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It’s in such moments, as in many others, when empathy wells up in medical practice. I could clearly imagine myself or my family members in their position. Their emotions became all too familiar and upsetting to me. I wanted to do everything in my power to help them and to fix their situation. But this strong sense of identification seemed odd given how brief my interaction with them had been.
In reality, however, such a feeling is not so unusual. Robert Louis Stevenson, the famous nineteenth-century Scottish writer, co-authored a short story called The Ebb-Tide. It is an account of three criminals who steal a ship and the deeply troubling moral situation they subsequently encounter. When one of them falls sick, Stevenson describes the healthy comrades’ feelings:
A profound commiseration filled them, and contended with and conquered their abhorrence. The disgust attendant on so ugly a sickness magnified this dislike; at the same time, and with more than compensating strength, shame for a sentiment so inhuman bound them the more straitly to his service; and even the evil they knew of him swelled their solicitude, for the thought of death is always the least supportable when it draws near to the merely sensual and selfish.
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Given the power of this selfless commiseration shouldn’t we cultivate it in medicine? No doubt it will help us to act altruistically even when we see the worst in patients or colleagues, thus leading to a better bedside manner and better patient care. Jean-Jacques Rousseau, the Genevan philosopher, saw such feelings differently, however. In Emile, or On Education, Rousseau points out that empathy is really an outlet for selfish passions, even if its effects can be positive. Rousseau writes that,
if the enthusiasm of an overflowing heart identifies me with my fellow-creature, if I feel, so to speak, that I will not let him suffer lest I should suffer too, I care for him because I care for myself, and the reason of the precept is found in nature herself, which inspires me with the desire for my own welfare wherever I may be.
He values doctors who take the time to listen to him and develop an understanding of his situation; he benefits from this sort of cognitive empathy. But emotional empathy is more complicated. He gets the most from doctors who don’t feel as he does, who are calm when he is anxious, confident when he is uncertain. And he particularly appreciates certain virtues that have little directly to do with empathy, virtues such as competence, honesty, professionalism, and respect.
This makes sense. I can imagine how exhausting it must be to feel so strongly about every patient. It would cause burnout and depression. But the psychologists Lynn O’Connor and Jack Berry respond to Bloom in the following way: “We can’t feel compassion without first feeling emotional empathy. Indeed compassion is the extension of emotional empathy by means of cognitive processes. Only if we have the capacity to feel empathy toward loved ones can this sentiment be generalized by the imagination and extended to strangers.” This addition to Bloom’s argument is absolutely vital. Both types of empathy are important.
Such balanced empathy keeps the physician honest. There are many times when, in a rush to complete the work of the day or under the pressure to see every patient, physicians take their frustrations out on patients. Empathy tames our impulsivity and gives us pause. It forces us to consider the actions we are about to take. And we can project empathy using reason and emotion. If an elderly woman is being difficult, instead of reacting with frustration and annoyance we can step back and ask ourselves, “What if is this were my grandmother or my mother? How would I want her physician to behave?” To do this is not easy, but it can make an immense difference in how one interacts with a patient.
Empathy may or may not spring from selfishness, and too much of one aspect of it (like too much of any emotion) can be a bad thing. But physicians do need empathy, both the emotional empathy that we feel towards some and the cognitive empathy that we can extend toward all. In the cogs of an impersonal medical system, it leads to the dignified treatment of a suffering patient.