I see a unique side of people: the tops of their heads. I can spot gray hairs, roots, and baldness at a glance. Faces, however, escape me. At six foot three, it’s hard to always see them. Where does that leave me? Out of touch.
We are inherently different people, seeing from different perspectives and facing different challenges. I hit my head on low ceilings, they get lost in crowds. I barely fit in an airplane seat, and they can’t reach the top shelf. But all it takes to remove the “I” vs. “They” distinction is a bend of the knees. Now I look through their eyes and walk in their shoes. I know how it feels to lose myself in a crowd and to ask for help to reach my favorite crackers. In two words, I empathize.
And if a person practices medicine, her career depends on meaningful conversation. A primary care physician’s first question might be: How do you feel?—a sentence brimming with subjectivity. She is vulnerable to receive any answer, whether it be “my leg hurts” or “I feel depressed.” As a health professional, she must then diagnose the problem and begin a conversation with her patient regarding treatment. Though, as Theodore Roosevelt said, “No one cares how much you know, until they know how much you care.” Without empathy, the doctor-patient interaction loses affect. The patient perceives that the physician does not (or cannot) fully understand the problem he or she faces and, therefore, cannot treat him or her at a high level of care.
The above is routine, but then there are patients with whom it takes extra emotional proficiency to empathize, because they cannot speak your language. Take, for example, my recent conversation with a neonatologist. He explained that a baby who is born prematurely must spend time in a neonatal intensive care unit under the care of a neonatologist, and even after receiving high quality care, it will likely spend its life suffering from various health problems. In our individualistic culture, one might assume that the family’s wishes would be honored without question—if they want the baby to survive, the physician will do his best to keep it alive. But the neonatologist keenly acknowledged that he must treat the newborn, not the family. He has to consider the implications of continuing treatment, asking questions like: “Will this baby lead a normal, productive life with minimal suffering?” The doctor did not say this during our talk, but his role at that moment is to speak for a human life that cannot speak for itself. In order to make the best-informed decision regarding its future, he seeks to understand how the newborn feels in its current state and how it will feel years down the road. Only after walking in the small shoes of his patient can he then choose a course of action.
The same applies to all physicians, including surgeons. Surgeons are different from most physicians because they must suspend their empathy when in the operating room, but according to a neurosurgeon, it is crucial to also remember what you are dealing with: a human life. While the shortest path to any point is a straight line, each route a neurosurgeon might take to remove, say, a tumor, could affect the patient differently. It is the surgeon’s responsibility, then, to discuss the repercussions of each scenario with his patient and choose the most appropriate one. If he is a pilot, steer clear of his occipital lobe.
So then, it is apparent that empathy (and a balance of empathy and distance) is necessary to practice high quality medicine, but the question arises of how to teach it to aspiring physicians. In my own experience, I have found that studying the Arts & Humanities exercises one’s capacity to empathize.
I am a pianist, and like every student, I began with the basics—scales, some chords, and a few melodies. Fast-forward a few years, and I am playing the works of Chopin, Mozart, and the like. But something happened during that time. Music is a profoundly intimate endeavor, and every note or rest is there for a reason—anything else would change the feeling of the piece. It took me years to understand the emotion and motive underlying the structure of a piano piece, and with that understanding, I resurrect works of passion. What’s more, I can make that passion resound in the ears and minds of everyone listening, as if the composer himself were within them. Yet, he remains speechless. Is it not also the neonatologist who speaks for the speechless? As a pianist, I prepare myself to perceive and manage the emotions of my future patients.
Reading literature such as the psychological novels of Georges Simenon has also trained my ability to empathize. A story would develop in the Belgian author’s mind until the pain reached Simenon’s limit, at which point he would disappear to write a novel, one chapter per day. His series of psychological novels (romans durs in French) features men whose lives turn from ordinary to criminal, comfortable to inescapable. Kees Popinga, the main character in The Man Who Watched Trains Go By, for example, is a typical father but boards a train for Paris after losing his job, only to commit murder. To my surprise, I found myself empathizing with the felon. I often read on the train coming home from school, and with every bump, I held my breath. Goosebumps rose on my arms, as if I were a wanted man. Upon reading the final sentence, I felt deep sorrow, as if I had lost my best friend. I empathized with ink on a page, a doomed father, someone who had lost it all.
Is that not what a physician is expected to do? In all the glory of medicine, perhaps one’s greatest responsibility is to maintain human emotion under the pressure of a dehumanizing profession. The Arts & Humanities offer aspiring doctors a powerful way to practice that responsibility, but the question remains: how do we as leaders in learning improve the status of the Arts & Humanities in higher education?
2 Responses to “Teach Empathy to Aspiring Health Professionals”
July 26, 2013
GiovanniGreat essay Jakub! Having studied at a liberal arts institution myself, I can appreciate your stance. An aspiring doctor might enroll in a science-only curriculum, assuming that this is the best route to an MD, but I would also argue that this is insufficient for some people. I didn’t always think this way, though.
My first course at Holy Cross was entitled, Memory in Ancient Greece. It was arbitrarily assigned as part of my first year program. I was not too thrilled at first. Classics? Who wants to study that? However, it turned out to be one of the most interesting and enlightening courses I have ever taken, much most engaging than orgo for sure!
Anyway, what I am getting at is that the well rounded candidate has the capacity to succeed. Having taken philosophy, history, religious studies, and literature classes has made me more appreciative of the the other’s craft.
This is a difficult era to become a physician. This is the age of “ME,” where people do not like to inconvenience themselves for the sake of others. And I have to admit, I have lived up to the stereotype many times, residing in my own comfortable bubble. We have to realize that our lives affect the lives of others. This is especially true for a physician! Besides an medical knowledge, an ability to empathize is key for success as a doctor. It is unfortunate, however, how little this is stressed at times. Many times, when you go to a specialist, you get a whole 10 minutes of their time! You present A, they prescribe B. Next! There is no dialogue, no understanding of the patient. This is very unfortunate! I don’t know if I am young and ignorant, or if they are cold and hardened. My reply is all over the place…I digress.
A focus on liberal arts education is a step in the right direction, for sure. Great work!
July 31, 2013
Susan FrostIntuitive design. It makes products that delight us from the tool that we hold comfortably, to the car that seems to have everything in the most natural place, to the computer that responds like an alter-ego. Intuitively designed products tickle us to pieces. How often to you sit back and say, “Well, wasn’t that neat!” – if it is even recognized at all. Intuitive design is to products what empathy is to any kind of creative problem solving, but when it is applied to the practice of medicine, it is as effective in communicating and healing as any medicine, medical equipment or medical procedure. Empathy is the human touch and how can we be whole without it.
We live in an age of digital communication, of pandering to the bottom line, and because we don’t listen, because we don’t take the time, we lose our humanity and with it, our effectiveness. Perhaps in an effort to protect the emotional health of those who deal in illness, we have taught healthcare professionals to be emotionally absent, to convert the human efforts to heal into a business transaction. Sympathy is emotionally depleting and we can’t really “feel together” as the root implies, without becoming exhausted. Empathy, on the other hand, allows us to stand in another’s shoes, to see it from their point of view, and that produces a comprehensive picture. It evokes meaningful exchanges and better insight into a better practice of medicine. It inspires trust making patients feel valued. Those are the positive interactions that provide comfort in living and in dying. When medical practices – delivery systems, hospital design, economics and political involvement – take on empathy, the results produce effective care systems.