I see a unique side of people: the tops of their heads. I can spot gray hairs, roots, and baldness at a glance. Faces, however, escape me. At six foot three, it’s hard to always see them. Where does that leave me? Out of touch.
We are inherently different people, seeing from different perspectives and facing different challenges. I hit my head on low ceilings, they get lost in crowds. I barely fit in an airplane seat, and they can’t reach the top shelf. But all it takes to remove the “I” vs. “They” distinction is a bend of the knees. Now I look through their eyes and walk in their shoes. I know how it feels to lose myself in a crowd and to ask for help to reach my favorite crackers. In two words, I empathize.
And if a person practices medicine, her career depends on meaningful conversation. A primary care physician’s first question might be: How do you feel?—a sentence brimming with subjectivity. She is vulnerable to receive any answer, whether it be “my leg hurts” or “I feel depressed.” As a health professional, she must then diagnose the problem and begin a conversation with her patient regarding treatment. Though, as Theodore Roosevelt said, “No one cares how much you know, until they know how much you care.” Without empathy, the doctor-patient interaction loses affect. The patient perceives that the physician does not (or cannot) fully understand the problem he or she faces and, therefore, cannot treat him or her at a high level of care.
The above is routine, but then there are patients with whom it takes extra emotional proficiency to empathize, because they cannot speak your language. Take, for example, my recent conversation with a neonatologist. He explained that a baby who is born prematurely must spend time in a neonatal intensive care unit under the care of a neonatologist, and even after receiving high quality care, it will likely spend its life suffering from various health problems. In our individualistic culture, one might assume that the family’s wishes would be honored without question—if they want the baby to survive, the physician will do his best to keep it alive. But the neonatologist keenly acknowledged that he must treat the newborn, not the family. He has to consider the implications of continuing treatment, asking questions like: “Will this baby lead a normal, productive life with minimal suffering?” The doctor did not say this during our talk, but his role at that moment is to speak for a human life that cannot speak for itself. In order to make the best-informed decision regarding its future, he seeks to understand how the newborn feels in its current state and how it will feel years down the road. Only after walking in the small shoes of his patient can he then choose a course of action.
The same applies to all physicians, including surgeons. Surgeons are different from most physicians because they must suspend their empathy when in the operating room, but according to a neurosurgeon, it is crucial to also remember what you are dealing with: a human life. While the shortest path to any point is a straight line, each route a neurosurgeon might take to remove, say, a tumor, could affect the patient differently. It is the surgeon’s responsibility, then, to discuss the repercussions of each scenario with his patient and choose the most appropriate one. If he is a pilot, steer clear of his occipital lobe.
So then, it is apparent that empathy (and a balance of empathy and distance) is necessary to practice high quality medicine, but the question arises of how to teach it to aspiring physicians. In my own experience, I have found that studying the Arts & Humanities exercises one’s capacity to empathize.
I am a pianist, and like every student, I began with the basics—scales, some chords, and a few melodies. Fast-forward a few years, and I am playing the works of Chopin, Mozart, and the like. But something happened during that time. Music is a profoundly intimate endeavor, and every note or rest is there for a reason—anything else would change the feeling of the piece. It took me years to understand the emotion and motive underlying the structure of a piano piece, and with that understanding, I resurrect works of passion. What’s more, I can make that passion resound in the ears and minds of everyone listening, as if the composer himself were within them. Yet, he remains speechless. Is it not also the neonatologist who speaks for the speechless? As a pianist, I prepare myself to perceive and manage the emotions of my future patients.
Reading literature such as the psychological novels of Georges Simenon has also trained my ability to empathize. A story would develop in the Belgian author’s mind until the pain reached Simenon’s limit, at which point he would disappear to write a novel, one chapter per day. His series of psychological novels (romans durs in French) features men whose lives turn from ordinary to criminal, comfortable to inescapable. Kees Popinga, the main character in The Man Who Watched Trains Go By, for example, is a typical father but boards a train for Paris after losing his job, only to commit murder. To my surprise, I found myself empathizing with the felon. I often read on the train coming home from school, and with every bump, I held my breath. Goosebumps rose on my arms, as if I were a wanted man. Upon reading the final sentence, I felt deep sorrow, as if I had lost my best friend. I empathized with ink on a page, a doomed father, someone who had lost it all.
Is that not what a physician is expected to do? In all the glory of medicine, perhaps one’s greatest responsibility is to maintain human emotion under the pressure of a dehumanizing profession. The Arts & Humanities offer aspiring doctors a powerful way to practice that responsibility, but the question remains: how do we as leaders in learning improve the status of the Arts & Humanities in higher education?