The US medical entrance test tries to assess the empathy quotient of candidates and teaches empathy to medical students
When we were students in the 1950s, we had such wonderful role models as teachers, during as well as before the medical course, that one just needed to follow in their footsteps to be a good doctor and a good human being. There was no special need to teach empathy in the medical course. The following story will explain.
I was a Commonwealth fellow-cum-senior registrar in cardiology at The Middlesex and National Heart Hospitals (London) where my chief was the late Walter Somerville, a five-term president of the British Cardiac Society and editor of the British Heart Journal for 30 years! He was a great human being. He would sit at the foot-end of the patients’ bed and listen to their tales of sorrow. I have seen his eyes welling up on such occasions, at times.
My mother was diagnosed with cervical cancer when I was there—at the fag end of my first year. I am the only child and my father was no more. I went over to Dr Somerville’s editorial office late in the evening, when I received the telegram from home, to ask for leave. He read and re-read the message and I could see him take out his handkerchief to dry his wet eyes. He called the Commonwealth Commission chief and told him to sanction airfare for me and my family to go back home to look after my mother (however long it might take) and also for the return journey to complete my second year of fellowship. He did tell me that looking after my ailing mother was my first duty and the training could easily wait till then.
Such empathy is the need of the hour in a humane doctor. I can never forget that example. I have been trying to treat my juniors the same way. I have been always stressing that, for a good doctor, it is necessary not just to sympathise with his/her patients but to put oneself into the patient’s shoes to feel his sorrows and anxieties, that is, to empathise with him.
I was, therefore, extremely happy to read in the American press that the teaching schedules at the Mass General Hospital and Harvard University now include courses in empathy for medical students. This might look silly to many of our scientific mafia who may feel that unscientific things like empathy that cannot be measured scientifically are included in the curriculum. After all, their boss, Marie Curie, defined science as “science is measurement and measurement is science.” Unfortunately, these reductionist thinkers do not realise that, in this dynamic universe, we can easily comprehend much more than we can grasp with our five senses.
The need to teach empathy to medical students in the US arose when they discovered that doctors there do not like to spend time with their patients. They were under economic pressure to spend the least amount of time with patients, to assist the hospitals to save money. On an average, doctors were found to interrupt a patient’s talk after 18 seconds! This is ridiculous. They have also modified their medical entrance test, MCAT, to have a section to find out the empathy quotient of the candidates.
“If you listen to your patient long enough, s/he will tell you what is wrong with her/him,” wrote Lord Platt, a legend of British medicine in the previous century. Recently, this statement’s veracity was tested through a prospective randomised controlled study which was triple blinded using even the PET (positron emission tomography) scanner in London by late Lord Platt’s old students—the present giants of medicine there. The study showed that a good 80% of the accurate final diagnosis, and 100% of the future management strategies, could be arrived at just by listening to the patient and reading the referral letter from the family doctor. This could be refined only by 4% more with all the physical examinations and investigations including the PET scanner! Empathy, therefore, helps a lot.
Listening is an art. Talking could be easy but listening is not that easy. An empathetic physician knows how to listen which was described in a book by Professor James Calnan of the Hammersmith Hospital fame. He titled his book Talking with Patients and not talking to patients; the former simply means listening to the patient. I had discussed this extensively in my book, The Fine Art of Communication.
The West is feeling the pinch of fast-tracking patients in their hospitals and basing all their patient management strategies on investigations. This is wrong medicine. The essence of medical consultation is the coming together of two human beings: one who is ill or imagines being ill and another in whom the former has faith. This patient’s trust not only helps in diagnosis but even the final outcome. Extensive studies by four leading Western universities have recently shown how even pain relief by morphine depends on the patient’s trust in the doctor—the placebo effect. Even if the doctor injects saline and convinces the patient that it is morphine, the pain could be assuaged.
Recent American studies have further shown how the final outcomes of medical, or surgical, interventions depend, to a large extent, on the empathy quotient of the doctor. Many have additionally shown that an empathetic doctor is less likely to overdo investigations and interventions for making money alone as is happening now in the field of disease mongering.
Indian ancient physicians were all basically humane and empathetic. Let’s hope the Medical Council of India, which is supposed keep an eye on the state of medical practice and education in India, will introduce courses on empathy and good bedside manners. This should be done sooner than later—of course, if they have any time left from inspecting the medical colleges and filling up their till! A good doctor is one who knows how to treat patients; a better doctor is one who knows when to interfere in the patients’ problems. But the best doctor is one who knows when NOT to interfere with patients. Patients need the full of empathy of the best doctors.
“The opposite of anger is not calmness, it’s empathy.” — Mehmet Oz
(Professor Dr BM Hegde, a Padma Bhushan awardee in 2010, is an MD, PhD, FRCP (London, Edinburgh, Glasgow & Dublin), FACC and FAMS.