Empathy: A tool every doctor must possess

Now, let‘s stop a moment

No, the vast majority of doctors don’t view patients as the enemy or sub human. Some do, and certainly some doctors historically have. To say these are the exceptions that test the rule, would be an understatement.

But becoming doctors does alter our brains’ chemistry and circuitry.

In an experiment, a group of physicians experienced in acupuncture was compared with a non-physician population. The two groups were scanned with MRIs while watching videos that depicted needles being inserted into various body parts, including the mouth, hands, and feet. It turned out that doctors did not activate their anterior insula or the anterior cingulate cortex, the brain’s P.O. boxes for empathy. In the non-physician group, these zones lit up brighter than a Diwali celebration. Are there differences between doctors and civilians? Is it true that we really don’t feel your pain?

Why shouldn’t we feel your pain?

A few months ago, a study revealed that crabs, lobsters and other crustaceans feel pain. For those of you who are not vegetarian, will you swoon over the billions caught and killed this year? Will you continue to lower them into pots, head first, boiling them alive? But why then do you wonder how doctors don’t seem to show compassion? We aren’t planning a seafood dinner. We are saving your lives!

We know that situations can be painful for our patients and we’ve learned throughout our training to inhibit our empathy-pain response. Empathy can cause poor care and emotional hardening and in order to help another survive, the heart must first pump blood to itself.

Knives cut, needles pierce, catheters invade, cauteries and lasers burn, and medications poison. It’s our stock in trade. Many patients stare into a doctor’s eyes that are as reflective as bottle caps. When doctors are afraid that others’ emotions will become contagious, they will limit and constrain their expressions of empathy.

How do we deliver the news of the disease that will affect every subsequent day of your child’s life in ways too horrible to contemplate, much less witness? We often inform you of the manner and timing of your death—and then attend you during it. We see, and often don’t register, the terror, medical indignities, and painful daily declines even your family cannot witness. For doctors, there should be no pain more easily experienced than yours. Re-instilling empathy in doctors by ‘teaching’ it, has shown no convincing results. And who said it was gone? But yes, it is hiding.

Empathy in Medical Care: Two Alternatives

Even in the face of apathy, your doctors must offer you something, some essence of humanity. What is the price of a touch, with the half-smile and furrowed brow that silently transmits an understanding of your problem? Patients expect and demand something. Where will it come from? We doctors strain against the biological leashes that demand our empathy.

With all our pressures, the glance, touch, smile, and sigh can easily come from us, even if it’s not within us. How? By acting! Yes, faking it. This is what I call ‘genuine artifice’. Are we lying? No. If this is lying, then so is the routine prescription of placebos.

Genuine artifice is no oxymoron. Its demonstration softens what otherwise would be the harsh blast of our profession’s form of medical autism. Its use improves our impoverished relationships and communication skills. It’s a ploy that’s calculated, not inculcated. It’s admirable given how helpful it is, how easily it can be provided, and how rarely it is used. Erving Goffman, a sociologist well-known for his analyses of human interaction says, “When the situation seems to be exactly what it appears to be, the closest likely alternative is that this situation has been completely faked; when fakery seems extremely evident, the next most probable possibility is that nothing fake is present.” That’s how the fake can be real, and the real can be faked.

Here’s option two. A substitute for artifice is Dr Michael Kahn’s concept of etiquette-based medicine. Simply put—just be polite. He says, “During my own recent hospitalisation, I found the Old World manners of my surgeon revealing. Whatever he might actually have been feeling, his behaviour— dress, manners, body language, eye contact—was impeccable. I wasn’t left thinking, “What compassion.” Instead, I found myself thinking, “What a professional,” and even [unexpectedly], “What a gentleman.” The impression he made was remarkably calming, and it helped to confirm my suspicion that patients may care less about whether their doctors are reflective and empathic than whether they are respectful and attentive.”

Sadly, we have learned that most doctors are unable to naturally show empathy; they must learn to simulate it or at least acknowledge the importance of manners.

French philosopher, André Comte-Sponville says “Politeness is the first virtue, and the origin perhaps of all the others.” He lines up politeness and morality by saying, “It is like a politeness of the soul, etiquette of the inner life, a code of duties, a ceremonial of the essential.”

Doctors don’t have to fake empathy, if they would only be polite. Do all you can to promote a doctor’s identification with you. If you promote a cognitive and socio-economic parity with your doctors; it forces them to see your eyes as mirrors. Mirrors of themselves. Being part of his ‘tribe’, simulates a kinship of sharing ‘hearth and home’. This is the best way to obtain genuine empathy. Because this is its evolutionary origin.

This was first published in the March 2013 issue of Complete Wellbeing.