Trying to Teach Empathy at the Bedside
Each week I would take a group of three students to an actual patient’s bedside to practice doing an interview. The patients knew they were “students in training” but usually responded to them as if they were doctors taking a history from them. On a particular day, before we entered the room, I told the student who was to do the interview that sometime during the interview he must use the following words, “that must have been very difficult.” The student proceeded with the interview with the other two students and myself standing by the bedside. At one particular point in the interview the patient started to talk angrily about how she hated to go through all these tests when she knew she was going to have an operation anyway. The student was a little flustered by the patient’s emotion but then he remembered and said, “That must be very difficult.“ The patient’s demeanor changed and she continued in a very friendly and cooperative manner. At the end the interview the patient remarked to all of us that “this doctor was the most caring physician that I have seen in the hospital.” In our post-interview discussion the student was beaming (his overall interview actually was quite poor). I asked why did he think that the patient thought he was so good. He couldn’t answer, apparently feeling he had just done a good job. The other students understood and were able to appreciate the value of the comment that he had made at the right time. However, the next week I suggested the same technique to another group of students who objected to this approach. They felt it was artificial, phony, and they did not want to be actors when they were trying to be doctors. Other groups had similar responses. This was another indication of how teaching medical students to be empathic was quite complicated.
Life Experience Teaches Empathy
After several years my teaching and clinical work took me away from this particular type of medical student teaching. One day, however, I encountered the following situation. I was a psychiatric consultant called to a difficult situation in the medical emergency room. A male patient in his thirties with multiple traumas did not survive a motor vehicle accident and died in the emergency room. The mother of the patient became hysterical and out of control. Nobody could calm her down. A first year medical resident (two weeks out of medical school) was the only one to stay in the room with her while she screamed and berated the hospital, the doctors, and the medical system. After he patiently stayed with her during the tirade, he gently asked if there was anything he could do for her. She said, “Yes, remove the damn tube from his mouth “ (the breathing tube from her son). While he knew this was not usually the procedure because of the preference of the medical examiner, he did so in her presence and then turned to her and asked if she would like to help him clean up the body. She agreed to do so and he asked the nurse for a basin of water allowing her to clean her son’s face. He stayed with her until she was ready to leave. When I asked him later how he felt and how he was able to do this, he told the following story. Recently his best friend had died. In his own grieving, he repeatedly thought of how painful it was for his friend’s mother and how he had imagined such a loss would affect his own mother. He also recalled how his friend’s mother said many times that she was bothered by seeing the IV lines in her son’s arm after he died.
Empathy is a very complicated issue. The capacity for empathy does vary from person to person. We need to provide teaching and mentoring to our students on this subject, and we need to listen and be empathic to them in regard to their previous experiences. It is no different than our obligation to be empathic to our friends, family, and especially our children. This will make future generations better doctors and better people.