Let’s have some new clichés
This is my third blog post for Study Hub and I am getting into the swing of things. However, since starting this project I have realised how easy it is to fall on clichés: words and phrases that fit conveniently into the gaps where concepts are not easy to communicate, language fails to convey precisely what we mean, or maybe we are not entirely sure what we mean. Take our current situation (drawing on the pandemic as an illustrative example has already become cliché in this blog, sorry): in our collective psyche, covid-19 has been chunked into a clutch of stock phrases and banal platitudes (‘the new normal’, ‘unprecedented’ and ‘the science’, I’m looking at you). On the one hand this is understandable – there is a comfort in clichés that bridge the gap between the writer and the reader. But on the other, clichés can create distance when they are used as a veil between the writer and their true thoughts – in this case they become the linguistic easy option for avoiding scrutiny or debate.
Which brings me back one medical cliché in particular: empathy. This week, I have been listening to the latest episode of the BMJ’s primary care podcast that explored how to have productive conversations with patients about making positive lifestyle changes. As you might expect, the word ‘empathy’ came up a lot. It is, after all, the medical profession’s go-to panacea for all communication ills: be empathetic and you won’t go wrong. Except . . . What does it mean to genuinely feel empathy? And is it always possible or desirable to be empathetic? To even ask the latter question feels heretical – empathy takes centre stage in the professional literature as a prerequisite for good care and I must be clear, I am not in any way disputing that every single person we engage with in our work must be treated with kindness, compassion and the utmost respect. But I have been asking myself whether attempting to enact an approximation of my (admittedly, somewhat hazy) understanding of empathy is the best or only way to achieve this end. A very lazy google took me to the Wikipedia entry for empathy, which states that it ‘encompasses a broad range of emotional states’. Hmmm. Further page one rummaging proved inconclusive – empathy is still subject to debate (this controversial episode of the Invisibilia podcast made the issue live). I realised that since I first drafted my personal statement for medical school, I have been casually using the term ‘empathy’ without digging too deeply into what it means to be truly empathetic in a clinical context. Of course, I have been operating with my generalised lay idea of empathy as something involving me imagining myself into the shoes of the person in front of me. But I’m definitely not the first to wonder about the usefulness and safety of this exercise, and whether what we’re learning in medical school isn’t actually empathy but instead a specialised toolkit of professional politeness and kindness.
The more I think about empathy, instead of getting answers, I find myself asking more questions. What if I empathise too much with someone – might the experience of taking on their distress prevent me from delivering effective care? Or – maybe even worse – what if I do not feel enough empathy for someone else? Would my emotional response (or lack thereof) immediately preclude me from being a good clinician? How are we to judge what is too much or too little empathy? If empathy is something that can be taught, can it be objectively measured? If so, should we be expected to meet specific empathy targets, and to improve year on year? And what is the usefulness to the patient of their clinician projecting themselves into their situation? Could a clinician’s vicarious musings on a patient’s situation lead them to make wrong assumptions and even do harm? To what extent does a clinician’s biases play into their exercises in empathy? Could these lead to worse outcomes? And does empathy have a role to play in burnout?
These are questions for which I do not have answers at this point. I know I will continue to use the word empathy when describing the attributes that I think are essential for good care. But I will also ask whether an alternative for delivering better patient care, better allyship and being better colleagues might involve not presuming that our apparent empathy is enough. Instead I think it might consist of taking the time and learning the skills to listen to the subjective experiences of others, which in my mind are more important than our imagined versions of them. And I will try to think a bit more critically about clichés in general, even though they are very hard to avoid. I mean, I have counted 12 that I have used in this post alone – I will try my best to get this number down in the next one.
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