I once shadowed a surgeon who made a habit of patting his patients on the shoulder. He informed me that studies suggested malpractice rates were lower for proceduralists who engaged in nonverbal communication. I couldn’t help but reflect on how he would have acted if not for the statistic.
Every so often I wonder if I will become like him. Will I catch myself in the mirror furrowing my brows to feign concern? Will I lose myself going through the motions? Worse yet, will medical school become a finishing school of sorts for me, diluting my human connection and transfusing clinical distance in its place?
Once accepted to medical school, students are given a script. We rehearse our lines until the words become but a string of syllables. I’m-sorry-for-your-loss comes as automatically as Do-you-have-any-allergies? Empathy is not a quality so much as a criterion. Check the box and move on.
Professional schools across the country are teaching patient communication by adding improvisational theater to the curriculum. Subpar bedside manner? Take a course. The sequencing of this instruction seems funny to me. “You’re going to be a doctor, so we have to make sure you’re a human!” The operating theater is not a stage. Does wearing a surgical mask mean you have to get into character?
I fear that assessment and instruction on bedside manner may dissociate the people skills from the person. Bedside manner should be streetside manner and couchside manner and barside manner and grocery storeside manner without geographic dependence. Though I’ve learned a lot in medical school, I would still like to hold on to the hope that I am more than what I have been taught. I would like to imagine that I would have furrowed my brow and held your hand subconsciously. I would like to think that the words “I’m sorry” would be unscripted.
I’m proud to say that most of my classmates do not need lessons in empathy. Empathy often comes coupled with tragedy, or rather, tragedy comes bearing empathy in tow. Despite seatbelts and vaccines and surgeries, tragedy is not something we can avoid. My peers learned their empathy from summers spent caddying at golf courses for the middle-aged man who lost his swinging arm, or growing up with the little sister with the blue eyes who did not wake up one day. The reality is that, for those who would need an empathy lesson, just a lesson would not be enough.
For several weeks during my first year of medical school, I watched an otolaryngologist see the same young woman after his Friday evening clinic was over. She had lost over 80% of hearing in one ear, and he was giving her steroid injections. One day, she asked why he was going out of his way to restore her hearing.
“I lost hearing in my ear suddenly when I was your age. I never fully recovered.”
This is empathy, honed and chiseled only by human connection.
Sometimes people skills are learned when we aren’t talking. When my middle-school singing lessons evolved into a postgraduate job as a funeral soloist, I found myself tethered to people I was seeing for the first time. All of a sudden, the church would feel empty except for me and the widower or the son of the police officer or the parents whose child had overdosed. I felt as though every word I sang was in answer to the pleading question, “Tell me where it hurts.” I’ve never felt more like a doctor than when I was singing at funerals. The principle is the same, isn’t it? Our role is to heal. I don’t think anyone could teach me how to react. All I know is that I found myself crying over eulogies for people I had never met.
I used to think empathy was fluffy and medicine was accurate and precise, but perhaps the opposite is true. Medicine can be unwieldy: The test is 99% accurate, and the complications of surgery are very rare, and the protection usually lasts, and the clinical trials have been said to succeed. I pray I will not succumb to the script: I’m-sorry-for-your-loss, but I thought I asked do-you-have-any-allergies? And the-complications-from-surgery-were-very-rare. I hope that if you have empathy, you will carry it with you from the bedside to the bar to the church to the grocery store to the waiting room. I hope that my humanity will remain when I am tired and don’t remember the words I am supposed to say.
And, if nothing else, I hope that I will always find myself wordlessly seeking an answer to the question, “Tell me where it hurts.”
2020 Hope Babette Tang Humanism in Healthcare Essay Contest
The Arnold P. Gold Foundation holds an annual essay contest to encourage medical and nursing students to reflect on their experiences and engage in narrative writing. The contest began in 1999 focused on medical students and expanded to include nursing students in 2018. Students are asked to respond to a specific prompt in a 1,000-word essay.
For the 2020 contest, students were asked to use the following quote as inspiration to reflect on when they’ve experienced or observed, as an individual or as a team (doctors, nurses, therapists, etc.), the impact of human connection:
“Medicine cannot heal in a vacuum. It requires connection.” —In Shock, by Dr. Rana Awdish
More than 200 essays were submitted. A distinguished panel of judges, ranging from esteemed medical professionals to notable authors, reviewed the submissions. Three winning essays from medical students and three winning essays from nursing students were selected, along with 10 honorable mentions. The winning essays will be published in consecutive issues of Academic Medicine and the Journal of Professional Nursing in the fall/winter of 2020.
The contest is named for Hope Babette Tang-Goodwin, MD, who was an assistant professor of pediatrics. Her approach to medicine combined a boundless enthusiasm for her work, intellectual rigor, and deep compassion for her patients. She was an exemplar of humanism in medicine.
The Arnold P. Gold Foundation infuses the human connection into health care. The nonprofit organization engages schools, health systems, companies, and individual clinicians in the joy and meaning of humanistic health care, so that they have the strength and knowledge to ensure patients and families are partners in collaborative, compassionate, and scientifically excellent care.