Empathizing with others’ suffering is one of the most human expressions in life. For empathy to nurture, like any other emotion, it needs time and space, and in none other professions, this maxim is codified as profoundly as in medicine. Even in the times of pre-modern medicine, humans had the temptations to heal fellow humans’ suffering from ailments about which they knew little and had no therapeutics to offer. Nevertheless, medicine as a profession existed, primarily to provide hope, served as a platform for religious rituals to seek healing, and make death sacrosanct.
Then dawned the era of modern medicine. From the invention of the microscope, the discovery of antibiotics and that of insulin that turned the death sentence of type 1 diabetes to a chronic condition to surgical advances that transformed the prohibited territories in the human body explorable, from deep tumor resection in the brain to manipulation of heart including plumbing its blood flow, fixing electrical circuitry and rebuilding its valvular structures. During this era of modern medicine, there have been waves after waves of new pathologies, from chronic non-contagious to acute infections. However, sooner or later, humans either cured or transformed those into manageable conditions. And modern medicine continues to be on its quest to defy death with its discoveries of new knowledge and treatments.
However, in doing so, one key link has got progressively weaker. We lost our sense of empathy. I keep wondering if it is the scientific advancements that caused empathy to take the backseat. When we did not have much to offer except for empathy, and now have limitless resources but not much empathy. I wonder how can it be, that a trait that makes us human lost its central role from one of the most humane professions.
And so I realized, for empathy to nurture, it needs both time and space. Humans are bound in these two dimensions. All human endeavors take place at a specific time and in a specific place. In our quest to defeat death and, of course, monetize that process, we created fancier and glorious spaces. We created hospitals and medical complexes with valet parking, attached hotels, pianos on entrances, and expensive art in the lobbies but sucked the time available for the human to human interaction, that is, physician to patient interaction where empathy nurtures.
The practice of modern medicine is becoming more complex than ever. Patient-related data that determine diagnosis and treatments is compounding with the expectation to analyze and act upon in a lesser and lesser amount of time. Science of medicine has become a business itself. But is it the right way to practice medicine? Have we already surpassed the point of no return to reincorporate empathy, and the only thing we can do now is to alter patients’ expectations? But if we are in the business of dealing with human lives and if empathy is a significant part of the human experience, then why should we give up on that element of our existence to take care of others’?
I believe that the current epidemic of physicians’ burnout and self-reported moral injury has its roots in part in the inability to express empathy. As health care professionals, we do want to be empathetic, but the issue is that of time and space. The space part has been taken care of, but in doing so, the time component has been squeezed out as the trade-off. In order to improve patient outcomes and physicians’ burnout, there should be a “time-opportunity” for empathy.
This problem of lack of empathy is clear but not simple, nor its solutions. In order for empathy to take the front seat, a few other things will need to take a back seat. Health care needs spaces like hospitals, clinics, infusion centers, rehabilitation facilities, nursing homes, etc. which are decent and appropriate but not luxurious and glorious. Patients will experience a higher level of empathy, not by an expensive art on the wall but a quality human interaction.
Technology and big data that once stole facetime with patients are now reorganizing and maturing. I usually have all the numerical facts in front of me even before I see the patients and hence can spend whatever little time I have to connect with them at the human level. Nevertheless, there are huge gaps in technology efficiency, especially electronic medical records systems and seemingly infinite layers of quality measures courtesy to the health care bureaucracy.
Most importantly, greed, be it individual or institutional, is the ultimate anti-empathy variable in the equation. One can either be greedy or empathetic, not both. There are four key players in the health care system: patients, health care professionals, pharmaceuticals and device manufacturers, and insurance companies. When two of those are listed on the stock exchange, then clearly steering wheel of health care is being controlled by greed (under the guise of innovation/R&D but to sell the product by any means) and not the empathy.
Gross domestic product (GDP) is defined as the total value of goods produced by a country. Health care comprises around 18 percent of U.S. GDP. GDP indicates the health of a country’s economy. The purpose behind the provision of health care services to citizens is to promote and maintain their health and enhance their longevity so that a healthy citizenry participate in industries that contribute to the country’s economy and increase its GDP. It is paradoxical that in the U.S., the health care industry itself has become such a significant shareholder of GDP and hence one of the driving factors of the country’s economy. Therefore any attempt to undermine the greed in health care risks the destructive consequences for the national economy.
As complicated as this issue is, I do not see any other approach when standing in front of the patients but to be empathetic. Because being able to empathize is to be able to heal, and we are in the business of healing.
Ameer Khowaja is an endocrinologist.
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