes, and it can be both learned and lost. I would go further and argue that empathy is not an optional extra but a clinical competence essential for sound medical practice, no matter what our specialty. All clinical practice requires a doctor–patient relationship, the core skill of which is empathy.

I wish to draw readers’ attention to a time-honoured but, in Australia, somewhat neglected educational activity where empathy is the major focus — that of Balint groups. In London in the 1950s, Hungarian-born psychiatrist Michael Balint and his wife Enid developed a unique method for studying the doctor–patient relationship.2

A Balint group is an experiential, small-group educational activity in which practising clinicians meet regularly to discuss their own doctor–patient interactions. The focus is on the emotional content of the doctor–patient relationship; the group’s primary task is to describe and empathise with both the doctor’s and the patient’s experience. Participants’ learning, therefore, is based on real-life situations they have encountered in their practices.

A rationale for this kind of training is that all doctors tend to have habitual responses to certain clinical situations. Although these responses can be strengths which doctors bring to the care of some patients, they can also limit their capacity to help other patients. In certain situations, limits to doctors’ capacities for empathy may be unhelpful or even harmful to patients.

A growing body of research suggests Balint-group training increases:

• practitioner sensitivity to hidden patient cues;3

• the proportion of the consultation spent listening to the patient;4

• practitioners’ experience of wellbeing during the consultation;3,5

• practitioners’ sense of control in their work situation;5 and

• practitioners’ work satisfaction.6

• At the same time it decreases:

• practitioner burnout;3,5 and

• unnecessary prescriptions,3 referrals5 and tests.5,6

In many countries today, Balint-group training is used in undergraduate and postgraduate education, most often in general practice training, but also in psychiatry, paediatrics, obstetrics and gynaecology, and internal medicine. At an international level, the vibrancy and energy of Balint-group work is reflected in the 26-year-old International Balint Federation (http://www.balintinternational.com). The Balint Society of Australia (http://www.balintaustralia.org), formed in 2005, joined the Federation in 2007.