Empathy and Sympathy

Empathy is the ability to vicariously feel what another person is experiencing, while sympathy is the ability to understand what another person is going through. The medical profession has many people who care deeply about their patients. I think this is a fair assumption, even though there may be some who are in the field for other reasons.

What kind of doc would you want?

If I was totally banged up in a car accident and I was a mess to look at, I certainly would not want my emergency room (ER) doctor to connect with me on an emotional level. I would want an excellent doctor who knew how to compartmentalize; who knew how to see me as a problem to solve.

Recently, one of my childhood friends who lives in Alaska, sent me a book called Beyond the Bear, by Dan Bigley. This book is a memoir by a young man who was mauled by a bear. It opens with a description, from the point of view of the surgeon who was called in the middle of the night, and how he had to retreat to a rote procedure in order to get started on the surgery. Pictured in the book is a CT scan taken when Bigley was brought in. I don’t think I’m that squeamish, but to think of the human face surrounding that shattered skull…

OK, I think you’ll agree, ER doc: sympathy = good; empathy = bad.

One size fits all?

I don’t think so. One would not expect a mental health professional in a counseling session to put up a barrier. A bit of sympathy would be nice, but I think empathy is much more important in this case. A person in mental anguish or with brain problems doesn’t need to be faced with a sympathizing, bobble-headed shrink. Can you imagine such a good-intentioned professional, listening intently, making notes and speaking soothing platitudes, intending later to thumb through the Diagnostic and Statistical Manual of Mental Disorders (DSM) to determine what is wrong with you? Of course, I’m exaggerating; before long, DSM-5 will be committed to memory.

Sorry, got carried away…

Psychiatrists and Clinical Psychologists study brain anatomy, diseases affecting the mind; they see many patients during medical school, internship and residency. If a patient acts in a certain way, chances are, an experienced clinician has already encountered something similar, and can offer some strategies to alleviate the problem.

What if the patient can’t explain?

Suppose a patient can’t get out of bed? He or she is just so exhausted. Fatigue doesn’t really explain it, nor does tiredness. There are no words to describe the lethargy. This is the case with Chronic Fatigue Syndrome (CFS). It is not categorized in DSM-IV.[1] There was even contention about how to address it in DSM-5, where it is called Chronic Somatic Symptom Disorder (CSSD).[2] I suppose there is always the ‘Not Otherwise Specified’ category. Even with all the publicity surrounding CFS, I venture to say that there are doctors today who think of it as malingering.

The solution?

I’ve had the idea that it should be a requirement of medical schools to have each student actually experience the diseases that they treat. I think the patient would be understood a lot better this were the case. I know that things are much more complicated than this. I should have sympathy for the medical students. Before they rise in the hierarchy, they are at the bottom of the barrel. An article in the Boston Globe highlights their plight and the fact unsympathetic treatment during their training may lead to hardened attitudes toward the patient.[3]

Better treatment of medical students at the low end of the totem pole may help; if it doesn’t, bring on the disease simulator.

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