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From the Editor's Desk

Martin B Van Der Weyden
Med J Aust 2002; 177 (8): 401.
Published online: 21 October 2002

Extinguishing empathy

Search any dictionary for "pathography" and the word will not be found with "pathogen", "pathogenesis" or "pathology". But pathography has become a tool in medical education. Its roots are pathos ("suffering") and graphe ("writing"), and refers to stories which explore the emotions and suffering of those who are ill. Such poignant, personal passages are now used in medical training to promote compassion and empathy.

For most of the last century the ideal in medicine was Osler's aequanimitas — described by the US academic and author Melvin Konner as "poise in the face of a crisis, grace under pressure". However, some claim aequanimitas encourages clinical distance and dispassionate care. Moreover, the hold of technology and diagnostic disciplines on modern medicine has spawned the image of doctors as distanced and passionless.

But medical training has begun to take up the challenge and now stresses the value of listening to, feeling for and identifying with patients — in short, empathy — an emotion that the US physician Howard Spiro so evocatively captures as "when 'I and you' becomes 'I am you', or at least 'I might be you'."

Students at the start of their medical journey are fired with enthusiasm and empathy.

But the crowded curriculum's emphasis on bioscience, the pathology of disease and accuracy of diagnosis detached from patient care does little to encourage empathy. Students soon learn detachment and equanimity.

After graduation, empathy is further drained by the dark and demanding side of humanity, and detachment becomes the essence of survival.

But, more importantly, empathy requires time for conversation and connecting.

As long as medicine's most scarce commodity is time, the embers of empathy that once fired the student will be extinguished. And doctors will remain distanced and passionless.

  • Martin B Van Der Weyden

  • The Medical Journal of Australia

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