Loss of an empathic connection between doctors and their patients

It has been reported that up to 60% of doctors suffer from symptoms of psychological job-exhaustion, or physician burnout, leading to diminished career satisfaction, substance abuse, divorce, quitting the profession, and suicide.

An article in a recent Journal of the American Medical Association by Helen Riess, a Harvard psychiatrist, attributes much of this psychosocial carnage to the loss of an empathic connection between doctors and their patients.

The author summarizes a number of studies positing that empathy resides in specific areas and structures of the brain, such as the anterior cingulate cortex and amygdala. In one report, 17 experimental subjects viewed images of patients experiencing intense pain; simultaneous magnetic resonance imaging (MRI) of the study subjects’ brains revealed heightened neuronal activity in the purported empathy centers.

It also appears that the amount of empathy one is capable of mustering from these locations—which can be measured by psychotherapy tools like the Empathic Understanding Scale—is not static, and can be modulated up or down by external circumstances. The article describes the phenomenon of “empathy erosion” documented in third-year medical students—caused, perhaps, by a reflexive, self-protecting down-regulation of empathic neural circuits in order to keep the students from being overwhelmed by their exposure to so much pain and suffering.

But too much of this self-protective down-regulation by physicians can give rise to a permanent empathy deficit. They become hardened to human misery, and rupture the vital empathic connection between doctor and patient that is the cornerstone of all medical care. Patients who bond emotionally with their physicians have better outcomes, and physicians who are emotionally engaged with their patients are happier and more satisfied with their jobs—and less likely to suffer from the destructive malady of physician burnout. Dr. Riess advocates education and the use of certain acquired behavioral skills to help prevent the erosion of physician empathy.

So what does the crippling syndrome of physician burnout have to do with Quasimodo? Regular readers of this blog know the answer lies at the nexus of literature and medical science, in the realm of the discipline known as narrative medicine.

Victor Hugo’s hunch-backed bell-ringer of Notre Dame Cathedral is one of the most sympathetic characters in all of Western literature. Only someone possessing the heart of one of the gargoyles crouched atop the roof of the Cathedral could remain unmoved by this deformed, grotesque foundling who, at the same time, is the very soul of innocence and purity. We pity him for his deafness—caused by the loudness of the bells that are his greatest love—even as we share the bewitching Esmeralda’s disgust at his desire for her.

The act of identifying deeply with a complex literary character such as Quasimodo cannot help but result in the beneficial stimulation of the brain’s empathy centers that Dr. Riess advocates. Her failure to mention the reading of literary fiction as a time-tested means of increasing empathy is my one criticism of her article.

It is an effortless, natural way of healing hearts and souls one book at a time.

Richard Barager is a nephrologist who blogs at The Literary Doctor.

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