Pity is not the same as empathy
Your doctor: Smarter than Bill Gates , chattier than Oprah, but as cold as Darth Vader. Two out of three qualities! Not bad, right? Well, no. Brains are most important. Communication skills follow. Last but not least is empathy. Few docs have all three. Many have none.
The three qualities of understanding that are used when approaching others in times of difficulty or distress are pity, sympathy, and empathy. The definitions of these words are obviously confused when each is used as a synonym for the other, and each is used in the dictionary’s definition for the other.
Pity separates the observer from the sufferer. No one wants to be pitiable. It is an emotion that is placed on its victims. It can be considered, at worst, a type of contempt.
Sympathy for a sufferer suggests an association but not identification with the stricken party. It’s a shared experience but not a mutual one. It finds its best example in the act of consolation, when an uninvolved party shows support for someone in mourning.
Empathy is a quality that is shared. There is resonance, a key concept when differentiating sympathy from empathy. Empathy doesn’t simply understand another’s emotions. It shares the feelings, if not their intensity. Sympathy understands others’ emotions; empathy resonates with them.
When it’s most needed, it’s most likely lacking
There is no pursuit more demanding of a doctor’s empathy than oncology. What other field is more characterised by patients suffering from illness and pain, who dread the possibility, and often, the certainty of death? In three published articles, hundreds of expressions of negative emotion, and existential concerns regarding morbidity and mortality were voiced. They suggest that an oncology office is a ‘compassion-free zone.’ In one of the studies published in the Journal of Clinical Oncology, it was reported that oncologists responded with empathy only 10 – 35 per cent of the time. They dodged, diverted, or summarily ended the discussions without empathic acknowledgment. Even tasteless humour was employed as a distancing technique. These results are not unusual, nor are they limited to oncologists. In a study that observed responses in surgery and general medicine doctors noted that 62 – 79 per cent of the time they missed opportunities to respond to patient clues.
You’re in the army now
Ever wondered how could a cardiologist ever be heartless? The short answer is: He does have a heart—he just checked it at the hospital door. Doctors are trained to modulate, even eliminate, their empathic feelings toward you. The process of becoming a doctor is not far removed from the training that armed service recruits experience. The biologic demands for empathy arise from the ancient limbic system of the brain. In battle, empathy needs to be first eliminated in soldiers, when it comes to the enemy, and then stoked to the max when it comes to their comrades in arms. When facing the enemy, the soldier is trained to stop thinking of them as human.
But wiping out feelings of humanity for an adversary exacts a toll. Moms, after a school bus accident, how many of you will step over other children, regardless of their injuries, in order to get to your own child? Yes, empathy is present; but it is fluid and adjusts to the circumstances. It can be refused or offered selectively when the demands are extreme.
And so it is for medical students
We enter medical school with a desire to care for people in need. But medical school is like a boot camp. Empathy is not enhanced in medical school; rather, it is systematically and deliberately degraded by the experience of going through training. And just as it is for our armed forces, a price needs to be paid by medical trainees when their biological leashes are strained to the breaking point. Almost 50 per cent of the medical students were found to suffer burnout, and an alarming 11 per cent contemplated suicide. With tougher competition in India, one can but wonder about your pre-med and medical students’ frames of mind.
Just learning to do what doctors must do, instills attitudes that would be unacceptable in others. A few careen down career slopes that lead some to treat patients in the same way soldiers treat the enemy.
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