Empathy in Medicine

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Paul Curran does not have a blog per se, but he has guest posted all over the place including at Cordelia’s Mom Still and Willowdot’s and Doobster’s (don’t click the link to Doobster… it will just depress you). He also comments a lot over at Gibber’s place. This man knows an awful lot about an awful lot of stuff. In fact, he is pretty much an expert when it comes to healthcare because he has had to live it, through some very difficult times.

I say all of that to lead up to the questions he asked me on the It’s All An Act post:

Do you think medical school prepares a doctor sufficiently for seeing the big picture – the quality of life of the patient – or do they over-emphasize the technical side of practice? As you can tell from the question, my personal experience is that the medical profession spends too much time on the disease or organ and too little on the patient. How do you feel about that statement? Do you find it a common concern?

My answer:

I agree that there are a fair number of physicians who lack the ability to empathize with their patients. This is probably on par with any other profession but in medicine you feel lack of it more acutely. When a patient is hurting and frightened and confused, more than anything they want someone who can show some degree of compassion.

Why is this so hard for some physicians?

Sometimes it is an issue of survival. Critical care specialists? They are machines. Not very personable. But if I were the one dying, I want that physician on my side even if they are not giving me warm hugs. If you allow yourself to feel everything, you will soon lose yourself to it all. 

Sometimes, the subject matter precludes it. Nephrologists? Numbers. All they care about is numbers. And they are crazy smart, too. But take an astrophysicist and put them in the midst a group of religious fanatics and someone is going to go crazy. Or die. The two cannot coexist. 

Often it is a time issue. In the rush of a busy day it can be hard to slow down and take the time to find that place of empathy. Sometimes it hits me later, long after that patient has left my office, when I have time to process everything. This is one of the reasons why divorce rates are so high among physicians. The job is fast paced and demanding and overwhelming and at the end of the day there has not been enough time to even consider your partner’s needs, much less fullfill them. Patients get lost in that, too.

How do you fix it?

Some will probably disagree with me, but I am not really sure that empathy can be taught. Certain people are born with the ability to place themselves in someone else’s shoes. Some people stumble upon it, often because of finding themselves living through something awful. Others have to be taught how to fake it. 

The market rewards empathy. When I refer patients to specialists, I want someone who first knows their stuff, but secondly someone that the patient will like. I try to match personalities if I can. Not everyone wants a physician who holds their hand. Doing it like that makes me look good. Managing up the other physician doesn’t hurt, either. “This neurologist is just the best there is!” But getting patients in to someone personable is often not possible… those physicians are too busy. High demand. When we have to settle on someone else, I will often tell patients about that physician’s personality… knowing what they are getting into often helps.

What do you all think?

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168 thoughts on “Empathy in Medicine

      • Your comments pretty much leave the empathy up to the doctor – I guess I would like to know: Is any attempt made in medical school to help doctors relate to patients?

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      • Oh, gosh. Yes. But like I said you cannot teach it. They do video patient encounters, critique opportunities, etc. All of that teaches you how to fake it if you are someone who doesn’t have it. Which is probably just fine, in the end. Like having sex with a woman. If she fakes it, what do you care so long as it is convincing?

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      • I think there would be long term consequences – in the case of the faking orgasms. the relationship would eventually end up in a bad place. Same thing with a doctor faking it, I would imagine. Excluding emergency doctors.

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      • Women have been led to believe that they should be wet and ready at the drop of a hat and that a normal frequency of intercourse is 4-5 times a week. Anything less is perceived to be a medical disorder. The vast majority of women are not wired that way.

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      • Ha ha ha ha!! Not funny at all, honestly–the self-centeredness of many male partners doesn’t surprise me–but I’m laughing because I have dating profiles on the two free sites (Oh, Hey, Stupid, and Tons’o’Tuna) and, since November, I’ve been getting cr#p results. I made a couple of changes. One was to the question “How often do you see yourself having intercourse?” (or some wording like that). I’d answered, honestly, “Daily”. I’d noticed that men had all answered “Every other day” or less, even those who claimed they had a “stronger than average” sex drive. So I figured I was scaring them off. Yup–I changed my answer to “Every other day”, and now: Presto! Vastly better results.

        But I don’t get wet’n’ready instantly, and I shouldn’t have to.

        All may be moot. Can’t find a non-pet-owning guy who doesn’t fall short in other ways. Sigh. Me, I’m perfect, of course.
        ๐Ÿ˜‰

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  1. It is the age old question of nature vs nurture. The best doctors (in my humble opinion) are the ones who have an inherent ability to empathize and with training can control it. No one wants a doctor blubbering in sympathy but you also need to know they honestly care. IMHO

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  2. Victo, important thoughts! Working in psychiatry, empathy works, and it’s part of the treatment. In medicine, it needs to work at some level, along with competent, detailed systems care. Being clear and straight with diagnoses and medicine, I’d say is a first priority. Understanding with empathy the patient’s reaction to what you tell them comes next, a very quick next. With your 10 to 15 minutes seeing patients, I think adjunct staff can fill in, especially nurse practitioners and staff nurses. Many times the patient connects with them before the physician. It does take a team. I’d say you’re one physician who understands all sides of patient care. Brava! Christine

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  3. I know not everyone can empathize, Doctors are no exception but I don’t want to keep on but the brilliant, as he was surgeon who mended my spine via three ops, was so sarcastic and rude he upset me each time I saw him! ..eg. I asked him if he could explain why I was waiting for my op ..he barked I told you yesterday DO I HAVE TO TELL YOU EVERY DAY?

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  4. My cancer surgeon and oncologist were both empathic. My radiologist wasn’t but he was super smart. Sometimes I had to have one of the other two help me to understand something because I just didn’t get it from the radiologist. The surgeon has one of the busiest practices because all he does is breast cancer surgery. You can imagine the state his patients are in. One of my friends went to him when she was diagnosed at 33. When he came into the room she was bawling on the table. He sat her on a chair and spent 10 minutes assuring her that there were options, her life wasn’t over and he was going to see her through. That was about 15 years ago and she’s still kicking. Sometimes empathy is critical. Sometimes (like my radiologist) you can do without if you are getting it elsewhere and the care is good.

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  5. I love my GP /internist because he treats me like a person worthy of kindness and RESPECT. Wow! What a concept! He is the best because I feel comfortable bringing up any concerns with him. He listens and takes me seriously. Very important.

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  6. My computer decided I had finished talking ..I had not! I was so upset by the guys reply, another time Surgeon, OH! yes these are huge lumps the screws must of moved.. me I don’t usually complain about nothing he said to me ” This building is full of people who complain about nothing!” I could go on… when I was having a procedure and he and his team ignored me ( wide awake ) while he discussed his cars ..four of them! ..He Registrar was so kind though a lovely chap he made my month or so in hospital bearable just by popping back and reassuring me! Sorry I don’t mean to go on! xxx

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    • Ha! here in Ottawa the head of our Heart Institute (a surgeon) got caught trolling the market for ladies of the evening. The cops had a sting set up and he was caught.He had a beautiful Jaguar rag top and one day one of my my truck drivers came tooling into our parking lot at work with this very infamous car (there had been a lot of pictures of it in the various newspapers). He jumped out and came in to get his orders for the day while we gaped at the car. Apparently the driver’s wife was a surgical nurse who worked in the operating room with this doctor.One day after the doctor was caught, he was operating and they were talking about cars – exactly as you said Willow- when the doctor said he couldn’t drive this infamous car any more because the press followed him.. The nurse piped up and said “My husband collects cars and he would love to have it if the price is right.” The driver wouldn’t say what he paid but I understand the price was very. very reasonable. So, you see all operating room car talk is not just in vain. Ha!

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  7. What they all said! My first husband needed back surgery and that surgeon was our first experience with a lack of bedside manner. I never forgot it. More recently but still a few years ago, my now husband has gout. He saw a new primary care doctor at our HMO who changed his meds. The med change led to one of his worst gout attacks ever – he was practically bedridden for days! Plus, all the while we were sitting in the exam room with the doctor he never spoke TO us, only AT us, staring at his laptop the entire time. I like my naturopath much better. ๐Ÿ™‚

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  8. As an expert patient, I think it depends on the situation. In an emergency, I want competence above all else.

    But I generally pass on jerky docs. Years ago when I was frantically searching for a surgeon because I was misdiagnosed with advanced ovarian cancer and I needed to find a surgeon willing to try to find my ovaries/uterus in my gut which is chock full of scar tissue, my husband and I interviewed one prominent surgeon who was highly recommended by everybody. His office, where he brought us to talk about what needed to be done, contained two uncomfortable plastic chairs on one side of the room. On the other was a lovely roll-top desk pushed up against a window. Mr. Fancy Surgeon sat with his back 2/3ds towards us as he explained what he expected to do. He addressed 90% of what he said to my husband. Then, when we were leaving, we all stood up. The Doctor high five’d me (I’d put out my hand to shake his) and shook my husband’s hand. What a twit.

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  9. There is sometimes, I think, a barrier of self preservation around the critical care specialists. At the time, surprisingly enough, I found that helped. I didn’t want my hand held through third degree burns… I wanted relief. I didn’t need a hug from the surgeon… a needed him to save my son.

    The aftercare, however, when the adrenaline had settled, often felt cold. Given the prognoses on the wards, I had to wonder how much they could have borne and still done their jobs had they ‘let everone in’.

    On the other hand, the bear hug the same large and illustrious surgeon dived over to give me when my son showed signs of waking, I shall not forget. He whooped with as much joy as I did.

    The surface does not, I think, always tell the whole story.

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  10. I don’t really have that much experience with doctors, to be honest. As I’ve mentioned before I try to avoid needing their services and, most likely through sheer luck and a little determination on my part, for the most part have been able to. I can see all of your points, though. And since I am very empathetic I try to put myself in the shoes of the physician. No, they don’t want to sit around and chit-chat with me for twenty minutes. They need to do what they need to do and get on to the next patient who’s probably been waiting for a while. I try, try, try to only go to the doctor once a year(and only then for my annual…:rolls eyes:) The only small talk my physician gives me is during the actual exam, I guess, to make me feel more at ease. I’m good with that. I’m an accountant. It baffles me that clients act as if I should just know off the top of my head every little detail of their business. I’m their only accountant but they aren’t my only client. I’d think it works pretty much like that in every profession.

    I would think that if physicians, and as you say particularly critical care physicians, internalized every patient’s to be sufficiently genuinely empathetic it could eat their soul. I’m thinking about physicians who deal with things like terminal cancer, or ALS, or Muscular Dystrophy, or Cystic Fibrosis or any number of other illnesses that don’t have a sunny prognosis.

    Side note: I did what you said not to do. What is going on with Doobster? Is he okay? I’ve been in sort of a hole and haven’t been online very much. I’ve obviously missed something important.

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  11. Great question and answers. ๐Ÿ™‚
    I have no trouble understanding what a full day a physician puts in. Most of the ones I’ve had interaction with have been kind. Some have been stand-in for God.
    If you can’t deal with the whole person, why go into medicine? Just a little empathy goes a long way and calms the patient, I’m sure.

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  12. I don’t want sympathy from any doctor. What I want is for them to listen and try to understand. Some people call that empathy. Whatever you call it, that’s what I want. Just make an effort to understand. No emotional involvement is necessary.

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      • You’ve really touched on what is needed, I think, more than anything: Is it empathy, or sympathy, we are lacking from those cold doctors, or is it respectful listening? Treating us as equals? Warmth is appreciated, but if you have a medical concern, I think your primary concern is to feel that the doctor has taken you seriously, and done her/his best to address the medical side–more than holding your hand. If you think s/he’s done this, you feel cared about, even if no specific empathy words, touches, or hugs are used.

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      • Yes! Yes! *Taken seriously* – assuming one’s sanity, IQ, common sense, etcetera, are not in question. I *don’t* want hugs or faux feeling. I was thinking more about this post and I fear that good, empathetic doctors will be driven out or discouraged by all the bureaucratic nonsense and be increasingly replaced by those who thrive in that kind of overly regimented environment.

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  13. True empathy comes from within. It can’t be learned or faked. Quasi empathy can be faked, but it lacks something. (yes, of course quasi empathy is too a term) It takes a real talent to fake it, and come across as believable. I think it is ingrained in us as humans, and like everything else, we have varying degrees.

    P.S. I like the horsie picture! ๐Ÿ™‚

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  14. Respect and courtesy can be taught. Listening can be taught. Those go a long way to patient satisfaction, too. I was thinking just the other day that doctors (probably like most practitioners) are most likely taught to “be in charge of their session.” Having worked with the public, you NEED to be able to do that, or you’ll spend 3.5 hours listening to Irene discuss her neighbors and tv and … However, too many doctors (and NPs) seem to be taking this to mean, “My way or the highway.” One notable NP basically told me to shut up when I was trying to tell her an important symptom. Yeah, that went over well.

    Empathy can be taught, to an extent. This is one of my pet peeves though and is Planned Blog Post #419. Too many people think that just saying, “Sorry” or parroting back the situation is empathy. It isn’t.

    It’s a fine line. I want to be respected as a patient. I realize the doctors, et al, only have x-amount of time. If I got smooshed by a bus, I’d rather have the detached Jerk who is good at his job attending to my oozing innards. With a GP, I want someone who will remember I’ve been there if I’ve been there several times, someone who listens, and someone who might even crack a joke or laugh at one of mine.

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  15. I have found a large number of physicians lacking in empathy. Here in Ireland I blame the educational system. To qualify to study medicine you are required to get the maximum number of points in your final exams. Personally I feel this attracts those who are more about ‘I can study this so I will’ rather than those who would really make wonderful doctors.
    I have met a number of dreadful individuals who are surgeons, and who have been allowed, over many years, treat their patients and junior doctors very badly.
    Equally I have met some who were amazing.

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  16. I love that you warn patients what they are getting into. I had a great family doc that knew I needed to see a specialist right away. There was only one that could get me in that quick. So she said she was going to send me to him but he is very weird. That helped a lot he was very weird but I was prepared for it so it took the stress out some.

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  17. I have much to say about this but I will try to be short-winded. Empathy is not teachable. It is intrinsic. The best you can do is try to give language and cues to someone who is lacking in that arena. But there is nothing worse than fake empathy. My role at work is to teach all the touchy-feeling patient centered classes. What a frustrating role. I also oversee patient satisfaction for the agency. Truthfully the patients want respect, excellent care, and the truth more than touchy-feely. Matter of fact, I have had complaints when the clinician oversteps the boundary line.
    I did some research on why Doctors and other clinicians can be so gruff and short. And I did more research about trying to build compassion and empathy โ€œlessonsโ€, which is where I came to the conclusion you either got it or not. One reason is the high level of competition in medical school. They sort of instill a cut-throat race to be the best. I think that it transfers to โ€œI donโ€™t have time for nice-nice.โ€
    As we roll towards conveyor belt (bundles) medicine, it will only get worse.
    I personally struggle daily with the omnipotent โ€œI know more than anyone attitudeโ€ from all levels. Although it pisses me off personally, I understand that having confidence in oneโ€™s practice is imperative. I actually wrote about it in my blog and then deleted it. I am the opposite. I love getting close and personal with people. I get it with clinicians. I feel good that I am teaching them to be mindful and breathe.
    I think I am going to make a suggestion for recruiting new doctors at the University for the Med Center: โ€œMedicine is not for pussies!โ€

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    • Jane: you say that conveyor belt medicine is a bad thing but I am not sure that is always true. In B-school we studied Shouldice Hospital outside Toronto Ontario, Canada. ( http://www.shouldice.com/ ) They do only hernias in an “assembly line” style and have an awesome reputation for the best results and the best patient care in the world. They actually have a patient reunion gathering where literally thousands of their happy patients meet and greet. Costs are the lowest, patient satisfaction is highest , and cure rate is amongst the highest in the world. Good patient care and high satisfaction are possible with assembly line care – IF it is done right..

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      • The key is doing it the right way. Standardizing care can be good provided it does not stop everyone from thinking or prevent deviation from that standard when it is necessary.

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      • You know that comes back to leadership and is true in every workplace Victo. This is one of my pet beefs with today’s workplace – not enough emphasis is placed on leadership. Get the right leaders and any system will work. We need to spend more time and emphasis on training leadership skills.

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  18. To empathise is to feel/understand what another person feels. But since there is no way to ascertain the thought of another, our empathy gauge is set to monitor what we think it should look like. This is inherently inaccurate.
    The empathy I feel, and the “empathy” a patient sees/thinks that I feel are quite different things. One is an unperceived, evoked emotion, the latter is purely acting. It seems to me that people don’t want empathy, in fact, true empathy might prove too tedious for most. What people really want, is a well disguised form of sympathy, a form that doesn’t hurt their pride to accept.

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  19. I’ve always thought that I will choose competence over compassion if a choice was needed. Of course I’d like both but I realize that isn’t always going to be the case. I have a lot kindness and love in my life so not getting that from a doctor who treats me is fine. As long as she looks at my rash!

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  20. Ms. Overwordy here: Just one last issue I didn’t see touched on:

    The truly unfortunate chosen style of many docs when “reassuring” patients who present with something they are concerned might be a sign of cancer: A mole they feel has changed, a mark on their skin, a tiny lump under the skin–whatever. The doctor responds “THAT?! THAT’s nothing to worry about!” Even sometimes chuckles, I have heard.

    I have heard this from friends and family members going back years–since…1977. Americans keep getting told “Tell your doctor if you have one of these common signs”, and then get embarrassed when they do. This would be an easy issue to train for in med school:

    “That was smart of you to bring that to my attention, Mr. Mendoza. This time, it is good news–nothing to be concerned about, but don’t hesitate to ask me any time something concerns you.”

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  21. Reading all these comments, I’m thinking of a continuum. Rude – Arrogant- Distant- Cold- Analytical- Logical – Attentive – Listening- Understanding- Respectful- Empathic- Caring- Compassionate- Emotional. The ones in the middle feel right to me, and I believe you can teach listening skills to most people. I would definitely want to know if you were referring me to some one cold/distant and warned if the person was worse. He or she would have to be pretty darn smart, for me to put up with cold/distant. I think rude/arrogant can do more damage to a sensitive patient.

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  22. You are right, it’s most often about numbers. During residency, I was examining and treating up to 100 OPD patients in about six hours. That’s less than 4 minutes per patient, include the extra time some patients needed for a more detailed examination or special investigations, and you can imagine how much hand holding I could do.
    In the end though, doctors are human too, and do end up desensitized to a greater or lesser extent. That’s human nature too.

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  23. Very good read. I read some parts twice.

    I agree empathy is a difficult aspect of providing personal services. Beyond the nature-nurture debate some people are either more empathic or less. After much reading including Hofstede and Trompenaars I find there are no easy answers.

    In the end it goes back to an ancient principle for me: treat others like you would want to be treated.

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  24. I feel like I could say so much, but I don’t know where to start… Personally, I don’t think medical school prepares us well for empathy – not because they don’t try, but because it’s not something that can be easily taught in a short period of time. You need to have time, exposure, and a desire to earn it.

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  25. This talk of picking a physician like you’re shopping for a piece of fresh fruit in the grocery store by squeezing it is unsettling. It’s all necessary and there nothing inherently wrong with it, but it does set my teeth to grind. But when you get down to its core, it’s a business decision, isn’t it? One with potentially grave consequences, but a business decision nonetheless.

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      • Is that really your experience? Do most people think physicians are inherently flawed and up to no good? I hope not! Lord, what has society come to when doctors and teachers become the bad guys. We’re like ancient Rome right before it feel.

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      • Perhaps the question is, is it a matter of perception is reality, or reality is reality? E.g. Do more than a few bad apples–more than a small number of doctors–fail at being good listeners, even allowing for their severely-limited times per patient?

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  26. Well said. But I wonder if the question didn’t so much relate to empathy and bedside manner as it did the notion of holistic care. In other words, taking the time to evaluate/appreciate the patient’s overall condition, as opposed merely to the specifically malfunctioning organ.

    Whether Paul meant that or not, I’d be interested in your take on whether medical schools prepare physicians sufficiently for seeing the big picture โ€“ the quality of life of the patient โ€“ or do they over-emphasize the technical side of practice? Is there a tendency to focus on the cure rather than the cause? What about the patient’s lifestyle, diet, stress-level, etc.

    I realize there’s no time for that sort of thing in critical care situations, but what about in general practice? I do wonder if there isn’t a tendency to address problems with pharmaceuticals and prescriptions, rather than changes in diet and lifestyle (for example). And in my experience, that’s often what the patient wants. I’ve heard of specific instances of people rejecting advice to change their diet, for example, saying, “I don’t want to do that. Can’t you just give me a pill?”

    Love your blog…

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    • Thank you! Yes, we do talk about prevention in medical school but not as in depth as some might expect. Many treatment guidelines start with diet and exercise changes as the first line. Sometimes that is not possible. If someone comes in with high cholesterol and they say they want to fix it, I tell them to prove it to me by rechecking labs in 3-6 months. Very few actually follow through. A fair number do just want me to give them a pill to fix the problem. Not cholesterol medication. They feel that is too dangerous. They want weight loss meds. Those are fine as a tool for long term changes in diet and exercise but they don’t fix the underlying issues that brought then to me in the first place but they really don’t want to hear that from me. I won’t write a prescription without having the patients follow along with me making measurable changes, most go to a pill mill instead. Soooo… After all of those words, not sure I answered the question! I did address more of it in the comments when Paul asked for more info about med school training as it pertains to this, so maybe see of that helps some, too…

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      • Bill’s question was excellent and your answer was of equal quality Victo. I would have liked to have meant “What steps are taken to address the patients’ concerns in a holistic manner?” but I am too realistic to think that could ever be “taught” – it is closer to “wisdom” than training. I see empathy as a doable, teachable action towards answering that question. Empathy being understanding and acting in the manner most helpful to the patient, as defined by the patient. Whether that is fast, efficient, emotionless treatment in Emergency or the kindness of holding a hand when consoling a patient with a terminal illness – what is best for the patient. Honestly i don’t care what diseases or illnesses or conditions i have -I care about my quality of life and longevity. And I am even willing to sacrifice some longevity for quality. Most are.

        Honestly Victo – it is rare that any of us actually get to say what is on our minds to a real doctor who will listen and respond. The vast majority of doctors I have had have been very good – even the very few assholes were professional, just really lousy with people. I have yet to meet a doctor that i could call incompetent (I’ve seen them make mistakes but not for lack of trying) . Please don’t take our complaints as an indictment of your profession – it is not. You have tapped into a pent up reservoir of hither to unvocalized concerns. Think of it as lancing a boil – the pus that comes out is disgusting but there is a great satisfaction in knowing that you have struck on the infected tissue and the very draining of the pus is therapeutic for the patient.

        In Canada we have had a French/English tension for many centuries. There have been a few referendums that came close to seeing the breaking up of Canada and the separation of the primarily French province of Quebec. A federal French political party was formed and many representatives elected to our federal government. At one point this supposed “separation” party actually were the official opposition – meaning they had the second most votes nationally in our federal government. When this happened, the desire for real separation dropped substantially.- as measured by polls. The moral of the story Victo – is that people really only want their concerns heard and considered, they aren’t trying to lynch anyone – and that includes doctors.

        Thank you so much for listening to us, it is very therapeutic – for me anyway – and helps me to see doctors for the humans they are. Our conversations here definitely have and will affect my perceptions of the medical profession in a positive way.

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  27. I would take competence first; on the other hand, the doctors I know say that they can often figure things out through conversation (and through a long-term relationship). Patients don’t reveal everything under normal questioning, especially when it is all business. A doctor who knows you will see and hear things another doctor might miss. That’s a big problem in the way medicine is conducted now, dictated by insurance companies.

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  28. Pingback: My Article Read (4-16-2015) | My Daily Musing

  29. Good post. From personal experience, I believe it is a combination of things. Money, numbers, and time being the major driving force. Also, I’ve noticed doctors have a difficult time saying “I don’t know how to fix the problem.” It’s try this, and test for that, rather than listening to the patient. Sometimes a patient needs a good ear and a plan to improve their quality of life.

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    • From a physician standpoint I think most doctors are afraid to say “I don’t know how to fix you…” People come to us for help and saying that feels like failing. Unfortunately sometimes the “fixing” process requires trial and error as what doesn’t work helps to pin down the diagnosis. Often it is a process but I hear from patients all of the time about their frustrations about not getting better immediately so they switch doctors. I may get it right and fix the issue but that is only because I know what has already NOT worked. ๐Ÿ™‚

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  30. Great post! This is one I can relate to…after being on a medical journey with my the hubs for 11 years now. In march 2004 the critical care doctor in MD told me to call a friend to be with me when my hubby dies, not to call our son who was in college in FL, too far to make it in time. Soon thereafter, a famous cardiologist in the nations capital told us he’d have 1 in 20 chance to live 12 months. Then a compassionate (and otherwise fantastic) cardiologist took over his care here in FL (hubs wanted to live in FL before he dies) – that was 10 years ago. Hubs is going strong and has a very compassionate doctor to thank for it. Pairing personalities is beyond important!

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  31. Thanks for great Doc insight to Paul’s usual smart question, Victo.

    My anecdotal evidence from living 32 years in the Syracuse, N.Y., area, makes me believe that geography has something to do with personality of care as well. I spent a 15-year chunk in the middle of my time here living in a village 35 miles out in the country, were there was a small but vibrant hospital five miles in another village the other direction. My wife at that time was a nurse in that village, and I became socially active with many of the doctors and nurses and all levels of personnel that made that hospital and surrounding, supporting practices go. They were talented, committed to their patients and provided top care. They also seemed to have a bit more time or make a bit more time to concentrate on other aspects of life, too. During that time, my primary care physician diagnosed me with Type II diabetes. My eye doctor fit me for reading glasses and then performed laser surgery on my eyes for complications discovered immediately after my diabetes diagnosis. I continued with my regular care from both, and keep them as my doctors, even though I moved back into the city 11 years ago. It’s worth the drive. They know my name, talk to me as a person, ask me specific questions about life as it relates to my health.

    As I said, anecdotal evidence, but it’s what I have to offer. Do you think geography plays a role in a culture of doctor’s care-giving, hospital-by-hospital perhaps?

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  32. I don’t believe empathy can be taught, either. Of course, having two autistic kids, neither of whom have an ounce of empathy in their entire bodies, and then there’s my own autistic self who is the exception to the rule, and has too much, it’s difficult for me to be objective. ๐Ÿ™‚

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  33. Empathy – I used to have it. Now where has it gone? – when i first visited India 25 years ago, I cried whenever I saw a beggar with hands held out for money. Now I walk right by with the rest of the locals – I have to because I cannot afford to feed India. I have limited resources. Yet, I also feel guilty and so sad that I am unable to help these people. That to give away ten rupees to one beggar would help just a little, but then if I do that, ten more beggars would be with me in a moment. Maybe that is what’s happening in medicine and in the West in genereal. We have gotten used to seeing pain, poverty, and hardships, so we just turn off. (Or perhaps i have another set of genes that have kicked in…) – well, anyway, this is my two cents… Eve

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    • Certainly over exposure breeds callousness. I am not sure that you are calloused, though. There is a peace in recognizing that you cannot be all things to all people, that you are not able to save them all. We are only called to do what we can, however small. Right? Sometimes as a physician that means just listening.

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      • maybe you are right. Given a choice would you choose medicine again? – It is a tough job nowadays, well always was. Now I am off to watch my new hero, Bernie Sanders, – Oppps, should not say that here.. best of luck Doc. Eve

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