THE UNCARING DOCTOR — Weakness or Strength ?

Your favorite meta-physician here has been pondering the question of empathy and the medical community for decades.

In the past I wrote about the pre-med selection process which, I fear, selects for the more studious, analytical and compulsive among potential applicants.  The more intuitive, free-thinking and perhaps empathic young folk just don't make it through the process.

A fascinating article in Scientific American by Haque and Waytz http://www.scientificamerican.com/article.cfm?id=doctors-and-dehumanization-effect explores the science behind physician empathy.

In the study they perform  functional magnetic resonance imaging (fMRI) on physicians performing painful procedures on patients.  Compared to controls, physician's brains reveal less empathy.

The observations in the article imply that physicians begin medical school with a considerable amount of empathy ( ? evidence for this assertion) and gradually learn to suppress it during training.

They also speak of the balance between the empathic response and the cognitive, decision making aspects of a physician's role.

 As a self-proclaimed empathic physician I do understand the condundrum we face. 

Two days ago I saw a patient whose GYN found a rectal tumor.  Her fear was palpable and I knew she should not wait the usual interval for further testing.  I squeezed her into my busy schedule for colonoscopy the next day.  Unfortunately the findings were as we both feared and I had to tell her and her husband that I found a tumor in her rectum.  Clearly I could show empathy in the manner in which I spoke to them.  I lowered my voice, came close and touched their shoulders.  But I knew that what they needed to hear from me in the next moment was the "next move".  They needed direction because they were in a state of shock.  I tend to lead my patients in that manner.  I know they are immediately filled with fear and worry about the future so I attempt to  provide a strong direction for them.   I suggest that they focus only on what needs to be done next.  I do not believe it is in their best interest to confront a teary-eyed physician who only mirrors their own panic.  A physician who feels "too" emotionally connected with their patients may lose the impartial, objective cognitive approach which is needed at such times.  Yet without enough empathy they may allow a patient to suffer more than necessary.

 I had them schedule at CAT scan immediately and make an appointment to see a colo-rectal surgeon ASAP.  I have instructed my nurses to make sure she gets seen this week by a surgeon.  Because of my relationship with this particular surgical group and my insistence I know this will happen.

The point here is that empathy and detachment must co-exist in a dynamic balance.  I believe that there are physicians who do care but for reasons that may be subconscious or arising from their own fears are unable to transmit and communicate that concern to their patients.    In other words the perception of an uncaring, unfeeling physician may reflect an inability or unwillingness to commincate this precarious, nuanced and  balanced position.

It is a difficult but necessary aspect of medical practice.  Just as in other aspects of life there are individuals who are better at expressing feelings and empathy than others. 

 When it comes to life and death health issues the difficulty becomes exaggerated yet finding the correct balance is crucially important.

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