From the first day of medical school orientation, we are taught that medicine is holistic and humanistic and should always be infused with genuine care for patients in addition to routine medical knowledge. Perhaps predictably, this emphasis degrades as we progress through our training. The volume of information that we are expected to learn in both the basic and clinical sciences is overwhelming. We are overwhelmed with pathogens, physiologic mechanisms, drug names, and diagnostic weapons. In the interest of efficiency and self-preservation, we begin to speak more and more cryptically about the diseases we are studying and the patients with these diseases. When we hear of a family member or friend diagnosed with a medical condition, our brains whir paging through all that we have learned about each disease.
But what have we learned about each illness? How do you combine the heart sickness and sadness of humanism with the mental acrobatics of medical science, when both are required to be a good doctor, but only one is reinforced in our training? Can empathy be taught or preserved? Does being a good doctor mean that detachment is a prerequisite and the emotional side of care is not acceptable. Certainly you can’t function if you are too enmeshed with the experience of a patient. I don’t try to run from a patient’s pain or to deny it, but often times my heart beats faster and my throat tightens slightly. It is impossible for me to have an empathetic response without having a sympathetic response.
During medical training, being a patient is more a liability than an asset. However, we need to be taught to trust our patients, trust that they are as valuable as our medical education, because although they have not seen a hundred pregnancy losses, they have experienced one. And one is quite enough to offer some real insight.
We commonly say “I can only imagine.” Maybe the “only” is not so important if the imagining is truly taken seriously. “Empathetic imagination” allows me to connect with, learn from, and further my understanding of the patient’s experience. Of course, there is always some distance between the doctor and the patient, because we cannot experience their situation directly. However, the gap needs to be narrowed with imagination and empathy, not widened with learned medical detachment.
The capacity to engage humbly with patients’ pain cannot be sacrificed in the name of practicing excellent medical science.