We should value competency over empathy
During a recent visit to my general practitioner, I had my blood taken by a medical student. He missed and, as his face paled from empathy to my pain, I leaked blood all over the table. Before he could take another stab at it, a stern faced but more competent nurse swooped in to finish the job.
Skim the bibles of modern medical practice, such as Tomorrow’s Doctors or Duties of a Doctor, and you will notice that empathy is regularly cited as a quality all doctors must have. Defined as emotional identification with patients, empathy features highly on the entrance criteria of medical schools—part of the general ebb and flow away from biomedical instruction and towards an integrated humanistic curriculum. If you don’t have empathy, you must at least have the capacity to develop it.
But time spent training to be empathetic siphons valuable, instructional time. Last term, I sat through a one day communication skills course, which included empathy training. Later that evening, we had a 30 minute session on cardiopulmonary resuscitation. Under pressure to master the skill quickly, we asked the instructor for more training. She replied that this was all the training we would receive—the curriculum was already too pressed for time.
This experience raises the question: which is more conducive to effective medical care, empathy or competency? Weir and colleagues at Queen’s University Belfast argue that doctors who demonstrate higher levels of empathy during a consultation are more likely to foster patient trust, which has been shown to improve control of blood glucose and cholesterol levels in diabetics. Indeed, Weir argues that patients are less likely to sue an empathetic doctor when things go wrong.
Yet I’m inclined to side with Smajdor and colleagues at the University of East Anglia, who contend that such interactions with patients are not instances of deep emotional identification, but good old fashioned politeness. The authors explain, among other things, that empathy is poorly defined. They prefer teachable etiquette to impractical empathy.
For example, “Mrs X is annoyed that she’s been waiting 45 minutes for her appointment. When you call her in, she is plainly irritated, and this starts the consultation off badly.” The empathetic approach asks us to enter into Mrs X’s subjective experiences, desires, and values—to feel that we are Mrs X. The etiquette approach, on the other hand, tells us to make eye contact with Mrs X and to listen to her when she speaks—to be courteous.
Etiquette training differs from empathy training because the latter has been politicised. The truth is that we are late for Mrs X’s appointment not because we disrespect her, but because our clinic is short staffed due to budget cuts. After the tragic findings of the Mid Staffordshire NHS Foundation Trust public inquiry, politicians and the medical establishment have determined that clinical training is at fault. But the conclusion that a “lack of empathy” permitted patients to be left covered in their own faeces, among other indignities, is, quite frankly, a crock. The NHS needs more money and staff, and increasing empathy training is unlikely to improve outcomes. At its worst, it will detract from training in the various clinical skills in which we need to be competent.
Since we’re not likely to see an injection of cash or extra staffing any time soon, we should make better use of the resources at hand. Instead of offering vague courses in empathy training, we should focus on a clear set of generalisable rules for courteous behaviour shared across doctors and patients. This would free up time for more practical, skills based training. I could properly learn cardiopulmonary resuscitation, and my colleague could learn to draw blood. The best we can do for our patients is to show them the courtesy of advocating for our own competence.Joseph O’Keeffe, second year graduate medical student
1University of Leicester, UK
Correspondence to: firstname.lastname@example.org
Competing interests: None declared.
Provenance and peer review: Commissioned; not externally peer reviewed.
Follow Joseph on Twitter @JOCaoihm
- General Medical Council. Tomorrow’s doctors. 2009. www.gmc-uk.org/static/documents/content/Tomorrows_Doctors_1214.pdf.
- Spiro HM. Empathy and the practice of medicine. Yale University Press, 1993.
- Weir JM. From Hippocrates to the Francis Report—reflections on empathy. Ulster Med J 2015;84:8-12.
- Smajdor A. The limits of empathy: problems in medical education and practice. J Med Ethics 2011;37:380e383.
Cite this as: Student BMJ 2015;23:h3892