When the star of the local high school’s football team walks into the ER with a sprained wrist, the doctor on call strides into the exam room. Looking down at an open file listing numerous similar hurts, he asks the teenage athlete if he received his newest injuries on the field; after a brief pause, the player nods. The doctor wraps his arm and sends him away with a smile and packet of care instructions. The file lands on the receptionist’s desk as the physician passes, en route to his next patient.
The man thinks nothing of it until a few weeks later, when he sees the boy’s mother on the pediatric floor. One of her eyes are black and swollen nearly shut; the father is nowhere in sight. He looks away once she disappears inside a room down the hall. A quick question at the nurses’ station leaves him reconsidering every bruise he’d been so sure was the result of a too-hard field tackle.
Sometimes, the most important cues in a patient’s case are the ones that are never said – a too-long silence before an answer, or perhaps an assumption gone uncorrected. But for doctors focused on helping as many patients as possible before the close of the day, firing off a volley of diagnostic questions during appointments and drawing conclusions from verbalized answers seems the only way to carry a heavy workload. Their busy schedules do not allow them to pick at the meaning behind a patient’s posture or verbiage; all they can do is provide an encouraging word and snippets of friendly conversation amidst professional discussions of symptoms and diagnoses.
According to an article published by Marie-Thérèse Lussier, an associate professor of family medicine at the University of Montreal, physicians overlook important cues for a number of reasons. They may miss a subtle cue because it doesn’t fit in with their diagnosis or even, as the doctor in the opening scenario, not dig deeper into a case because they are overworked and believe that the patient’s condition is already known.
Moreover, as Jodi Halpern MD., research professor at the University of California Berkeley points out in a research paper on physician empathy: “on-the-job experience of medical training tacitly promotes detachment, objectivity, and self-interest.” Doctors are expected to exude detached compassion by relating to their patients without displaying “unprofessional” amounts of emotion. In order to preserve their outward appearance of clinical competence, doctors bottle their feelings and subsequently face serious long-term problems such as emotional burnout and depression. Thus, as ingrained as the idea of the detachedly competent doctor is in popular and medical culture, such behaviors might actually be harmful to medical professionals.
But as the star athlete’s story suggests, doctors aren’t the only ones to suffer under the assumption that physicians should be withdrawn. Studies have shown that patients who engage with empathetic doctors are more likely to communicate effectively, be less anxious, trust their physicians more, and disclose more information than those who work with more detached professionals. Moreover, doctors who practice empathetic care develop their capacity for emotional literacy and are better able to pick up cues which – as in the case above – are both vital and nonverbally conveyed.
Empathetic relationships are undoubtedly beneficial to patients and doctors alike – so how do we alter the perception of the “competent” doctor to better allow for their development? Jodi Halpern suggests that the answer may lie in systemic changes to how medical professionals receive ongoing training. In her article, she writes that while “physicians cannot will themselves to empathize during conflicts […] they can cultivate an ongoing practice of engaged curiosity.” She goes on to suggest that practicing meditation, writing narratives from patients’ points of view, and running workshops on emotional problem-solving would all be productive strategies of supporting physician empathy. While Halpern’s suggestions are by no means exhaustive, they provide an excellent starting point for considering how opportunities for developing empathy and emotional literacy can be implemented in the workplace.
Sometimes, the most important cues are the ones left unspoken, and for better or worse, doctors are the professionals most able to hear and address a patient’s silent call for help. We need to delve into human empathy, and strip away the fiction of the disconnected doctor for the sake of physicians and patients alike.