What’s wrong with doctors today? I’m a doctor; I can tell you. Doctors and patients exist in two distinct worlds: the world of the healthy and the world of the sick. The only language that connects these two worlds is kindness and compassion—this is how doctors and patients connect. If you are fluent in this language, you can traverse the divide.
Several studies have shown a sharp decline in empathy by the time students finish medical school. The compassion continues to drop during residency and fellowship, until finally, he or she is a physician with patients depending on them.
The slow but ensured death of empathy in medical education is not an accident.
Today, medical students’ dreams and aspirations of being a healer of sick contend with the crucial task of mastering technology. We teach students to be, among other things, technicians who treat the human body as a collection of data, and we train them to be proficient in collecting and analyzing that data.
At first glance, focusing on this type of training makes sense in our data-driven information age, but sometimes a strong patient/doctor relationship is harmed.
If being a doctor was only about having a razor-sharp memory and delivering the right diagnosis, then IBM’s Watson would be the epitome of the “perfect” doctor.
Right now, he’s attending medical school at the Cleveland Clinic Lerner College of Medicine. He’s better than any physician at computing, connecting and analyzing data.
He has read and memorized thousands of medical books and journals and is much faster than a human brain at conjuring up the right answer. But there are some things Watson simply can’t master.
The art of relationships
A former patient of mine is an example of why relying solely on data and analysis is problematic.
I met this patient, Betty, about seven years ago.
She ignored the large mass on her left breast for seven months until it started bleeding. By that time, the cancer had already spread to her lymph nodes and bones; she was diagnosed with a stage-4 breast cancer.
She was so unhappy with the doctor who diagnosed her, that she was considering not pursuing treatment. Then, she came to see me.
“I did not care for him,” Betty murmured about the other doctor. “He was in my room for less than ten minutes. He didn’t answer any of my questions.” She paused for a minute. “He said he cannot cure this and I will lose all my hair… something like that.”
So, for the last seven years, she has been driving several hours past her original doctor so that I can care for her. Why? Because she said she couldn’t understand him. She didn’t feel like she could rely on or connect with him.
Betty told me she had been living alone since her husband died of stage-4 lung cancer about 15 years ago. She watched as he fought and suffered through every possible side effect from chemotherapy and radiation before losing his long, painful battle. Betty didn’t know if she had the willpower to take on a similar journey—she was terrified.
But she was raising her granddaughter after her daughter died in a car accident and she wanted to make sure she was there to see her graduate from high school. That was her only reason to fight for her health.
I looked into Betty’s teary eyes and told her I would do everything possible to make sure she sees her granddaughter graduate. Betty later told me that was the only thing that she heard from our one-hour conversation. It was the only thing that mattered to her.
Clearly, emotionally unintelligent Watson wouldn’t be able to help Betty. They simply wouldn’t have a connection. I question whether it is possible to teach Watson to smile, touch, hug and connect. Is it possible to teach students and young doctors to connect with patients like Betty?
Empathy doesn’t come easy to everyone. And that’s okay as long as students and physicians are willing to invest time in harnessing and incorporating compassion into their patient relations.
From a distance, health care may seem like a technology-driven world, but I don’t think that’s completely true. There are key aspects of health care that can’t be reduced to numbers.
So, how do we revive empathy?
As a doctor caring for thousands of cancer patients over the past 15 years, I’ve learned a few things about what it might mean to become a doctor whom patients can really trust.
1. Be Present: Whether a doctor spends five minutes or 60 minutes with someone, each patient should be treated as the most important person to the doctor during that time. The least we can do is be present during their visit.
Physicians must make an effort to disconnect from phone calls, emails, texts and pages whenever possible – and offer our undivided attention.
We can remind our medical students that although we see breast cancer patients every day, this may be the first time our patient is dealing with a life-changing diagnosis.
2. Be a Person: Each and every patient is truly unique and we must do our best to understand each one as a whole person. We need to know what keeps them going, their dreams, aspirations, fears, family, career, and what’s important to them.
For my friend Betty, if I had failed to understand the tragic loss of her daughter, her husband’s cancer diagnosis, her immense responsibility toward her granddaughter, I would have failed to see how these things could affect her treatment.
We should try to put ourselves in our patients’ shoes and understand what they are going through and how much this is affecting every aspect of their lives.
We can make an effort to try to relate to each patient and value the trust they are putting in us as their doctors.
3. Be a Partner: Treatment of any major illness or chronic condition is most successful when a partnership forms between the patient and physician. Both must be equally involved. We need their help to fight their cancer.
At the end of the day, patients have the highest stake in this relationship as it is their lives that are on the line. Building trust with patients is so important, and the value of trust must be passed to our students. Patients will only open up and truly get on board with their treatment plan when they can trust their doctor.
Not doing these things is truly a disservice to patients. They deserve our full attention, for their doctor to be at the top of his or her game, and to know they can trust me with their lives, whether I have a few minutes or an hour with them.
Betty’s granddaughter graduated from high school and is now pursuing a writing career. I know how much seeing that milestone means to Betty, and it’s a victory for both us.
Dr. Jame Abraham is Director of Breast Oncology program at Taussig Cancer Institute and co-director of the Comprehensive Breast Cancer Program of Cleveland Clinic. He is a Professor of Medicine at Cleveland Clinic Lerner College of Medicine.