Empathy is such a simple skill

A lot of patients like me, not because I'm a good doctor or because I'm terribly friendly. I'm not even all that good at explaining things or 'shared decision making.' My one skill that has pleased my patients is simply that I try to be empathetic.

Many doctors advise caution about getting too emotionally involved with patients, and that it can suck you in, and it gets dangerous. And that's true. Empathy though is a very simple skill, and I think it's really a shame that doctors are so bad at it in general.

Empathy is trying to understand where someone is coming from. I saw someone today who was refusing tests and generally being quite difficult, but her life was spinning out of control with all sorts of new and scary diagnoses, and she was afraid to go further, afraid what the next test would bring.

I am not psychic. I found out by asking her. She told me that she didn't want anymore testing. Why? Because all the testing so far was not good. Well, if I was in her place, I'd be pretty scared to find out what the next test showed too. And I told her that.

I know it sounds trite, but the key to empathy is treating patients like people. Only a doctor could talk to someone about their dead wife, and then in the same breath ask about immunizations. It's no wonder that nurses are generally more appreciated than doctors, and view themselves as patient advocates. Doctors treat disease. Nurses treat people.

I saw a patient today and we talked about coffee for a while, and I think one of the nicest pleasures of being a doctor is meeting all sorts of interesting people. If I had to offer some advice to other docs, it would be that if you stop seeing people and start seeing diseases, it's time to retire.

Doctors say the darnedest things

When I was a student, we were encouraged to have a 'thick skin' because attendings, residents, interns, nurses, social workers, MA's, PT's, and custodians all tended to lash out verbally at medical students. And it didn't really matter how good you were, or nice, or helpful. Eventually, someone would chew you out for no reason other than you are a convenient person to yell at. People have more scruples about kicking a cat.

I remember the times this happened to me. I was publicly humiliated by one attending at a conference for asking the drug rep a question. One surgeon threatened to make me do M&M, since this patient's imminent death was all my fault. One day I was assigned to eight patients in the morning, and I couldn't see them all before rounds, and the resident told me that I was lazy and useless, and should seriously consider dropping out of medical school. I strongly recall one attending who spent 20 minutes on rounds screaming at one intern until she broke down crying.

So when I graduated medical school, I promised myself that I would not perpetuate this horrible rite of passage. I would be nice. And that's such a noble thing to say to oneself, but in reality, I was just as bad. As a resident, I made no less than two interns cry, and there are a few students who likely went home and blogged about what a jerk I was after getting dressed down by me.

The problem for me is that I expect a lot out of people. I expect 100% all the time. That is the effort that I gave as a student and resident. That is the level I want. But my 100% is not the same as other people's. And it's not like I had to miss my daughter's soccer game or my wife's birthday.

When I finished residency, I promised myself that I would try to be more understanding. Being nice is tough. When you're pissed off, it's hard to turn that into nice. But as long as you're willing to listen and try to understand, even the most withering criticisms can at least be constructive.


Don't get me wrong. I never want to go through the hell of med school again. One of my friends was thinking about a second career in medicine, and I honestly think that if I had to go through medical school and residency again, I would quit. It's too hard to do twice.

But there are some things about medical school that I miss terribly, because it's stuff that I can't get back. I remember my first perfectly done suture. It was a vertical mattress, and the tails were just right. I remember following a running suture during a vascular surgery. Afterward, the surgeon told me that he'd never let a med student touch a vessel he was working on, but he trusted me. I miss the excitement of seeing my first trauma, a 20 yr old female MVA, no LOC, FAST scan negative, c-spine cleared. I miss the novel sense of horror upon seeing an apple core lesion on CT abdomen.

But most of all, I miss that moment in medical school when I was not an internist. I wasn't sure what I wanted to do, but I knew that I was capable of anything. It was entirely within my power to pick my medical specialty.

There was a very similar moment that occurred in college. I remember it exactly. It was 6:54 PM and I was getting out of chemistry lab. It was twilight, and as I walked home from lab, I stopped at one particular tree about 40 yards from the chem building. At that moment, I could be whatever I wanted to be in life. I could be a lawyer, doctor, investment banker, veterinarian, librarian, computer programmer... All my life and education had led me to that one point in time where I could choose, differentiate. I was a stem cell.

That is what I miss about medical school. I don't miss the studying or the work. I miss being pluripotent.