The Young Person’s Guide to Empathy
The only thing better than having someone take an essay you wrote seriously is knowing that the person is part of a generation of doctors that will replace me.
Sensible Medicine is a reader-supported publication. I you appreciate our work, please consider becoming a free or paid subscriber.
As a first-year medical student navigating my early patient encounters, these are some common thoughts I have as we discuss the burdens of life and illness:
“I can’t imagine what that’s like.”
“I don’t understand what you’re going through.”
“I don’t know how you feel.”
Even in my interviews with standardized patients, where the syllabus tells me to “effectively respond to empathetic moments,” I struggle to reply in a way that balances support without artificiality. Being fresh into medicine it is no surprise that I find this hard, but there is more to my challenge to empathize than a lack of patient interview experience.
Patients often comment about how I’m unencumbered by the kinds of suffering that come with age, and they seem to feel envious of or nostalgic for my position in life. Simultaneously, I am sometimes distrusted because of my age. I used to think that this mistrust came when patients perceived a lack of medical knowledge, but I wonder if they are also having a hard time relating to, connecting with, and trusting me for other reasons as well. Though I am, thankfully (and I know temporarily), spared many difficulties that come with years of life experience, I'm encumbered by something more difficult to detect and see: ignorance.
This is the paradox of being a young trainee: I need empathy and experience to be an effective healer, but empathy and experience take time. In his recent piece, “Empathy Earned and Learned,” Dr. Adam Cifu pointed out that as a young trainee, I have not had the terrible back pain, close family deaths, pneumonia, and other forms of suffering that would provide me with what he describes as direct empathy, arising from having experienced what your patients are experiencing. Direct empathy is imperfect, yet our own experiences can aid the way we relate to and care for our patients. I accept that I can’t – and probably shouldn’t hope to – accelerate my aging and suffering, but perhaps I can accelerate my development of empathy and of my ability to connect with patients in other ways. I believe our ignorance and inexperience as medical students makes us well-equipped to develop empathy in ways that more experienced clinicians no longer can; we cannot waste this opportunity.
The first asset of the medical student is a deep and energetic curiosity. My experiences in medicine are new and exciting and being a student positions me in encounters with people I would otherwise never have met. Mindfulness combined with experiences of loss, pain, and illness is one way to develop direct empathy, but I would add that mindful reflection on experiences of joy, curiosity, and love can also be a springboard for the connection and understanding that grounds empathy. Even being mindful of the mundane comes in handy. Using curiosity, a trainee can uncover loci of connection that build rapport, understanding, and respect. There is a difference between the curiosity I describe and the professional curiosity necessary to complete a basic patient interview. The curiosity that I describe is more genuine and whole – you really have to mean it. This is a skill that can be practiced, and in my experience, it becomes a reciprocal experience powered by positive feedback. The more passion and dedication I infuse into my interactions, the more I learn from my experience.
As patients answer our curious questions, another asset comes into view: we have little clinical power. Patients know who the boss is, and they know it’s not us. Our lack of authority curates a different dynamic than between patient and attending. Though patients might be caught off-guard if an attending physician asked them random questions about their life, their work, or their hobbies for more than a few seconds, these questions seem less surprising coming from a student. I perceive that patients actually appreciate when I take the time to position myself as a student to them, too. They tell me what they wish their doctors would do, and that we should do those things when we’re doctors. More often than not, it’s really good advice. As students we typically have more time and fewer clinical responsibilities than our seniors, and we should use this time to be patient, open listeners for our patients.
A final asset is the freshness of our senses. Our ignorance and inexperience allow us to hear things, see things, and smell things that, because of experience, acceptance, and age, experienced providers might not hear, see, or acknowledge. Working on an ambulance, I remember spending time with an older patient who had severe dementia, and although she no longer knew her name, she remembered the songs from her childhood church. She sang softly to herself while I was with her, beautifully and in perfect pitch, smiling all the while. It was easy to miss in the rush and noise of a transport, but I zeroed in on it because it was new to me. The singing was tragic and incredible, like a window into the past and a glance into the future of her disease process. I thought of her family, of the people she used to sing with and for, and how now, she sang to herself in a nursing home bed. I held back tears on the transport and made sure to mention her incredible singing to the nurse and physician in the emergency department.
Though these assets lay the groundwork for future empathy, they don’t get us all the way there. In a recent lecture on clinical empathy, family medicine physician and medical educator Dr. Sonia Oyola described being willing to “feel alongside” the patient. Feeling alongside describes an emotional openness in the clinician or student. This openness allows in and encourages reflection on the feelings generated in patient care. Feeling alongside is different than just trying to imagine how a patient feels. It acknowledges that our reactions are different than the patient’s. Being open to one’s own emotions and practicing real-time analysis of these emotions in relation to the patient’s own reactions, is feeling alongside. Honing this skill lets us tell our patients we are worried about them, helps us recognize our own biases and baggage, and reminds us and our patients of our shared emotional humanity.
When the medical students’ assets come together with a willingness to feel alongside our patients, it makes an impact that lasts. I was interviewing a patient, an older man in his 60s, who was gruff and quiet in his responses. He seemed uninterested in talking with me about his medication records, which was frustrating for both of us (they were in the electronic medical record, but I still had to ask). Eventually, I leaned into the discomfort in our interaction and changed the subject. Enter asset number one: curiosity. I learned he had worked in the dairy industry for decades. As a Wisconsinite, I had heard news of mass dairy farm closures, so I asked about the economics and politics of the dairy lobby and the “Got Milk?” ad campaign. He was warming up to our conversation; I had asked him questions about topics that he had informed opinions about and shown that I cared. Next up to bat was my lack of clinical power. Suddenly, he tearfully told me that this was the first time in decades that he would miss hunting season, and that he always goes with his son, who is a disabled veteran.
What my fresh senses detected was the most painful aspect of this situation. When the physician came in, he stumbled through the usual pleasantries without detecting how upset the patient was. Our patient tried to cover his tears by engaging in a conversation about treatment options, but this just led him to return to his gloom and gruffness. In turn, the physician was visibly irritated with the patient and his attitude.
After the encounter, I thought of my own experience with neighbors and family who live for hunting season – I was stunned he’d never missed one and understood why he would be so upset to be stuck in the hospital. I appreciated his insights on the dairy industry. I felt thankful for his son’s sacrifice and shocked by his father’s blunt language and descriptions of the explosion that wounded his son. I wondered what it will be like when my own father figures can no longer participate in our traditions. I was irritated with the physician (my future self?) for rushing through the visit rather than connect with the patient. I was also frustrated with the patient for being rude.
My instinct was to push aside many of these feelings – they felt like a distraction from doing my job. Instead, I sat with them and thought about how remarkable it was to have so many reactions to one conversation. How beautiful it was to see our humanity, in all its shades, and how privileged I am to be in a position where I get to experience that view every day. And, I have the power to take my lessons and emotions from each experience to the next. By feeling alongside the patient, I felt an empathetic compassion.
I worry that during my training, concentrating on developing empathy will interfere with the demands of my curriculum and the expectations of my evaluators. What will I lose by holding on to or speaking out when things stand out during a patient interview? Taking extra time to ease an emotional concern or correcting a colleague can be inconvenient, uncomfortable, and even damaging. Taking steps despite an entrenched power differential as a medical student is a risk. How will I stay in the moment and give patients the time they deserve while meeting the demands of a rigorous schedule? How will I handle all the emotions if I allow myself – actually, encourage myself – to feel alongside my patients?
With practice and mentorship, I think these worries will subside. As I interact with more patients, I have started to hear new thoughts:
“I can’t imagine what that’s like. Tell me more – I know that I am very young and have much to learn.”
“I don’t understand what you’re going through, but I have the time to try to understand.”
“I don’t know how you feel, but I can try to feel alongside you.”
David Deshpande is a 1st year medical student at the Pritzker School of Medicine at the University of Chicago. He a Wisconsin native who enjoys thinking and writing about empathy.