Impact in Qualitative Research: Nada I. J. Abualfita and Alhasan F. I. Ahmed on Ethics and Empathy in Healthcare
Dr Nada I. J. Abualfita is a medical graduate from Mansoura University, Egypt and successfully completed six months of clinical training in the Emergency Department at Mansoura University Hospitals. Dr Alhasan F. I. Ahmed graduated from Mansoura University in November 2023 and currently works as a medical trainee in the Emergency Department at Mansoura University Hospitals.
In this blog, Nada I. J. Abualfita and Alhasan F. I. Ahmed reflect on how qualitative research deepens understanding of ethics and empathy in healthcare by foregrounding care experiences as meaningful evidence that informs ethical reflection and clinical practice.
Behind the corridors and noisy monitors of every hospital, there are quiet moments that reveal what truly matters in healthcare: being present, listening and understanding. Qualitative health research treats these moments and care experiences as evidence that can inform ethical reflection, clinical practice and change within healthcare systems. We are Palestinian doctors who spent a year working in Gaza during our medical placement in 2023. During this time, we observed that some patients developed severe complications or even died after suddenly stopping their medications without consulting their doctors. When we asked them about their reasons, they explained that they were upset by the adverse effects of their medications. Although they had already discussed these effects with their doctors, they felt that the doctors did not show enough empathy toward their concerns. As one patient told us, “My doctor did not show any empathy toward the symptoms I experienced from the adverse effects.”
We believe that patients’ worries should be taken seriously throughout their medical journey as doing so can strengthen commitment to treatment and reduce the risk of non-adherence. Commitment depends on both patients and doctors, yet even when patients demonstrate full commitment, they often do not receive the empathy they need. Empathy is a crucial component of effective treatment. Qualitative research with people living with long-term conditions shows that patients understand involvement not merely as being offered choices, but as feeling listened to, respected and treated in a non-judgmental way. When this relational ethos is absent, involvement and engagement are undermined even if information and treatment plans are technically correct (4).
Qualitative health research has provided us with simple empathetic phrases that have informed our practice. Phrases such as “You may experience some side effects that might bother you,” “We will do our best to manage these effects or find suitable alternatives,” “Help me to understand your situation,” “I get the sense that you are feeling overwhelmed” (2) can make a significant difference when prescribing new medications or during follow-up visits.
These everyday interactions are also where medical ethics is most clearly enacted; they matter more than formal guidelines or institutional policies. Ethics in medicine is not confined to written codes or hospital rules; it lives in the difficult choices clinicians make every day. Ethics, particularly normative ethics, can be understood as a functional activity: through it, we decide how institutions should operate and what actions we ought to take (4).
A major challenge for doctors, especially those working in emergency care, is balancing ethics and law. The law sets fixed criteria that must be followed, whereas ethical principles are learned, flexible and shaped by the patient’s situation. For example, deciding which patient requires urgent intervention is not primarily a legal issue, it is an ethical one. Ethics in the emergency department is therefore a daily challenge, as decisions must be made quickly and under uncertainty. Qualitative research with emergency doctors and nurses shows how these dilemmas become particularly acute in end-of-life situations. Clinicians can feel “caught in the middle” between what they judge to be clinically and morally appropriate, what families request and what systems and documentation allow in the moment (5). Reading this work has encouraged us to slow down when possible. It has also pushed us to seek more collaborative decision-making with nurses and senior staff, rather than carrying these choices alone.
Empathy in medicine is often described as the ability to listen, understand and emotionally connect with patients. In practice, particularly within the Egyptian healthcare context, empathy is more complex. It involves acknowledging patients’ fears, respecting cultural backgrounds, and recognising the influential role families play in medical decisions. Qualitative health research shows that active listening and self-awareness are central to developing empathy, forming key foundations for meaningful communication between healthcare providers and patients (1)
This is especially true in emergency care, where the pressures of the system shape how empathy can be expressed. Studies with emergency doctors and nurses highlight the impact of time pressure, staffing shortages and constant uncertainty. Clinicians describe how being short-staffed, legally constrained or forced to make rapid decisions can limit opportunities for careful conversations with patients and families, even when they know such conversations are important. Empathy doesn’t disappear under these conditions, it just becomes harder to sustain consistently when structural pressures demand quick, high-stakes decisions (5).
This aligns closely with our own experience in emergency care, where shifts can extend to 48 or even 72 hours. In these circumstances, empathy does not disappear, but it becomes more difficult to access consistently. Fatigue, constant vigilance and responsibility for rapid decision-making can blunt emotional availability, even when the desire to care remains strong. Engaging with qualitative research has helped us understand this tension not as a personal shortcoming, but as a predictable effect of working within strained systems.
