Empathy is currently the fashionable thing to discuss in certain medical circles. Specifically, the need for health care professionals to adopt and exhibit more of it.
Who could possible argue with that?
Me. I disagree. I just want them to be good scientists – which in my experience – many, if not most, are not.
At one conference I attended the organizers announced that after a year of research and consideration they determined the focus of future leadership development should be imbuing ’emotional-intelligence’ in physicians.
My knee-jerk response was “I really don’t care in the least about my doctors’ social skills – as long as they do their job.”
At the time I kept that thought to myself since the doctors seemed very keen on it – and well, I was sensitive to the amount of effort and money that had gone into making this determination. The MBA consultants in attendance were also eager to make themselves available – for a fee – to give the doctors a higher ‘EQ.’ (Amusing side note – the EQ expert in my group kept crossing his arms over his chest and sighing whenever someone said something he didn’t agree with – usually me.)
Over time and as a result of other experiences with those in the field, I have become convinced my initial reaction was correct.
Actually, I would now go even further and argue that empathy may be hazardous to the health of the patient (and possibly the practitioner) – especially for someone, such as myself, who has a disability.
The definition of empathy is to imagine yourself in the other persons place and think about how you would feel.
And that’s where the problem lies. They are not in my position and they have no idea of how I feel and the substitution they make about how they ‘think’ they would feel is not only based on ignorance but prejudice, fear and sometimes hate.
The worst case scenario of empathy-on-the-loose leads to the nurse sitting by my bedside sputtering with frustration at my refusal to sign a DNR: ‘I don’t understand why you would even want to go on living.’
This nurse didn’t strike me as a serial killer lurking the halls of the hospital in search of prey. I suspect in her mind she was genuinely helping me. It’s just she wanted to help me die when I wanted to live.
And I blame empathy.
She put herself in my position and decided she would rather be dead – a perspective that is far from uncommon in health care.
I could have done without her empathy at that moment.
The concept of encouraging empathy towards patients assumes that every health professional can relate to the experiences of every patient in some way even if they haven’t ever been in their situation.
The assumption that we can all understand the situation of every one else no matter how different their life just might be what lies at the root of some the biggest social and political issues of our time.
A doctor who attended Upper Canada College and is a third generation surgeon probably has absolutely no point of reference to even begin to empathize with my life.
Likewise I do not know what it is like to grow up on a reserve and have to fight the government for clean drinking water and proper health care while a wealthy white man pens a newspaper column about the ‘Native problem.’
Certainly I can relate to the feeling of being stigmatized and misrepresented – but it is not the same. The difference in our circumstances is as important as the similarity.
A scientist – someone who earns that title by how they think and approach the world – endeavours to be as aware of what they do not know as they are of what they do know.
Which is why all I really want is for doctors to be good scientists.
Trying to imagine how someone else feels is important to building and maintaining relationships and character. It is particularly beneficial to the person attempting to be empathetic. It takes time, effort and usually some degree of intimacy to do it well. So I encourage health professionals to practice it – on their own time.
On my time I want them to listen. I want them to utilize their skills and knowledge and work with me – not because it’s nice or kind – because it is their job.
As good scientists I want them to embrace the best knowledge we have at this time – and that would include awareness of their own cognitive biases.
I want them to maintain ideals reflective of a profession engaged in aiding the health and well-being of human beings.
This means health professionals should be educated about the injustices and inequalities their patients face – not to ‘understand’ or ’empathize’ – but to utilize that knowledge to prevent misdiagnosis and improper or harmful treatment resulting from their prejudices and ignorance.
I want doctors to be learned people. Read more than medical journals. Look broader than the microscope.
I want them to care passionately about truth.
I want them to be possessed by curiosity and driven for the need for answers and understanding.
I want them to be humble because more than anything else,
I want them to know what they do not know.
On a practical level – health professionals can’t possibly emotionally invest and connect with every single person they encounter if for no other reason they don’t have the time. I am also not sure it would be healthy for them.
What they owe me and themselves is their best. If they are truly determined to uncover the right diagnosis they will want to learn as much from a patient as possible. If they want to be part of the best possible treatment they will need to effectively communicate with the patient. In other words – if they respect their profession, they will respect their patient. Empathy may happen at some point in some cases – but it is not the foundation that good medicine starts from.