On Empathy: “The Only Time I Remember Seeing A Physician Touch My Father”

You can’t reduce empathy to a formula. Read this Lancet perspective by Caleb Gardner. It’s about what he learned while a medical student from his father’s death from heart failure.

A few excerpts:

I attended a lecture on breaking bad news and having goals-of-care discussions with families in the critical care setting. The presentation was like many I had seen before: strategies for conveying empathy and assessing comprehension were offered, together with an acronym or mnemonic device to remind us when to speak, listen, and offer some gesture of understanding or solidarity, such as an empathic statement or verbal identification of observed emotion. I remember one slide in particular that showed a pie chart of the optimum speaking to listening ratio; the listening section, as the presenter pointed out, was larger.

The doctor on duty during the week my father spent in the cardiac intensive-care unit was young, focused, and energetic. In the few brief conversations we had she used many phrases that I recognised from medical school. But her approach couldn’t hide the fact that she would have rather been looking at the screen of her smart phone than talking to me or my mother; if anything, the rote phrases she used emphasised it. At one point she awkwardly nudged a box of tissues in our direction, although neither one of us was crying.

My father’s nurse was awkward as well, but in a different way. Older and reticent, he, too, was more comfortable doing things than making conversation, but when he did speak his words seemed unrehearsed. At one point, my mother and I were sitting in my father’s room, where he lay sedated and intubated, while the nurse and physician conferred by the door about some medication changes. I caught only fragments of the conversation, but one of them was the nurse’s observation that, “he has a crappy heart”. I hoped my mother had not heard this remark, and felt angry towards the nurse for his callous words. But then, despite my anger, I realised that his transgression also felt human and forgivable, unlike the doctor’s prepackaged expressions and superficial manner which seemed to preclude any meaningful connection and left me feeling far worse.

But as anyone who has spoken to a script-reciting customer service agent knows, they cannot convincingly take the place of those emotions. Evaluating a medical student’s empathy with a checklist can make it easier to grade a test or plot a graph, but real people suffer miserably every day for lack of what cannot be found there. Real damage is done, to both providers and patients, when medical training inadvertently facilitates the substitution of scripted empathy for the real thing.

My father’s cardiologist came to see him the day after he was admitted to hospital. He introduced himself to the nurse, who handed him the chart, which he paged through slowly, reading the story told by hourly recordings of medication levels and vital signs. Then, wordlessly, he took the stethoscope from around his neck and walked to the bed. He leaned over, breathed in, and, holding the firm blue tubing like the needle of record player, he placed the instrument on my father’s bare chest, closing his eyes for a few respiratory cycles, the room silent except for the rhythmic bursts of the ventilator and muffled monitor alarms filtering in from the hall. It is the only time I remember seeing a physician touch my father from the moment I arrived at the hospital to the day he died.





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