After reading Melvin Joice’s February 2015 post on The Doctor’s Tablet, I have reflected a great deal on my role as a medical educator. Reading his post about how my words in that early lecture in ICM (Introduction to Clinical Medicine) were heard and internalized by this first-year student was a great gift to me.
Melvin’s reflection on how “curing” and “healing” are two overlapping but very different tasks in medicine provides for me that all-too-elusive evidence that teaching about the doctor-patient relationship, emphasizing communication skills and stressing the essential role of empathy in medicine seem to make a difference.
Can Empathy Be Taught?
This reflection continued recently as I served as a faculty expert on a New England Journal of Medicine (NEJM) group open forum, “Getting the Right Medical Students—Nature vs. Nurture.” Since a kickoff article in NEJM, there has been a lively discussion between medical students and faculty on topics such as “Can empathy be taught?” and “What is causing the decline of empathy in healthcare?” The open forum discussion feels a bit as if we’re “preaching to the choir,” but all the contributions underscore that we can and must teach our students to understand the importance of empathy and improve their skills of building trust and rapport and demonstrating empathy with patients to their highest possible level. The responses are largely positive, and while there is both anecdotal and research evidence to back up our assertion that “Of course, empathy can be taught,” in the moments when we are true to ourselves we question how much of an impact we, as educators, actually have in this arena.
The Challenges and Joys of Teaching Empathy
Many students arrive on our medical school doorstep with a well-formed image of the caring and humanistic physicians they want to be. They have a sense of at least some of the interpersonal skills and the emotional intelligence they will need to fulfill that dream. This group is determined to make those connections with patients, and listens eagerly to our instruction as we try to help them ever improve. A much smaller group arrives here having excelled at science, basked in the glow of their families’ and friends’ approval of medicine as a choice and ready to ride, sword raised high, into the world of disease like Don Quixote. When the members of this latter group learn that the key to their success is not only learning about anatomical structures, enzymatic pathways and pharmacological interventions but also being able to listen to patients’ stories, respond empathically and learn about their patients’ messy lives, their response to their time in my course (ICM) can go any number of different ways. They might begin the year by rationalizing that this stuff isn’t nearly so important as the basic sciences and refer disparagingly to the behavioral-science content and communication skills as “soft stuff.” Many will see their peers enjoying some success with these patient connections and hear in the words of patients how key their trusting relationship with their physicians is to their health and well-being.
There still might be some hand-wringing when the history we take of the present illness of a patient with HIV infection involves great details of his or her intravenous drug use and sexual history, provoking the exasperated question “But isn’t that just the social history?” But a good number of them relent or even embrace their fate: that separating the curing from the healing is not a way to find success in the practice of medicine.
I Wouldn’t Choose to do Anything Else
Will there be some students whom we don’t reach? Yes, some will graduate and not reach their potential as caring physicians. Are there some students with certain diagnosable or unnamed interpersonal deficits that will make teaching them to communicate and establish rapport effectively very, very difficult, if not impossible? Thankfully, very few. I think most work hard to be their best empathic selves with patients. It is certainly what I work and hope for.
I have told my children that if they can find a job or profession that they truly love, they will never work a day in their lives. I cannot take credit for that old adage, but I honestly love what I do just about every day. And then there are the truly wonderful days when I really know I’ve made a difference. Thank you, Melvin!