Wilberg on Wednesday - The Illness Is The Cure pt 7/46

Empathy – a Foreign Language for Doctors?

(see also appendix 5)

It seems that most doctors literally cannot bring themselves to utter even the most basic and commonplace empathic phrases in response to a patient’s presentation of his or her symptoms – even though these can have an immediately beneficial and healing impact. Indeed they are even taught in their medical training empathy as such is a hindrance to maintaining clinical ‘objectivity’ in doctor-patient communication. In reality it can be the magic key to affirming – rather than defending themselves against – the patient’s lived, subjective experience of illness. In this way it can give an immediate sense of being recognised as a human being and with it an immediately enhance sense of well-being. In contrast, maintaining a stance of ‘clinical distance’ is a form of communicative pathology in the most literal sense– a ‘sick’ (pathos) use of language (logos). Yet since empathy is clearly a ‘foreign language’ for most biomedical doctors and clinicians what follows can be likened to a elementary language phrasebook, not in ‘English as a Foreign Language’ (EFL) but in ‘Empathy as a Foreign Language’ (EFL) one so basic it is quite extraordinary that it should be needed at all. Note: feel free to distribute or put a copy of it up for doctors in your local clinical practice or hospital!

1. Opening empathic phrases in response to patient’s presentation:

For example, how about simple phrases like:

I’m sorry to hear that. / I’m sorry to hear you’ve been feeling that way/so bad.

That sounds very unpleasant/distressing/painful.

How has that been making you feel?

I can understand why you feel so worried/upset/concerned/distressed.

I can understand why you wanted to see me.

How have you been coping?

2. Some simple closing phrases to end a consultation:

How are you feeling now?

How do you think you will cope?

Do you have any other worries?

Is there anything else that you’d like to tell me about/ that is bothering you?

Do let me know how things go. (which the patient could do by leaving a note for their doctor by phone)

The common failure to use this type of empathic language is itself symptomatic of a larger problem – namely the almost total lack of interest on the part of clinicians in the patient's lived experience of illness and its effects on their life rather than just their presenting symptoms.

“One unintended outcome of the modern transformation of the medical care system is that it does just about everything to drive the practitioner’s attention away from the experience of illness. The system thereby contributes importantly to the alienation of the chronically ill from their professional care-givers and, paradoxically, to the relinquishment by the practitioner of that aspect of the healer’s art that is most ancient, most powerful and most existentially rewarding.”

Arthur Kleinman M.D. The Illness Narrative: suffering, healing and the human condition