Medicine and Life: The Scientific Basis of Empathy - Physician Heal Thyself (with a little help from your friends)

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Dear readers,

I dedicate this blog to the empathy that I observed in my wife for our oldest daughter during our daughter's recent labor and delivery which resulted in our first grandson.

We all become aware of the suffering of family and friends which allow us the opportunity to experience empathy.  There may be confusion of the definitions of empathy, sympathy and compassion.

Empathy can be defined as the understanding, on an emotional level, of another person's suffering.  This may be thought of as being "in tune with" the emotional state of the other person.

Sympathy is emotion beyond empathy, during which the sympathizer shares the emotional state of the other suffering being.

Compassion is a related state that includes being consciously aware of another's suffering, combined with the emotional state of empathy, and then taking action to relieve, in some way, the other being's suffering.

In the October 13, 2010 edition of the Journal of the American Medical Association, is the commentary, "Empathy in Medicine -- A Neurobiological Perspective", authored by Helen Riess, M.D.  The article is a brief overview of the current medical knowledge of the physiology, anatomy and the relevance of empathy in medicine.  The article describes how recent advances in Neuro-sciences have led to improved understanding of human emotions.

Learning points include:

          1) There are specialized brain cells called "mirror neurons" that facilitate learning of the emotions and actions of others by simulation through mimicry. These are felt to be important in acquiring language and motor skills through imitation of observed behavior, as well as to promote emotional intelligence by embedding the social circumstances of these processes, including empathy, within the brain of the observer.

 

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          2) When an empathetic individual observes another person's suffering, he or she experiences sadness and pain associated with autonomic (not consciously controlled) nervous system changes in skin electrical activity, heart rate and breathing patterns. These physiologic changes are associated with increased cerebral metabolic activity involving multiple central and surface regions of the brain (amygdyla, cingulate gyrus as well as the insular, frontal and parietal cortex).

 

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          3) The degree of empathetic pain, sadness and other responses depend upon the caring individual and the circumstances that are encountered. Experiments using functional MRI techniques demonstrate that a wife may feel more empathy when pain is inflicted on her husband compared to the empathy response measured when pain is inflicted upon an unrelated stranger, or someone who "deserves" their pain.

 

 

Empathy

 

          4) Some individuals may preselect medicine as a profession because of a tendency toward empathetic responses.  The training process in medicine, however, may be associated with down-regulation of the empathy response. Without emotional regulation skills, the constant exposure to others' pain and distress may be too much to bear and can lead to anxiety, professional burnout or physiologic responses related to empathy which may hinder procedural performance.

          5) Diminished empathy may be a worse problem, leading to dehumanization of physicians' relationship with patients, shifting physicians' focus from the whole of the person to a state where the patient / person may be regarded as a combination of a disease process with target organs and test results. Physicians with lack of empathy may also experience lesser job satisfaction, greater rates of suicide and substance abuse, and higher rates of medical malpractice lawsuits.

          6) Empathetic relationships between physicians and patients (as well as a patient’s relations to other medical team members and care-givers including family and friends) is important in the healing process with measurable physiologic benefits such as improved immune function, shorter post-surgery hospital stays, stronger placebo response and shorter durations of illnesses.

As we all have seen (and my oldest daughter delights in telling me) it is unfortunately too often in the practice of "modern medicine" that the emotional connection to patients is lost due to various reasons, and in a well-intentioned attempt to cure every disease process and negate every symptom, the best interests of the overall condition of our patients may not be served or even understood.

Recently, I was directly reminded of the value of empathy.  For the first time in my adult life I experienced a significant illness.  The empathy, sympathy and compassion that I received from my friends and family, medical associates and personal physicians was truly uplifting.  These generous gifts certainly enhanced my healing and state of well being.  Thank you all.

In the words of my reading companion, Marcus Aurelius, from his Meditations, this passage seems relevant:

        The things which are external to my mind have no relation at all to my mind.—Let this be the state of thy affects, and thou standest erect.

To recover thy life is in thy power. Look at things again as thou didst use to look at them; for in this consists the recovery of thy life.”