The Art of Medicine: Dispensing empathy in the pediatric setting

Slowly, the student nods her head. On this, the last day of her pediatric rotation, she has learned a valuable lesson: listening to the patient with an empathetic ear will generally hold you in good stead. more»

Interested readers can now access my latest Art of Medicine column — Dispensing empathy in the pediatric setting — recently published in the Journal of the American Academy of Physician Assistants.

Please note that all of my previously published Art of Medicine pieces can now be accessed here.

Individuals and types

In a retrospective review of the origins of Antoine Saint-Exupéry’s Little Prince, Edward Rothstein observes that the children’s book might be ultimately “less about individuals and more about types.” It is an aviator’s perspective, sweeping across the landscape, only mildly hampered by earthly ties and human requirements, being guided by the stars. On the other hand, the message of the character of the fox is “far more grounded, empathetic, more concerned with others.”

“Saint-Exupéry may have often been caught between these two perspectives,” Rothstein writes. “He fought against detachment but also relished it, fleeing for atmospheric vistas whenever possible.”

There, briefly stated, you have the same dilemma faced daily by thousands of clinicians in medical practice.

At the outset medical education consists largely of learning how to recognize and diagnose illness. Students are taught to look for disease patterns, clinical signs that when taken together as a whole point to one specific medical malady. Unfortunately this method cultivates an attitude toward human beings as disease entities. Students, residents and even attending physicians are apt to refer to “the cholecystectomy in Room 508,” “the schizophrenic in 212,” “the diabetic in ketoacidosis in the ED.”

Such shorthand nomenclature provides a synopsis of the clinical condition and by implication, a plan for treating it. Yet if we are not careful, referring to patients as diagnostic entities or classifying them as types allows us to dehumanize them. If we come to regard patients as mere disease entities, we are less likely to suffer emotional attachment, more likely to maintain our clinical objectivity; but at what cost?

Patients who perceive that their providers are not interested in them tend to linger longer in the throes of illness than those who feel validated and nurtured as individuals. It has been shown that providing terminally ill patients with good palliative care dramatically improves the quality of life during their waning months.

At some point in their medical education it would behoove clinicians to move toward an attitude of empathy, to take a compassionate stance in dealing with patients entrusted to their care.

Perhaps that is what Saint-Exupéry’s Little Prince has to teach us grownup clinicians who have chosen a career in medical practice.

In the words of the fox: “Here is my secret. It is very simple. One only sees rightly with the heart. The essential is invisible to the eye.”

Humane Medicine — What’s bred in the bone

Decades ago during my early years of practice, shortly after performing rescue breathing on a pallid, limp toddler, I contracted a nasty enteritis. It ran its course over a period of 10 days. At the time, sick as I was, I remember musing to a colleague that an occasional bout of illness permitted us clinicians to better empathize with patients in their time of distress. My colleague looked at me askance, unable to muster any meaningful response. more»

Interested readers can now access my latest Humane Medicine column — Empathetic medicine: What’s bred in the bone — recently published in the Journal of the American Academy of Physician Assistants.

Please note that all of my previously published Humane Medicine pieces can now be accessed here.