Saturday, October 2, 2010

CBC News - Canada - The limits of feeling someone else's pain

CBC News - Canada - The limits of feeling someone else's pain

Interesting article that questions the value of empathy in some situations, particularly in the political contex.

The author also quotes an article by a physician, Jane Macnaughton, in a recent journal of Lancet who writes that feeling the distress of patients can be "unhelpful and even dangerous". Dangerous? Well, if one is in the midst of a delicate proceedure, maybe. And, sure, it may be emotionally and physically exhausting to work in a setting that exposes us to the pain of those who are suffering. We all have limits, and as professionals, we must learn to measure our own internal reserves, and find ways to replenish them when we are depleted.

Macnaughton apparently also writes that a doctor who says "I understand how you feel" can be perceived as insincere, provoking resentment from the patient. I agree that clinicians must be careful not to use this rather paternalistic response when a patient expresses a strong emotion. They also need to be careful not to prematurely assume what the patient is feeling. However, genuine efforts to understand the a patient's distress will almost always be valued and appreciated, especially when reflected back to the patient to check for undertanding. Softer responses like, "I can imagine" or "I think I understand what are you feeling" are more likely to be fully accepted by the patient.

I will go read the original Lancet article...look for more on this later.

However, in my own experience, one can never be too empathic.


1 comment:

  1. The article by Macnaughton appears in Lancet, Vol 373, June 6, 2009, pp 1400-1401. Dr. Macnaughon is Co-Director of the Centre for Medical Humanities at Durham University in the UK. Her argument is a philosophical one and is based on Martin Buber's view that "empathy was impossible in a therapeutic situation because of a mismatch of perspectives". Macnaughton argues that, in a clinical encounter, an objectified "doctor" meets with an objectified "patient" in a non-equal I/It relationship, with no hope of ever achieving a truly authentic interaction which characterizes a I/Thou relationship. Macnaughton argues that, in clinical encounters, a "full experience of mutality or understanding is not possible". She goes on to say that "all that is possible psychologically [in a clinical encounter] is an awareness of the other as an experiencing being; an d, if we are open enough and take time to ask, they can tell us what that experience is like".

    I agree that the "objectification" of the clinician-patient experience makes it more difficult, but not impossible, for a clinician to be authentic and empathic. In my view, clinicians can learn to address the limitiations of an "I/It" relationship by being open and curious; seeking to understand a patient's psychological experience. This includes not only asking about a patient's experience but also reflecting back what we think we heard, or saw, or felt, allowing the patient to let us know if we have gotten it right. This process of "emotional attunement", as imprecise as it always is, is usually experienced by the patient as empathic, particularly when we remain humble, and let the patient know we are striving to understand how they feel. Though we may not be able to achieve a truly authentic, "I/Though" relationship with our patients, we can be achieve empathic moments, and this in turn, helps us to build more therapeutic and effective "objective" relationships with our patients.