Intended for healthcare professionals

Observations Ethics Man

How to be a cool headed clinician

BMJ 2012; 344 doi: (Published 08 June 2012) Cite this as: BMJ 2012;344:e3980

Re: How to be a cool headed clinician

Some clinicians, as Sokol says, associate ethicists with bleeding hearts and sentimentality, but what William Osler said in the 19th century about imperturbability stands next to a passage in Abraham Verghese’s recent novel, Cutting for Stone. In it, Thomas Stone, head of surgery, asks his students, “What treatment in an emergency is administered by ear.” Only one knows the answer, “Words of comfort.”

Imperturbability is a quality, Sokol says, that can be developed. That may well be true, though probably some people have a head start over others. I think that empathy is much more difficult to teach and acquire.

There is plenty of evidence suggesting that as a GP you are less effective without empathy. There is a time and a place for imperturbability, but when a patient has just been told their son has been killed in a car crash detached calm isn’t much good to them. They want to feel the empathy from their doctor. That doesn’t mean crying in front of them: it means using a blend of non-verbal and verbal communication to make them feel understood.

In combat or in the middle of a difficult operation, empathy has no place because the action of the hero or surgeon is paramount, but there are few situations like that in general practice. A GP without empathy will struggle massively to find meaning in his job and life in relation to not only his patients but also his colleagues and his family.

Sokol’s article reminds me of the ’theory’, taught to medical students, of how to break bad news. These students are encouraged to follow guidelines when breaking bad news, such as finding a quiet environment for it and making sure the person has relatives with them. But the theory marginalizes all the emotion the doctor has to deal with. In reality, there is no substitute for actually breaking the bad news: it has to be done. If one is cool and detached that is fine when giving the news, but the doctor who can be empathetic as well is much better equipped to deal with the emotional fallout afterwards for the patients ¬– and for the doctor.

Saying to a patient ‘I understand’ and opening oneself to the richness of an emotional life does not mean you are a quivering wreck, but that you bring to your practice a holistic approach. Empathy from GPs makes perfect sense and is greatly valued in our ‘imperturbable ‘society.

Competing interests: No competing interests

25 June 2012
Anne Hawkridge
Bolton PCT
Stonehill Medical Centre