I rarely agree with the statements and positions of Ezekiel Emanuel, MD. Politically he is to the left of what I consider rational and reasonable, but when I comes to his opinion on medical education we are in complete agreement.
In his article Does Medicine Overemphasize IQ? In the February 20, volume 319 of JAMA he offers concepts I have shared in my own personal and published writings over the past few decades (including my book Meta-Physician on Call for Better Health). Emotional IQ, EQ is clearly an under-appreciated quality.
The system which produces physicians has traditionally valued the student who can assimilate vast volumes of scientific material and to score well on standardized tests. However, it is more than clear to me that the best physicians need an additional skill set. The process of treating and helping to heal patients is not a mathematical or scientific formula. Rather it is more like the working through of a serious philosophical, psychological or written narrative.
What becomes the best option, the most reasonable approach to the patient who sits before me in my exam room? How do I handle a patient who is NOT responding to my treatment plan? How do I tell a patient that they are not going to get better or that their condition is terminal? How I dance to this music determines ultimately what kind of physician I truly am.
My own personal journey began with my interest in science and the humanities. My fascination with the metaphysical origins and backdrop to nature and the human condition led me down multiple paths which ultimately brought me to medicine as a career. My undergraduate degree in Religious Studies seemed initially incongruous with becoming a physician. Fortunately I was able to persevere through the arduous and often irrelevant pre-medical obstacle course of calculus, physical and much of chemistry. I matriculated in an excellent medical school named after a brilliant physicist was well as a metaphysician, Albert Einstein.
But even there throughout my educational process, what was never emphasized were the deductive reasoning skills which would aid me in my chosen profession. What I found intuitively was what mattered most was not only WHAT I communicated to my patients but HOW I did so.
I learned to communicate both verbally and nonverbally that my concern was for that ONE patient who inhabited by exam room at the time I was with them. No other patient of mine mattered at all. My attention, my concern, my deepest thoughts centered on that one patient alone. And it was true. I did see my practice in those terms. Hopefully that sincerity was felt and understood by the patient.
Emphasizing the power of the mind to affect the physical, asking the patient to participate in their own healing process. All these are strategies I employ on a daily basis which are not in their nature ‘scientific’ per se. If that represented my Emotional Intelligence then where did it come from? I believe it was natural for me. But clearly it isn’t for all physicians. Can these skills be taught? Because I believe they are innately present within all of us I do believe that they can be awakened, brought to the level of awareness that might even make some physicians uncomfortable at first.
It requires lowering our personal guard, revealing some of our own humanity to our patients. Of course we are the professional healer ‘in the room’ but we are also merely human beings. We can share a bit of ourselves, our common humanity with our patients without threatening that ‘professionalism’ we so dearly seek.
The term EQ contains, after all the word emotion. We are emotional beings and although we are trained to withhold our emotional selves from our patients, it is not inappropriate to allow our own humanity to seep through when it is necessary and appropriate. It is not inappropriate to smile when we are dealing with patients. Not all medical conditions and situations involve life and death issues. Relatively benign conditions can produce considerable suffering. Allowing the patient to perceive our lack of concern for their ultimate improvement has healing value.
Admitting that we don’t always know all the answers, the solutions to their problems is necessary. But equally so we can commit ourselves to seeking those answers and remain committed to the process of healing itself. Allowing that the process may be long and difficult but that we will not abandon the patient or their condition is a powerful EQ tool.
We suffer through an age when medicine seems LESS personal, more regulated by insurance companies and bureaucratic nonsense, when physicians find themselves tethered to their computers and burdened by electronic medical records which force our gaze from those we are attempting to heal. We find ourselves labeled ‘health care providers’ and no longer physicians.
But why should honoring our EQ be the goal of physicians alone? Wouldn’t all of society benefit from all of us seeking to become more caring human beings who recognize our common humanity? Therefore, there is more need than ever to seek that inner core of caring and honor the challenge we as physicians have embraced. But it is a worthy goal all of us both physician and patient can share.