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in-Training: Stories from Tomorrow's Physicians, Volume 2
The Value of Empathy in Medicine
by Sarah Bommarito at Wayne State University School of Medicine
Empathy: it's what supposedly drives us to become physicians, and what we're told to demonstrate through our extracurricular activities and during our interviews. We yearn for that perfect patient interaction in which we comforted or understood in a way that changed the patient's perspective on medical care. In our idealized view of medicine, we truly believe that empathy will be our saving grace throughout medical school, residency and beyond. If we can simply connect with our patients, then we will succeed and the patients we care for will thrive.
And then we begin our clinical rotations.
During orientation at my clinical site, one of the attending physicians gave a presentation on how to avoid becoming "robots" during the course of our medical training. I sat in the audience and wondered how I could ever fully disregard emotion, but the entire premise of the speaker's presentation hinged on the certainty that this would happen unless we tried very, very hard to remain human. I considered this for a while and decided that while I could understand how some of my classmates might lose empathy, my hyper-empathic tendencies simply could never be diminished. After all, studies have shown that physician burnout is worsened by forcing down negative feelings that naturally occur over years of bending to the burden of patient care.
In the following days and weeks I kept this lecture in the back of my mind as I began to learn how to interact with difficult patients, take overly detailed histories, complete monotonously thorough physical exams, and present this information to my often-impatient superiors. Early on I realized that when you're part of a medical team, empathy isn't valued nearly as highly as virtues such as efficiency, confidence and medical knowledge — and did I mention efficiency?
Many aspects of clinical care can be reduced to measures of time. Insurance companies become vocal if they have to pay for a longer length of stay. Patients become irritable if you ask seemingly similar questions too many times — even though we've all seen that slight rewordings of a question can yield strikingly different answers during rounds. The interns to whom you're assigned are too swamped with paperwork to care about the fact that your patient is apprehensive about being discharged and wants more information before leaving. The attending physician has to be somewhere this afternoon, and how could you even consider bringing up patients' trivial concerns when there are lab values to be discussed and additional tests to be ordered before lunch?
It isn't that one part of the system demands efficiency — it's that most parts do. In order to function as a valuable member of a medical team, you almost have to conform to these standards. People and companies expect this from you. You learn to optimize the amount of work you can do and the number of patients you can see in a morning and an afternoon, and the standards continue to become more rigorous.
During my second rotation, I was placed on an oncology floor. In the beginning, I often inconspicuously shared in the sense of sadness and hopelessness that my patients and their families faced when trying to understand their diagnoses and prognoses. I learned not to go to my superiors with details of personal talks with patients after being told and reminded that I wasn't allowed to be sad after long discussions about impending death. It was my job to be strong for patients so they wouldn't see tears in my eyes and assume that all hope was lost.
Within a few short weeks, I had accepted that stage IV cancer could be equated to certain death in a shorter amount of time than any patient was ready to accept, and I had even begun to think somewhat negatively of patients and family members who stubbornly refused to agree with these now-obvious realities. In large part, this way of thinking shielded me from the pain of relating to these patients. I began to think that medical professionals might be on to something: maybe it's right to disregard empathy in favor of a more logical approach to patients, a bedside manner that is more realistic than overtly comforting.
However, I was forced to reconsider this idea. This way of thinking caused me more exhaustion and misery than I had ever felt in my medical training. I went home with headaches, complained about my day and then holed up to study. While I enjoyed learning about medical conditions, I felt little emotional pull to continue my day-to-day work.
And then a patient and his family put me back on track. The patient, middle-aged and in a relatively new marriage, had been diagnosed with stage IV cancer about two weeks before I first met him. When we first spoke, he was irritable and quick to disregard me. His wife apologized for him several times during the difficult interview. I told her I understood that he was in a great deal of pain and exhaustion and appreciated their patience with me. Over the next few days, she began to tell me details of her husband's illness that never came up during rounds.
The patient declined slowly at first and then, after a routine procedure, his mental status became severely altered. No available treatment could prevent further decline. The team recommended hospice care to keep him comfortable. His wife, though upset, seemed to understand, but admitted that she needed time to think and to discuss this with their immediate family.
By the time I went to the patient's room to check on him later in the day, his wife's attitude had changed drastically. She began to accuse the team of giving up on her husband. She told me that he was a good man who had provided for his kids for many years. He was a hard worker. He cared so much about her. Why did he get worse so suddenly? She wasn't ready to give up on him; why was our team giving up?
I listened to her with conflicting emotions. I knew this was difficult for her, but I also knew from my admittedly small amount of experience that the best thing to do was to ensure his comfort in his final days. But something in this woman's tone sank into me and reminded me that we were dealing with a unique patient. She hadn't faced this situation before. This is easy to forget after seeing so many patients with similar afflictions. Even in the small amount of time I had been on the service, I began to comprehend that physicians become used to certain situations despite changing patients. Disregarding a patient's individuality allows for treating the condition based on medically sound evidence without the need to understand the patient's whole story. This certainly saves time and energy that may be better spent on other tasks, after all.
At the end of the woman's tangential musings she began to cry — quietly at first, and then with sobs that shook her body. Without considering my actions, I moved a box of tissues closer to her and placed my hand on her shoulder. I told her that we weren't giving up on her husband, and that we would do everything in our power to decrease his pain and maintain his comfort. I told her I knew her husband was a good man just by seeing how much she and their family cared for him, and that the team would be there to answer her questions and do as much as possible for her and her husband. My sentiments were genuine. Nothing I could have said would have soothed her entirely, but she was noticeably less upset and more open to considering the difficult decision at hand.
Empathy didn't save the patient's life, of course. He passed away comfortably under hospice care a couple of weeks later. But that day — in that moment — I knew I had improved the situation simply by seeing the patient's humanity and relating to his wife. While our conversation did not make the decision for her, it seemed to give her a sense of peace in making a difficult decision. Because of her decision, her husband was ultimately granted comfort in his final moments.
A later experience during my psychiatry clerkship provided further support for the value of empathy. I was placed at an addiction treatment facility for two weeks and primarily saw outpatient encounters. One day, I was invited to a group therapy session in which the patients wrote letters to their addictions and the residents and students wrote letters to those suffering from addiction. I wrote about how I hoped patients would find support, care, comfort and acceptance in us and how proud we are that they were taking the necessary steps to find clarity and overcome their addictions to lead healthier, more fulfilling lives. In short, I told them we're on their side.
While I wasn't able to stay to hear many of the letters, the therapist later told me that when she read our letters to the group, the patients became very emotional. They hadn't realized how much we cared, she said, and it changed their perspectives on seeking care from physicians after their stay at the facility. Many of them had felt discouraged at their appointments and assumed that we saw them as a nuisance. In reality, many of us saw them as strong and determined people who were ready to get back on track and repair their damaged relationships and lives through treatment.
Showing empathy to patients can mean more than we realize or understand. Simply knowing that someone truly cares can help patients feel comfortable and justified in seeking the appropriate treatment or making a difficult medical decision.
As medical students, we're in the unique situation of experiencing some amount of responsibility to care for patients as well as the time to do so in a way that many residents and attending physicians cannot. Our time isn't billed to insurance companies, and there are so many options when it comes to how we can choose to spend it. I realize that I will reach a point where my time will become more limited, when I might find myself in a more robotic state with the eightieth patient who presents with a certain condition, but I hope I find the strength to return to this empathic state of mind at least as often as I leave it. I hope no one is ever able to fully convince me that empathy in medicine isn't worth the effort.
In continued lectures, I am reminded that empathic interactions need not take more than a couple minutes to cause a positive impact, and I've seen that a couple minutes is often enough to show a patient that you truly care about his or her outcome and that you are undoubtedly on his or her side. Sometimes patients and their families need to feel that sense of shared concern in order to feel comforted and adequately cared for. Sometimes physicians need to remember that their patients are human in order to avoid a sense of emptiness in their careers.
I am often given cause to wonder, even if the interaction takes slightly longer, what do we have to lose by showing concern, listening to our patients, and allowing ourselves to hold on to that feeling that drove us to become physicians in the first place? In truth, it seems that, to the contrary, we all have so much to gain.
Sarah Bommarito (1 Posts)
Contributing Writer Emeritus
Sarah is a Class of 2016 medical student at Wayne State University School of Medicine in Detroit, Michigan. She majored in Honors English at the University of Michigan. Her interests beyond medical school include reading memoirs, baking, and travel.
Tags: burnout, death, humanism in medicine, medical education
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