Paul Bloom thinks empathy doesn’t make someone a better person. But might it make someone a better doctor?
The medical community seems to think so. A growing consensus holds that doctors should show empathy, and, in response, medical schools have begun trying to teach it. The argument is that bedside manner—a vague term that seems to encompass both empathy and common courtesy—is a central component of good medical practice and a skill that should be taught and measured, just like a student’s ability to suss out anatomical landmarks or identify heart sounds.
Indeed, empathy has been named an “essential learning objective” by the American Association of Medical Colleges. A 2006 paper entitled “Educating for Empathy” in the Journal of General Internal Medicine states, “Empathy is believed to significantly influence patient satisfaction, adherence to medical recommendations, clinical outcomes, and professional satisfaction.” Teaching strategies abound: lectures and skills workshops; audio and videotaped examples of empathetic interactions; nontraditional curricular requirements including courses in wellness, spirituality, and literature; theatrical performances; reflective writing assignments. Some students are paired with patients in nursing homes to learn firsthand about the experiences of sickness and aging. Many are given laminated “empathy cards” to keep in the pockets of their white coats.
‘That must have been hard for you,’ reads one empathy card distributed to medical students.
Empathy cards offer readymade lists of empathic statements for students to use in patient interactions. “That must have been hard for you,” reads one. “I can imagine that was difficult for you,” reads another. If we accept Bloom’s definition of empathy as the ability to put oneself in another’s shoes—to feel her pain—it is difficult to imagine how stock phrases such as these could engender that ability in our medical providers.
Imagine the following scenario. A medical student is doing a rotation on the inpatient unit where I work with psychiatric patients who may be suffering from suicidal ideations, hallucinations, paranoia, or the consequences of recent trauma. A patient confides to the student that her depression is the result of unrelenting grief following the death of her young child. What if the student reaches into his pocket, consults his card, looks back, and replies, “I can imagine that was difficult for you”?
I agree with Bloom that too much empathy in patient care can be overwhelming and therefore counterproductive. If, while listening to the grieving mother’s raw and unbearable description of her son’s body in the morgue, I were to imagine my own son in his place, I would be incapacitated. My ability to attend to my patient’s psychiatric needs would be derailed by my own devastating sorrow. Similarly, if I were brought in by ambulance to the trauma bay of my local emergency department and required immediate surgery to save my life, I would not want the trauma surgeon on call to pause to empathize with my pain and suffering.
Still, in most of the interactions physicians have with patients in everyday medicine—indeed in my own clinical work—it is easy to see how a reasonable amount of empathy can be beneficial, for both parties. Patients feel heard and understood. Doctors appreciate their patients’ concerns and feel compelled to do as much as possible to alleviate their suffering. But I am not convinced this kind of authentic relationship can be taught with laminated cards, audiotapes, and skills workshops, even if students memorize the statements on their pocket cards and deliver them convincingly. What our young doctors are learning is probably not empathy but the performance of it—a charade that happens to improve patient satisfaction and outcomes.
Who cares, so long as the outcomes are improved? My hunch is that the answer depends on who is asking. Insurance companies and health care conglomerates—profit-driven, empathy-devoid institutions that they are—are far more interested in outcomes than in how they are achieved. But I suspect that most of us, as patients, would prefer that our doctors care about us, not just pretend to.