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From Detached Concern to Empathy: Humanizing Medical Practice

BMJ 2001; 323 doi: (Published 08 December 2001) Cite this as: BMJ 2001;323:1373
  1. Philip Berry, medical registrar
  1. London

    Jodi Halpern

    Oxford University Press, £29.50, pp 165

    ISBN 0 19 511119 2

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    Like all good inventions, Jodi Halpern's new and “controversial” model of empathy appears to be the result of common sense imaginatively applied. Empathy should, she asserts, result from a willingness on the part of the doctor to take cues from his own emotional responses to a patient's suffering. It requires more than the “detached concern” that she believes, a little harshly I think, is the norm. Nor is an insufficiently intellectual “sympathetic immersion” in a patient's woes enough. Through an awareness of the feelings that are induced within us we will succeed in communicating our interested concern, thereby encouraging the patient to reveal elements of her history that would otherwise remain hidden. Having become aware of her own emotional state, as reflected by the doctor, she will be stimulated to form new goals, dealing more rationally with the diagnosis or the disability that misfortune has delivered to her. Thus empathy becomes a therapeutic tool, easing the patient from what has frequently become a pessimistically “concretized” outlook on life. The patient rediscovers her autonomy.

    One gets the sense that the author has worked backwards, seeking to “prove” what she knows and feels is right by invoking and examining the work of a long line of philosophers and medical writers. She studied philosophy before qualifying in psychiatry, and is well versed in the works of Descartes, Kant, Heidegger, Freud, and Stein, to name a few. As the foundations of the central thesis are put into place the reader finds himself wandering through an intensely philosophical and metaphysical building site.

    The author hopes that her “road-map” to empathy will be used. If it appears impractical she risks the accusation of creating an impossible ideal within a book lined ivory tower. She asks that doctors allow their patients to “move them emotionally.” “Curiosity” about the emotional states and the personal histories of those patients is a prerequisite.

    Is this really feasible, for the younger, developing doctors at whom this book is aimed? It is difficult to square the delicacy of these interactions with the waves of resentment that trouble the house officer called to an ailing patient at the end of a 30 hour day, or the irritation felt by a registrar as she observes a litigiously inclined relative copy her every word into a notebook. This model of empathy depends on time, and on a limitless store of altruism; these obstructions to empathy are explored too swiftly.

    I would recommend this book not as a manual, but as a vital reminder of how things should be, and as an insightful and philosophically educational analysis of how things probably are for the luckiest patients in our practices and hospitals.

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