Patients don’t need someone to appear empathetic; they need someone who is empathetic. You can be that person without burning yourself out! In this article, Osmosis Medical Education Fellow Jon Urquidi Ferreira discusses the prominent role empathy has begun to play in medicine and why he thinks we should commit to it even more.
Modern medical schools have an entirely different perspective on what it takes to be a clinician compared to 20–30 years ago (when most of our teachers were being trained). Back then, medicine was paternalistic and authoritarian; there were no waiting time targets, and the public didn’t have access to (or possibly an interest in) the kind of information about health that we have now.
Thankfully, person-centered medicine is the new standard and is at the heart of the teaching at my medical school: King’s College London. Roleplay with patient actors and patient educators (“professional” patients invited to the medical school to educate medical students about their ideas, concerns, and expectations in clinical encounters) is routine and highly helpful. In the NHS (Britain’s national health service), we are increasingly exposed to patient stories to help us appreciate and understand patient experiences.
Yet, there is a grain of sand in the middle of this change, which has equal potential to irritate or to develop into a pearl. Increasingly, I hear experts in clinical communication tell students to “appear more empathetic” in their interactions with patients. Whether these patients are real or simulated, these interactions are opportunities to connect with patients, to feel what they feel, to hold a space with them—now, while we are students, rather than when we are overworked, raw, and stressed foundation year doctors (or interns for our American friends).
What am I talking about?
Just to remind you (sorry): The cliché definition of sympathy is an appreciation of another’s feelings, while empathy is where you experience what another person feels—“em-” meaning “in” and “-pathos” meaning “feeling.”
If you continue to dive down an etymologist’s wormhole (more specifically, Kelly Knox’s), you, in fact, find that empathy is a rather new word, and its Latin roots are perhaps not too important. The word was likely crafted to express the German concept of einfuhlung, literally meaning “in-feeling.” The New Century Dictionary gives a much more psychological perspective that defines empathy as “…mental entrance into the feeling or spirit of a person or thing; appreciative perception or understanding.”
This is much more illuminating—but also much more confusing when you consider someone being asked to “show more empathy”…. It sounds more and more like an arcane or occult task, inappropriate for a rational and empirical student of modern medicine.
“Display your mental entrance into the spirit of another” is not exactly the kind of command any of us signed up to receive when we applied to medical school. But arguably, the more and more laughable the idea of working on “displaying empathy” becomes, the more crucial the experience of it becomes.
Why should we bother?
The interesting question then becomes: How do we foster this experience? How can an individual cultivate this bizarre, occult phenomenon? But before that is answered, perhaps we should briefly address a powerfully simple question: Should we?
Historically, it was argued that doctors should experience neutral empathy. One of the most famous and erudite pundits of this viewpoint was Sir William Osler, who argued that “by neutralizing their emotions to the point that they feel nothing in response to suffering, physicians can ‘see into’ and hence ‘study’ the patient’s ‘inner life.’” While it is unrealistic to carry all of your patient’s burdens, and it is important for clinicians to guard against burnout in a world of seemingly endless demands, this perspective cauterizes away the human element of medicine: the therapeutic potential of connection and listening (see Harvard’s Professor Ted Kaptchuk’s work for a powerful argument for harnessing the power of placebo).
For a powerful account of the damage that this neutral empathy and emotional distancing can do—not only to patients but also to clinicians—please read The House of God (1978) by Samuel Shem. Frequently recommended by clinicians, it is a challenging first-person account of a medical intern’s desensitization and burnout by medical culture until he learns to empathize once again and reconnect with himself and others.
So, if you will please do me the favor of taking that for granted, I will continue and give some examples of ways to cultivate experience.
If you’ve made it this far, keep your mind wide open!
The key to experiencing empathy is building a repertoire, library, vocabulary—whichever word you prefer—of experience.
Novels and films are infinitely better poised to give us an understanding of other people’s lives than walking around in their shoes; all that will really do is give you blisters and bunions. There are tremendous depictions of people’s experiences of psychosis, leprosy, and anything else. For a great starting list, see this list compiled by double-threat physician-filmmakers at Stanford.
However, while it is brilliant to expand and imagine lives that are totally different from your own, it has been argued by philosophers that human experience is surprisingly universal. The emotions we experience and the thoughts we have are uninspiringly commonplace. Which means that the best place to start is inside your own consciousness. Being aware of what you experience is the starting point for recognizing and understanding changes in others—things they could never communicate in a seminar but that are the meat and veg of building an emotional connection with another.
There are myriad methods for this, but the one I have personal experience with is meditation. Not so much the 10-minute mindfulness session we might practice together during a wellbeing week (though this is excellent, and I recommend you continue doing it or give it a try if you haven’t yet). There are forms of meditation that focus on cultivating insight into the sensations that we all experience and which underpin consciousness. There are countless exercises on the Internet using body scanning, mainly for self-compassion—this is inseparable from empathy and will help you develop this faculty. For the skeptics out there, here is some scientific backing for the importance of somatosensory processing in compassion and empathy. For some exercises to start with, you can have a look here, and for anyone wanting to dive deep, I recommend looking into any Vipassana retreats near you (the most widespread school calendar can be found here).
Don’t lose sight—or feeling—of your emotions.
Do not be afraid of difficult emotions, as the resistance to them is worse than they themselves could ever be. Each of us can find a way to process them—whether through art, dance, the written word, or meditation, to name a paltry few.
So I implore you—yes, you—to stop “displaying” and to keep “experiencing.” Sneak some black magic into your clinical encounters whenever you have the opportunity.
About the Author
Jon Urquidi Ferreira is a third-year medical student at King’s College London and is currently participating in the Osmosis Medical Education Fellowship program. His background is in neuroscience, and he has an interest in psychiatry. Jon is also a passionate climber and a deeply addicted rambler. Feel free to reach out to him on LinkedIn for potentially bizarre but hopefully illuminating conversations.
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