DOCTORS & EMPATHY — A Teachable Moment ?

A recent NYTimes article by Pauline Chen seems to have received wide readership and commentary and for good reason.  The perception that my fellow physicians suffer from a lack of it is enough reason to discuss it further. Can it be taught?  The conclusion of the article is –yes.  I'm not entirely convinced of that point.  But should it be part of a training curriculum?–Of course.  I certainly can't hurt. 

The fact that it needs to be taught is unfortunate.  To me the empathic personality should precede the decision to enter the healing arts.  I know that many in the public arena believe that we all entered medicine for money and prestige.  I'm sure some of my colleagues did.  But in 2012 those students who seek money had better look elsewhere. 

Ironically, I am told that the "best and brightest" students are seeking Wall Street careers.  Really?  I would hate to think that careers in medicine and Wall Street are interchangeable based on dollar denominated factors. 

Perhaps this is leads to the bigger issue anyway. I have no doubt that the "screening" process for prospective doctors is flawed.  The undergraduate pre-med grind rewards students who excel in math and science–not the humanities.  Is there little wonder that some physicians appear to be automatons or borderline Asperger types to their patients? Those who can "ace" standardized exams make it to med school.  Where is the  Emotional Quotient (EQ) evaluation?  Where is the empathy exam? 

 And then there is the training path of residency and fellowship which leads to practice.  The "fraternity hazing" aspects of grueling hours and dehumanization of the prospective physicians may have been lessened since my days.  But the process unquestionably leads to an "empathy" draining effect on its participants. 

I found the need to re-gain my "humanity "once my practice began.  It was certainly not encouraged by the process itself.  Other issues strain the bonds of empathic connection.  Believe it or not malpractice claims cannot be reduced by compassionate care.  Surprised?  Unfortunate outcomes dictate the initiating of such claims.  The most mutually rewarding doctor/patient relationship is quickly dismantled by a friend or relative to insists that your doctor "messed up" and that a monetary reward is possible.

Perhaps the issue should also involve the eventual professional direction that physicians take.  The MD/PhD lab researcher and teaching professor do not need to deal with patients on the intimate level that private practitioners do.  Pathologists do not speak to patients.  Anesthesiologists and radiologists may do so on a care by case basis.  Perhaps the personality type should find the practice type that best suits their EQ.  Easy, no.  But awareness never hurts.

Empathy may be best defined as compassion with caring.  It is more than an emotion because it directs us to act and recommend in a specific way.  It manifests in the ability to "read" the patient and best fulfill their needs and expectations.  But equally important is the ability to communicate and exchange ideas with our patients.  The most brilliant, compassionate, empathetic physician who cannot speak in simple language or respond directly to their concerns will not acheive the personal connection.

This touches on the newest trend in medicine–Patient Preference.  It has emerged as a dynamic challenge to pure Evidence Based Medicine which promoted  plans of treatment based upon the latest "scientific evidence". 

The challenge for contemporary physicians is how to integrate the two.  I fully support the contention that empathy training cannot hurt.

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