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Empathy, Heart of Medical Practice
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.)



Narendra Doshi

2 years ago

Dear Dr. Hegde,
Your personal story mentioned has played an important permanent role in your entire future - thinking & implantation. I totally agree and appreciate this factor. As you mentioned, let's hope the Indian Doctor & Medical Council insists on this factor.

Room still for people to come clean on black money: Jaitley

India will not be allowed to become a tax haven


Finance Minister Arun Jaitley on Monday said India will not be allowed to become a tax haven and that the government would provide a reasonable window of compliance to those who have stashed away ill-gotten money overseas to come clean.
"India needs a stable tax regime, not a tax haven... The taxes that are due must be paid," the finance minister said at the annual session of the Confederation of Indian Industry (CII) here, adding: "A reasonable compliance rule would come."
He was alluding to the Undisclosed Foreign Income and Assets (Imposition of Tax) Bill, 2015, that was tabled by him in the Lok Sabha last month that calls for a 300 percent penalty on the quantum of black money abroad along with rigorous imprisonment of up to 3-10 years for perpetrators.
At the same time, the bill also has some amnesty provisions to bring back such money back from overseas, allowing people to declare such assets within a prescribed time period, pay some tax on it and retain the remaining amount.
It provides for tax to be charged at 30 percent of the undisclosed assets outside India as also a penalty of 100 percent of such tax, taking the effective rate of tax and penalty to 60 percent, leaving room for people to retain 40 percent of such declared assets.
India has no official estimates of illegal money stashed away overseas, but the unofficial ones range from $466 billion to $1.4 trillion.


Regular exercise can keep lifestyle diseases away

Kler said with increasingly hectic lifestyles, most Indians in urban areas nowadays do not walk to the neighbourhood store but rather order groceries on phone for home delivery or drive down


Cardiovascular disease, diabetes, and osteoporosis - Indians are facing an unhealthy future burdened with a slew of lifestyle diseases. But instead of expensive medication and therapy, the cure lies in making exercise a compulsory part of everyday life, health experts say.
"Indians are increasingly leading a sedentary and machine-dependent life, which may seem comfortable but has extremely adverse effects on health," T.S. Kler, Head of the Department Cardiology, Fortis Escorts Heart Institute and Research Centre, told IANS.
Kler said with increasingly hectic lifestyles, most Indians in urban areas nowadays do not walk to the neighbourhood store but rather order groceries on phone for home delivery or drive down.
"We do not climb stairs any more, with lifts being omnipresent. Riding bicycles to work or to school is not cool in urban areas any more. Forget adults, this conditioning begins with children who prefer to stay indoors watching television or playing video games rather than spending time in the playground," he added.
"We all know that cardiovascular diseases are today a major health concern in India. They are the single largest leading cause of deaths in the country, and relatively younger people are today afflicted by coronary artery disease," the noted cardiologist said.
Various surveys done in India have shown that the incidence of coronary heart disease is 8-10 percent in urban areas and 5-6 percent in rural areas.
Kler said regular exercise can help prevent risk factors for cardiovascular diseases such as hypertension and type II diabetes. It also keeps the weight in check.
"Incidences of coronary artery disease can be reduced substantially if the entire Indian population religiously takes to physical exercise. Even 30 minutes of moderate exercise daily can be immensely beneficial. We need a national focus on this less-talked about subject," Kler said.
According to Rajeev K. Sharma, senior consultant orthopedics and joint replacement surgery, Indraprastha Apollo Hospital: "Adequate levels of physical activity decreases the risk of a hip or vertebral fracture and helps control weight. In fact, exercise is very crucial for maintaining good bone health, besides adequate intake of calcium."
"WHO estimates that globally, one in four adults is not active enough while more than 80 percent of the world's adolescent population is insufficiently physically active. This is a dreadful scenario as all these inactive people are making themselves vulnerable to several health issues," he said.
Osteoporosis-related injuries such as vertebrae fractures not only cause pain but also degrade the quality of life, curtail movement and increase dependence. Since the bone is a living tissue, it becomes stronger when subjected to exercise, Sharma said, adding that loss of bone mineral density that begins during the 30s can be curtailed by exercising regularly.
"People who exercise are found to have greater peak bone mass as compared to people who do not exercise."
According to the International Osteoporosis Foundation, the malaise annually causes more than 8.9 million fractures around the globe.
"Though exercising can, to a large extent, help in building strong bones, there is a general lack of an exercise culture in India. This needs to change. Schools, colleges and other institutions should take the lead in nurturing an exercising culture."
Harvinder Singh Chhabra, medical director and chief of spine services at Indian Spinal Injuries Centre, Vasant Kunj, said Indians generally do not realize the importance of exercising unless hit by an ailment.
"Many patients start walking regularly after back pain or osteoarthritis has already set in their bodies. We tell them they could have delayed it by being active all their lives," he added.
According to Chhabra, in the West, there is a lot of focus on physical activity and people are moving away from sedentary ways of life. "They are junking television and going for cycling, running, or adventure sports such as rock climbing. This shift is yet to take place in India."
To make exercise a national culture, apart from awareness, many enabling policy measures are also needed.
"In urban areas, several environmental factors discourage people from leading more active lives even if they want to. Lack of public spaces such as parks and grounds, safety issues on the roads, pollution and irksome traffic do not allow many people to step out of homes to run or walk. This needs to change," he said.
The latter half of the 20th century has brought substantial progress in disease control due to expansion of health infrastructure. With food and nutritional consumption also improving for a vast majority of population, life expectancy in India has gone up over the years. Experts say that deaths due to communicable diseases have decreased while those from non-communicable diseases (NCDs) have risen.
NCDs at present account for 53 percent of all deaths and 44 percent of disability adjusted life-years lost. Projections indicate a further increase to 67 percent of all deaths by 2030. Cardiovascular disease is the major contributor to this burden, attributable to 52 percent of NCD-associated deaths and 29 percent of total deaths.
(Sreeparna Chakrabarty can be contacted at [email protected] )


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