Really nice essay. I found when I was young, I would try different avenues that others would not because I didn't know any better. Some of my best results were due to my inexperience. I also found not no one took me seriously as a CPA until I reached the age of 40. Although that is not always the case in the medical profession, it still happens.
You'll be fine, David -- your essay provides abundant proof of that. Every patient is a potential teacher of the those clinical and life experiences you are just starting to accumulate, through their stories, humor, bitterness, grace, and courage in the face of illness. Don't forget what you'll learn from fellow trainees, friends, relatives, wise nurses and caregivers.
If you pay attention to your unease and delight in these interactions, you'll also be taught about yourself, as a humane fellow traveler in this hard wondrous world and life. Make time to savor it through art, literature, music and travel. Finally, be alert to the absurdities and profiteering of the U.S. medical system and look for ways to cushion your patients from its sharp edges.
This is a great essay. One of the biggest challenges you identify is time. Taking the time to let a conversation play out is a challenge in the world of 15-minute appointments and mandatory med reconciliation, PHQ screen, and other barriers between patient and doctor.
I will push back (gently) on the idea that empathy is a must. It may not always be possible to generate. But what one can do (and I try but it is a work in progress) is to be fully present in the visit and really listen. I think patients want to be heard, and hearing them is a prerequisite step for empathy.
Feb 24, 2023Liked by Adam Cifu, MD, David Deshpande
Great piece! I do often wonder about compassion vs empathy. Speaking for myself, empathy can be draining and a full body experience. I am not in a patient-facing role, but if I were I would have to figure how to find a balance and think I would focus on the whole person while being compassionate. I’m not sure I could “feel alongside the patient” and not get burnt out.
Feb 24, 2023Liked by Adam Cifu, MD, David Deshpande
The best gift of learning empathy when caring for patients is CARING. I went into the field of chronic non cancer pain having experienced it myself. And yet when people would tell me “You don’t know how I feel...” I would absolutely agree with them. That empathy tore down the walls between “professional” and “patient” and allowed for dialog and caring care. Self disclosure CAN be a good thing it helps your patient. But if you self disclose to help yourself - it’s better to see your therapist. 😉.
Good to read your views and as always I learned something new.
Feb 24, 2023Liked by Adam Cifu, MD, David Deshpande
Dear David — you seem to have discovered, on your own, and beautifully described the Zen Buddhist concept of “shoshin” or “beginner’s mind.” According to Wikipedia:
“It refers to having an attitude of openness, eagerness, and lack of preconceptions when studying, even at an advanced level, just as a beginner would. The term is especially used in the study of Zen Buddhism and Japanese martial arts, and was popularized outside of Japan by Shunryū Suzuki's 1970 book Zen Mind, Beginner's Mind.”
Feb 24, 2023Liked by Adam Cifu, MD, David Deshpande
Excellent post.
My advice (almost 30 years in) ... don't be "irritate" at the need to rush. Rushing is part of the job, and learning how to rush is good.
But cherish the moments when you can talk to a patient about "life." I like learning my patients' hobbies, and they love being asked why they got into that, or what their interests are in that specific hobby.
I like asking them about their thoughts on COVID, too ... they don't have to be "right," after all. I just like learning where they're coming from. That's empathy, too.
Feb 24, 2023Liked by Adam Cifu, MD, David Deshpande
Keep it up! Best thing I ever did in med school was participate in this humanities elective that was all about talking to the patients like actual human beings and learning their stories, never forget that. The best advice I ever heard in med school was “sometimes people just need someone to talk to, so just shut up and listen.”
Counterpoints: Our favorite pediatrician has no kids and the best OB in town is a guy, so empathy seems to have its limits
Empathy. Some are born with it and it shows and evolves naturally. Some need to approach it academically, study it, practice it. Some need to experience it by going through a tragedy and realize what you needed from others at that time. Twenty years ago my GP knew me. There was no computer in his lap. He looked at me, listened and learned. He knew my whole family which helped him understand how those dynamics affected my health. I felt whole. I wasn't an edematous, infected maxillary sinus causing pain on the middle nasal concha and frontal sinuses. He understood the probable reason for my acquiring this infection and what the effect it would have on me and my family.
As the years went by and the medical system 'advanced'?, 'shifted'?, 'mutated'?, his eyes stayed focused on the computer screen more than looking at me. I became a series of ICD 10 codes. I was a page full of point and clicks. Within a few short years going to my physician felt like being a cow in Temple Grandin's diagonal pen being 1 of many moving through the system.
For those who need to learn empathy and practice it, will today's medical system allow for it? Even if the disease is conjunctivitis which you diagnose as you enter and before closing the exam room's door behind you; would you still take the time or have the time to sit, learn, empathize?
Sometimes it's just easier not to. Not becoming entangled in the minutiae allows us to be protected from feelings, emotions, baggage of our own but mostly from others. Do what you've been taught, what you do best, assess, diagnose, treat, move on.
Great observations! I'm with the "assess diagnose, treat, move on". If one more GP directs me to fill in the yes or no dots on a very lame depression inventory, as they are apparently required to do, I will leave. Given the constant attention to a screen and the "I'm listening" response when you stop talking because of that, many of us just avoid any contact with medical people in general. In over 40 years of working with people who had endured incredible abuse of all kinds, I don't recall anyone disconnecting because I was taking hand written notes. When informed that this was no longer acceptable and I used a small laptop, people would generally, instinctively, not engage until I put it down. The screens cause isolation for the user and isolate the patient, but the computer "geniuses" who pretty much dictate how all professionals interact/communicate will never humble themselves and become the servants of those doing the work, until the workers refuse to adhere to their information gathering, cya, methods. People who are truly empathic will have to lay down their desire to actually do the work and pursue managerial roles that will allow them to make the changes that will allow others to do the work with integrity.
My son can multitask so I am used to him doing something with eyes focused elsewhere while still listening. However, it still feels like I am being ignored even when I know I am not.
Hence my observation that screens isolate. I do not believe, and never will believe, that anyone, smart, slow, whatever, can "multitask" in a way that gives equal attention and understanding to even two tasks simultaneously, unless one of the tasks is physical and repetitive. Though probably a majority of teens would insist that they are capable of interacting on a screen while interacting in person, there is a reason that the suicide rates are climbing in that age group and it appears that some form of their interaction is destructive and isolating, resulting in the hopelessness that precedes suicide. Most of us who have been around phone using teens can testify that they are not having deep, meaningful, thoughtful conversations on screens and will ignore a human in front of them if allowed to do so, in order to continue the screen conversation. If you're feeling like you're being ignored, you probably are. Eye contact is essential to meaningful interaction.
Actually I do. I should have clarified that for all not on the spectrum, blind or experiencing mental health symptoms that make eye contact uncomfortable or anxiety provoking, eye contact is essential, starting in infancy. Generalization does not mean offense or ignorance.
Really nice essay. I found when I was young, I would try different avenues that others would not because I didn't know any better. Some of my best results were due to my inexperience. I also found not no one took me seriously as a CPA until I reached the age of 40. Although that is not always the case in the medical profession, it still happens.
You'll be fine, David -- your essay provides abundant proof of that. Every patient is a potential teacher of the those clinical and life experiences you are just starting to accumulate, through their stories, humor, bitterness, grace, and courage in the face of illness. Don't forget what you'll learn from fellow trainees, friends, relatives, wise nurses and caregivers.
If you pay attention to your unease and delight in these interactions, you'll also be taught about yourself, as a humane fellow traveler in this hard wondrous world and life. Make time to savor it through art, literature, music and travel. Finally, be alert to the absurdities and profiteering of the U.S. medical system and look for ways to cushion your patients from its sharp edges.
This is a great essay. One of the biggest challenges you identify is time. Taking the time to let a conversation play out is a challenge in the world of 15-minute appointments and mandatory med reconciliation, PHQ screen, and other barriers between patient and doctor.
I will push back (gently) on the idea that empathy is a must. It may not always be possible to generate. But what one can do (and I try but it is a work in progress) is to be fully present in the visit and really listen. I think patients want to be heard, and hearing them is a prerequisite step for empathy.
What a wise and wonderful essay, especially from a student! It should be mandatory reading for students and doctors.
Great piece! I do often wonder about compassion vs empathy. Speaking for myself, empathy can be draining and a full body experience. I am not in a patient-facing role, but if I were I would have to figure how to find a balance and think I would focus on the whole person while being compassionate. I’m not sure I could “feel alongside the patient” and not get burnt out.
The best gift of learning empathy when caring for patients is CARING. I went into the field of chronic non cancer pain having experienced it myself. And yet when people would tell me “You don’t know how I feel...” I would absolutely agree with them. That empathy tore down the walls between “professional” and “patient” and allowed for dialog and caring care. Self disclosure CAN be a good thing it helps your patient. But if you self disclose to help yourself - it’s better to see your therapist. 😉.
Good to read your views and as always I learned something new.
Dear David — you seem to have discovered, on your own, and beautifully described the Zen Buddhist concept of “shoshin” or “beginner’s mind.” According to Wikipedia:
“It refers to having an attitude of openness, eagerness, and lack of preconceptions when studying, even at an advanced level, just as a beginner would. The term is especially used in the study of Zen Buddhism and Japanese martial arts, and was popularized outside of Japan by Shunryū Suzuki's 1970 book Zen Mind, Beginner's Mind.”
Excellent post.
My advice (almost 30 years in) ... don't be "irritate" at the need to rush. Rushing is part of the job, and learning how to rush is good.
But cherish the moments when you can talk to a patient about "life." I like learning my patients' hobbies, and they love being asked why they got into that, or what their interests are in that specific hobby.
I like asking them about their thoughts on COVID, too ... they don't have to be "right," after all. I just like learning where they're coming from. That's empathy, too.
Keep it up! Best thing I ever did in med school was participate in this humanities elective that was all about talking to the patients like actual human beings and learning their stories, never forget that. The best advice I ever heard in med school was “sometimes people just need someone to talk to, so just shut up and listen.”
Counterpoints: Our favorite pediatrician has no kids and the best OB in town is a guy, so empathy seems to have its limits
Empathy. Some are born with it and it shows and evolves naturally. Some need to approach it academically, study it, practice it. Some need to experience it by going through a tragedy and realize what you needed from others at that time. Twenty years ago my GP knew me. There was no computer in his lap. He looked at me, listened and learned. He knew my whole family which helped him understand how those dynamics affected my health. I felt whole. I wasn't an edematous, infected maxillary sinus causing pain on the middle nasal concha and frontal sinuses. He understood the probable reason for my acquiring this infection and what the effect it would have on me and my family.
As the years went by and the medical system 'advanced'?, 'shifted'?, 'mutated'?, his eyes stayed focused on the computer screen more than looking at me. I became a series of ICD 10 codes. I was a page full of point and clicks. Within a few short years going to my physician felt like being a cow in Temple Grandin's diagonal pen being 1 of many moving through the system.
For those who need to learn empathy and practice it, will today's medical system allow for it? Even if the disease is conjunctivitis which you diagnose as you enter and before closing the exam room's door behind you; would you still take the time or have the time to sit, learn, empathize?
Sometimes it's just easier not to. Not becoming entangled in the minutiae allows us to be protected from feelings, emotions, baggage of our own but mostly from others. Do what you've been taught, what you do best, assess, diagnose, treat, move on.
Great observations! I'm with the "assess diagnose, treat, move on". If one more GP directs me to fill in the yes or no dots on a very lame depression inventory, as they are apparently required to do, I will leave. Given the constant attention to a screen and the "I'm listening" response when you stop talking because of that, many of us just avoid any contact with medical people in general. In over 40 years of working with people who had endured incredible abuse of all kinds, I don't recall anyone disconnecting because I was taking hand written notes. When informed that this was no longer acceptable and I used a small laptop, people would generally, instinctively, not engage until I put it down. The screens cause isolation for the user and isolate the patient, but the computer "geniuses" who pretty much dictate how all professionals interact/communicate will never humble themselves and become the servants of those doing the work, until the workers refuse to adhere to their information gathering, cya, methods. People who are truly empathic will have to lay down their desire to actually do the work and pursue managerial roles that will allow them to make the changes that will allow others to do the work with integrity.
EHR
“Just a glorified billing platform with some patient stuff tacked on”
ZzdogMD (Dr Zubin Damania) 2015
My son can multitask so I am used to him doing something with eyes focused elsewhere while still listening. However, it still feels like I am being ignored even when I know I am not.
It is known, that at best, adults only listen/capture 50% of what another person is saying.
How much of the remaining 50% has your son heard?
Multitasking? I fear not.
Hence my observation that screens isolate. I do not believe, and never will believe, that anyone, smart, slow, whatever, can "multitask" in a way that gives equal attention and understanding to even two tasks simultaneously, unless one of the tasks is physical and repetitive. Though probably a majority of teens would insist that they are capable of interacting on a screen while interacting in person, there is a reason that the suicide rates are climbing in that age group and it appears that some form of their interaction is destructive and isolating, resulting in the hopelessness that precedes suicide. Most of us who have been around phone using teens can testify that they are not having deep, meaningful, thoughtful conversations on screens and will ignore a human in front of them if allowed to do so, in order to continue the screen conversation. If you're feeling like you're being ignored, you probably are. Eye contact is essential to meaningful interaction.
Re: "Eye contact is essential to meaningful interaction." You apparently have no idea what interaction is like for us on the autism spectrum.
Actually I do. I should have clarified that for all not on the spectrum, blind or experiencing mental health symptoms that make eye contact uncomfortable or anxiety provoking, eye contact is essential, starting in infancy. Generalization does not mean offense or ignorance.