An excerpt from Our Connected Lives by permission of Texas Tech University Press. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
I used to think that as an active oncologist for thirty-five years, I was well-versed on the subject of empathy. But I was wrong. It was only when, in a matter of seconds, I went from doctor to patient that I grasped its true significance.
I also came to understand the stark reality of being a patient. Susan Sontag said, “Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick.” Like my patients, I had left the realm of the well and had entered the realm of the sick.
A hiking trail that I had taken for granted for a long time betrayed me one day. The stones on a steep path that appeared solid beneath my feet suddenly shifted, and I slipped hard, slid fast, and fell off a cliff. My right foot landed on a rock slab, crushing my right ankle badly, with five fractures.
Once my swelling subsided after about three weeks, I made the difficult trip to another city to see Dr. M, the ankle orthopedist I was referred to. I believed that he, being a fellow physician, would surely be empathetic to me and understand my suffering.
To my shock, my belief proved to be utterly misplaced. He was unfeeling and showed more interest in my fractures than in me. He seemed unaware that the joint was attached to a living being. He didn’t bother to touch me and was aloof to the concerns I raised. I was just a technical challenge and nothing more.
“I’ve looked at your X-rays and scans,” he said, “and you’ve a hell of a lot of fractures.” He then scheduled my surgery. Desperate to get some personal attention, and unsure if he was aware of my profession, I told him that I was an oncologist. “That won’t change your surgery,” he said, and left.
I wish I could say that my experience is unique, but it is not. Countless patients can identify with me. Sadly, as I look back, I see that Dr. M’s behavior was partly explained by the silence of our profession. After all, neither I, nor likely any other physician, ever reproached a colleague who fell far short on compassion and empathy.
Sure, advances in medicine are saving and improving the quality of our lives, as they did mine, and my own surgeon was technically skillful. And of course, technical knowledge and proficiency are essential in medicine. But by themselves they do not ensure patients’ welfare. For one important attribute, empathy, is an integral part of care. Empathy helps to build bond between doctors and patients and lessens patients’ anxiety and distress; in turn, it improves patient satisfaction and clinical outcome. I believe that physicians’ empathy is particularly important for cancer patients, especially those who are on prolonged chemotherapy, since they see their oncologists so often, from weekly to monthly and so on, for years. It’s easy to become dulled to their distress hearing the same complaints again and again.
A lack of empathy has also another effect that’s not obvious: a corrosive influence on the doctor’s mindset. At least nine medical specialty groups have found that more than fifty procedures and tests currently performed by doctors have no demonstrable benefit, and they can even be harmful to patients. Although some tests and treatments are done with good intentions, others, unfortunately, are done for reasons that are less than altruistic. Surely, any empathetic physician would strive not to subject her or his patients to unnecessary tests or treatments. Moreover, a lack of empathy will also harm doctors’ own interests: the public will become increasingly disenchanted with our profession, and then, over time, they will make greater demands on our practice, demands that are less empathetic to our difficulties and frustrations.
Sensitivity to others’ anguish can’t be taught through science alone. Though science is the basis of medicine, it can’t grasp our life’s trials, foibles and incongruities. Empathy can be nurtured from the beginning of medical education. How? By teaching the humanities to medical students and trainees. Some medical schools take the issue more seriously than others.
I realize that studying all the scientific complexities of medicine and dealing with the diversions of modern living, there’s little time for anything else. But the complexity and diversions are all the more reason to have some room for arts and literature. Of course, any medical student and trainee can get certificates by learning only the science. But I have never forgotten my grandmother’s admonition about education: it’s more than earning certificates. Though unlettered, her lack of formal education was more than made up by her incisive wisdom.
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End-of-life care shouldn’t be treated as a stepchild of medicine. Physicians and students need to believe that caring for the dying is as noble as caring for the others. And the quality of life of the dying is just as important. Communicating with the terminal patients and talking about death is difficult for the young minds, but this can be overcome if we instruct them in a measured tone.
In my student and post-graduate years in Dhaka, New York and Houston, the overriding concern was on teaching how to cure and save lives, and the end-of-life teaching was an afterthought or avoided altogether. Things have progressed since then, but we still have a long way to go. This is especially pertinent now because medical technology is advancing faster than before, and we can keep the terminally ill elderly alive in ICU longer and longer, to their detriment. I have seen enough thoughtless CPRs inflicted on them, traumatizing their last days before their death. The uncomfortable fact is that the fastest growing population is 85+years, and with that, there will be more afflictions and prolonged debility for many. We will then be forced to confront more gray areas in medicine, and our compassion and empathy will be tested. We have no choice but to learn and teach how to deal with this newer world.
Medical school teachers must practice what they preach. I had been taught by many committed teachers in all the places I had been. But in more than a half a century as a student, trainee, practitioner, and sometimes a teacher, I have also seen the contrary type, who regurgitates textbooks and journals, and gives short shrift to empathy and personal connection. This attitude breeds cynicism among the learners and molds their thinking, which they will carry to their future careers.
We should instill into the young doctors and the would-be ones that medicine is more of a calling than a profession.
Fazlur Rahman is a hematology-oncology physician and author of Our Connected Lives.
