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.

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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.”

Poetry in medicine: Chapter and verse

In a previously published Musings blog entry, A plea for poetry in medical practice, I wrote:

Poetry (as well as good literature) is capable of stimulating the development of empathy in the reader—in this case, the clinician—and serves to enable him or her to approach the patient with an element of understanding and compassion. Such an approach undergirds the delivery of quality medical care.

In that piece I advocated for the inclusion of poetry in the medical curriculum to cultivate empathy on the part of clinicians toward their patients:

“It isn’t that clinicians are totally thoughtless people,” I opined. “In many instances they just never learned to appreciate what it might be like to stand in the patient’s shoes.”

On the heels of these words how heartened I was to peruse Dr. Pauline Chen’s recent New York Times column The Doctor as Poet, for here Dr. Chen expresses the same sentiment. more»

A plea for poetry in medical practice

I was pleased as punch to peruse New York Times executive editor Bill Keller’s delightful essay on the relevance of poetry, I Yield My Time to the Gentleman From Stratford-Upon-Avon. Here Keller expounds on the relative weight that a seemingly small, insignificant seminar carried in his course of summer study at the Wharton School of Business.

In my book we would do well to advocate for the inclusion of poetry in the medical curriculum—for largely the same reasons.  more»

“Notes from a Healer” — Like Tearing Up Children

I recall a segment from a TV documentary on the playwright Eugene O’Neill that I saw years ago. In an interview his widow described how she and O’Neill set about destroying sheaves of his unfinished work near the end of his life. “It was like tearing up children,” she said. more»

My latest installment of Notes from a HealerLike Tearing Up Children — is now online, newly published in the Yale Journal for Humanities in Medicine.

The Yale Journal for Humanities in Medicine is an online journal fostering discussion about the culture of medicine, medical care, and experiences of illness. Interested readers can access a list of editorial board members and regular contributors here.

Blue Collar, Blue Scrubs

It’s a fine spring day, the last of April. I’ve been sitting outside in the back yard all afternoon, plowing through Michael Collins’ memoir Blue Collar, Blue Scrubs: The Making of a Surgeon.

The first-born in an Irish-Catholic family of eight boys, Collins pursued an undergraduate degree in liberal arts from Notre Dame University before taking a job with a construction company breaking concrete for a living. Although he enjoyed the hard work, the long hours, the camaraderie (as well as the beer consumed on the job and in the pubs afterward), Collins reached a point where he needed to make a decision about what he wanted to do with the rest of his life. The answer he hit upon was to become a doctor.

It was an uphill battle. Collins had to spend two years completing pre-requisite courses in chemistry, physics and biology and sit for the MCAT just to be able to apply to medical school. Although he aced his science courses, his MCAT scores were average. Rejected by 7 of the 8 medical schools to which he applied, when Collins pleaded with the Dean of Students at Loyola in Chicago to be given a chance, he got in.

Blue Collar, Blue Scrubs describes his journey through medical school up to the beginnings of his orthopedic surgical residency at the Mayo Clinic. Collins spins the tale with wit, humor and pathos.

Throughout his training, while immersed in the seemingly overwhelming tedious task of rote memorization, Collins lapses into philosophical thought. “What, then, makes us human? A beating heart? A cogitating brain? Or is there something more, something, for want of a better word, we call a soul?”

At the conclusion of the first autopsy he witnesses, a pathologist tells him: “You have now peered into the deepest recesses of the human body and discovered the secrets of life.” As he files out of the room with his fellow students, Collins muses that “we haven’t even come close.”

Throughout his rigorous training Collins somehow manages to hold on to his humanity. He never loses sight of why he wanted to become a doctor in the first place: to render assistance to his fellow human beings, to alleviate their suffering.

It is good for seasoned clinicians to be reminded of such altruistic motives. Whenever I lose a patient to a terminal illness, I gravitate to the family. I sit with significant others, share the information I have at hand and prepare myself to listen to what they have to tell me. To do otherwise would be a disservice both to them and to myself; for in these instances, I’ve discovered that I need such interactions to help myself heal.

Patients are not the only ones who suffer.