Balancing Empathy vs. Emotional Detachment with Your Patients

Approximately 5 words were spoken to me by a former resident learner in the first two years of his residency. That number is generous. Resident learners vary in personality, and this resident was quite introverted from the moment I met him during interview season throughout orientation month and so on, so I never took it personally. One afternoon, I saw him out of my periphery, slowly strolling down the residency hallway. It was my assumption that he was looking for the Program Coordinator to plan vacation scheduling, or something of the like. You can imagine my surprise when he stopped at my office doorway and simply said, “Hi, Jillian” with a smile. This was the first time he engaged in any sort of dialogue with me in almost two years and I was motivated to turn his greeting into a conversation. My hope was to get to know him better.

After responding with a welcoming “hello” back, he entered my office and sat in a chair as if it were routine for him to stop by for a chat. Within one minute of conversation, he mentioned that he was 2 weeks into his MICU rotation. His smile disappeared almost immediately and his head shifted more facing to the ground. “Tell me how you’re doing with MICU…” I said, trying to validate with my tone that MICU is a rigorous rotation in many ways. We spent almost an hour in conversation. In summary, we talked a lot about the struggles no one talks about when physicians experience dying patients and/or challenging patient outcomes.

Realistically, medical students are taught and experience emotional detachment from their patients the moment they encounter their first cadaver – in the first year of medical school. Medical students are learning the visceral textures of the human body, using their own strength (and force) to tear through fascia, tug off the human skull and use cadaver tools, including the bone saw. Honestly, this is not the experience most learners stop to consider, “Who was this person?” or “What was their family like?”

Over the years, several Gross Anatomy Lab faculty have commented about how physicians have become skilled at viewing distress and ignoring it. All strongly agreed that this is not the best approach for physician development. Medical students know it’s there, but avoid engaging in the distress. Rather than saying, ‘Hmm, you look sad today, tell me about that,’ they ignore it and say, ‘Still going to chemo? How are your headaches? Nausea?” The struggle to balance empathy with emotional detachment from a patient is REAL.

Fortunately, if you struggle with this – KNOW that it is NORMAL. I’m not going to focus on emotional detachment from patients, but rather the value of practicing EMPATHY. Once you find your ability to practice empathy, you will begin to see that emotional detachment is no longer a necessary evil of practicing medicine. And your patients will notice, too.

First, note that empathy is not the same as sympathy. You can learn to have a quality understanding of a patient’s experience without living every emotion with them and their family. (If you are prone to that, see my blog about Burnout, Depression, and Suicide Risk in medical professions.) For now, the goal is to simply connect with your patients in a way that you can have an understanding of the patient’s experience. You can teach yourself to be more empathetic.

1. Know Yourself. The ability to understand others requires you to understand yourself. Accepting your feelings is the foundation for empathizing with others and is essential for living a healthy life. Learn about your personality and learn how you learn.
2. Understanding Others. The practice of thoughtfulness takes practice and commitment. ‘Put yourself in their shoes.’ Analytically develop your skill-set to consider different angles of a person’s experience (technical, financial, emotional, logical, mental, and professional). One innovative medical education program requires that medical students meet their cadaver’s family for dinner before dissecting. While some consider this extreme, it prevents students from deflecting the strangeness of the dissection situation (i.e. giving your cadaver a nickname or using comedic relief to objectify the body.)
3. Nonverbal Empathy. Learn how to use appropriate and subtle gestures to convey empathy, such as using eye contact and facing the patient during a visit. Video recordings of patient encounters are excellent strategies for learning how you engage with patients and how they respond to you.

At the core, those are 3 primary go-to learning points to begin your journey to a practice of empathy. The conversation I had with the resident learner incorporated these three points and he checked-in with me regularly to talk more about how he uses these techniques to cope with the emotions that are present when serving chronically sick and dying patients. At the end of his 3rd year of residency it came to no surprise to me when he expressed interest in pursuing hospice and palliative care fellowship training post-residency.

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