14


you must be polite, considerate and honest, treat patients with dignity and treat each patient as an individual,6


but warns


STEPS TO EFFECTIVE EMPATHY


■ Recognise strong feeling (eg, fear, disappointment, anger, grief)


■ Pause to imagine how the patient might be feeling


■ State how you see the patient’s feelings (eg, “It sounds like you’re upset about...”)


■ Legitimise the feeling ■ Respect the patient’s effort to cope


■ Offer support (eg, “Let’s see what we can do together”).12


Similarly, the Singapore Medical Council advises: “A doctor is expected to be dedicated to providing competent, compassionate and appropriate medical care to patients.”8


against establishing or pursuing “a sexual or improper emotional relationship with a patient”.7


Doctors have to be


careful not to abuse their position of power. In providing competent and compassionate care, emotion does sometimes creep in. Dr Charles reasons: “Doctors are humans as well, and though we would like to distance ourselves emotionally from our work so as to remain objective, inevitably there will be times when an emotionally charged situation arises.”


REFERENCES


1. “Let Me See If I Have This Right…”: Words That Help Build Empathy, Ann Intern Med 135:3, 221-27 (2001)


2. Zinn W, The Empathic Physician, Arch Intern Med 153(3):306-12 (1993) Ibid 1


3.


4. Wilmer H, The Doctor–Patient Relationship and the Issues of Pity, Sympathy and Empathy, Br.J.med. Psychol 41: 243-48 (1968) Ibid


5.


6. GMC, Good Medical Practice p15 (2006)


7. GMC, Maintaining Boundaries p1 (2006)


8. SMC, Ethical Code and Ethical Guidelines p3


9. Finlay, I, Dallimore, D, Your Child is Dead, BMJ 302:1524-5 (1991)


10. Ibid 4 11. Alfred, Lord Tennyson, Tears, Idle Tears, The Princess (1847)


12. Platt FW, Empathy: Can It Be Taught? Ann Intern Med 117(8):700 (1992)


DEALING WITH EMOTION Dr Leonard agrees. “Patients do value it if you look touched too. If you look like you are finding it tough to break the news, patients can see that there is a person beneath the professional.” A study, Your Child is Dead, asked


a group of parents who had suddenly lost their child about how the news was broken.9


Parents took comfort in


the fact that the informant of the bad news was also upset, with one parent stating: “He cared so much he had tears in his eyes.” The horrific loss of their child had not gone unnoticed by a cold, detached professional, eager to move on to the next job. Indeed, doctors may try so hard to appear professional that they come across as uncaring. Dr Lawrence Ng,


MPS medicolegal consultant based in Singapore, says: “Body language is important, but usually it is subconscious and not within voluntary control. One may appear stiff and aloof whilst trying to remain composed and professional.” Getting the balance right between professional detachment and apparent coolness is hard. Dr Ng explains: “Cultural differences play a role in whether some form of sympathetic touching is appropriate, eg, hand-holding or shoulder touching. Misunderstandings may arise, but not usually if the gesture is sincere.” Understanding, like charity, begins at Sincerity to oneself is essential


home.10


in order to reach out to others. Dr Rahim questions doctors who might seem devoid of emotion: “If you are not feeling any emotion at all, it might be a warning sign to yourself – am I able to connect with my patients?” Dr Leonard reveals: “Sometimes, I worry that I have shown too much emotion in a consultation. Sometimes, patients look at me and say: ‘Oh Dr Leonard, I wouldn’t want your job.’ Not that I seek it, but that is the ultimate sign that patients know that I understand their situation.”


PURPOSEFUL EMOTION “Tears, idle tears, I know not what they mean,” wrote Tennyson.11


The


empathic doctor should not be willing to indulge idle emotion or self- absorbed sympathy; empathy should be with a strong clinical purpose. Above all, empathy allows the patient to see the person behind the professional, and the doctor to see the person, and the suffering, behind the patient.


ARTICLE


UNITED KINGDOM CASEBOOK | VOLUME 19 | ISSUE 1 | JANUARY 2011 www.mps.org.uk


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