Sorry, Have I Upset You?

I was a first-year medical student when a stage 3 cancer patient gave me insight into the patient perspective. She described the heartless demeanor of the oncologist who first informed her she had cancer. 

As she started crying, his response was: “I’m sorry, have I upset you?”

Clueless. Many people have the preconceived notion that the key to being a good physician is book smarts and experience, overshadowing the value of nurturing a trusting doctor-patient relationship. However, over the past decades, there have been countless studies indicating that the emotional connection is a key aspect of caring for a patient. Fostering this connection not only cultivates trust, it also leads more patients to staying with their treatment. 

Now, modern medical schools have emphasized the importance of empathy and understanding, but is that enough?

Some feelings can be taught

Before medical school, I thought empathy and compassion were innate skills that could not be taught. However, years as a medical student proved otherwise; most if not all of my peers are trained to nurture empathy and humanity. That seems to indicate that the cancer patient’s Sorry oncologist started out with a sense of empathy and humanity, which unfortunately diminished throughout his career. This realization left a deep question: why do physicians experience a waning sense of empathy over the course of their working lives? 

While my first instinct was to blame this doctor, at some point I realized that as a physician, one is generally more exposed to death. Over the years, he might have eventually become so accustomed to death that he lost his sense of empathy — patience with the patient. 

This tendency may have been exacerbated by high patient volume, which can lead to physicians viewing patients as just another case while disregarding the essential humanity.

Avoiding burnout, physicians take a holistic approach to patient care, to hear and understand the patient’s journey. Listening to the big picture enables us to be empathetic to the little things. Like the language they use. 

Taking this approach would change the doctor-patient interaction from statements like “This is your diagnosis” or “Take this treatment” to a more heartfelt and compassionate conversation that ensures all patients receive the treatment they deserve, and expressed in a way they can absorb. 

Cultivating empathy

Physicians often focus intensely on gathering the most critical information to diagnose a patient’s condition, meticulously assembling the pieces of a complex puzzle. However, in their quest for accuracy, many become so engrossed in the details of the symptoms that they overlook other essential elements, such as the psychological aspects of patient care. 

I’ve witnessed doctors firing off questions, barely allowing the patient a moment to breathe. “Are your parents alive?” quickly followed by “Did they have a similar condition?” without pausing to consider the emotional impact of their words. I, too, have been guilty of this efficiency. However, the patient’s expression brought me back to reality, and I have sincerely tried to prevent this pattern from recurring. 

 As I have sought ways to foster my feelings of empathy with patients, I frequently remembered my own primary care physician, who manages to keep the embers of his humanity burning brighter each year. He told me that the secret behind his everlasting kindness and empathy was continuous training. Although that may seem straightforward, too simple, it is truly an integral part of life and an axiom I have gone back to time and again. As Leonardo da Vinci said, “simplicity is the ultimate sophistication.”

I also try to remember a favorite expression of my mother’s, who had always told me to “Put yourself in others’ shoes.” This life philosophy makes it easier for me to connect emotionally to my patients by incorporating the patient’s unique perspective.

Staying sensitized

To preserve maximum empathy, I have committed to the following principles:

1. The Continuous Practice of Mindfulness and Reflection: Medicine is a lifelong journey, and reflecting on one’s actions allows the physician to improve with each patient interaction.
2. Empathy Through Understanding: I strive to place myself in others’ shoes, recognizing that each patient is on a unique journey. By doing so, I no longer see them merely as numbers or cases, but as individuals with their own stories.
3. Maintaining a Healthy Work-Life Balance: This balance is vital in preventing burnout, a significant desensitization factor. By taking care of myself, I can better care for others.

I hope these rules will help me maintain my sense of compassion while pursuing a deeper understanding of the potential impact of a condition on my patient’s life. 

I pray that my three principles offset being overwhelmed by too many patients and desensitizing myself as a coping mechanism to their personal suffering.