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March 15, 2017

Does empathy have a future in medicine?

By Tyler Brobst

by Andrew M. Harrison

Does the patient with 11 out of 10 pain deserve empathy? The most contrite answer is probably "every patient deserves empathy". However, the first time I was faced with a patient in 20 out of 10 pain, I found my empathy waning as I typed "no acute distress". As an aside, I have long wondered what this term means. I type it so much. I suspect this phrase lingers because it reduces the internal angst of clinicians, but perhaps they simply have more empathy than me.

On January 18, 2017, I attended Mayo Clinic's 5th Annual Education and Technology Forum: Discover how to improve your teaching through learning analytics. Held across all 3 of Mayo Clinic's campuses, I found myself uneasy after this 3.5 hour session, as I wandered the desert of Phoenix. Eventually the source occurred to me. Perhaps I missed it during my many trips to the bathroom. Perhaps I missed it as my attention waxed and waned, but I never heard the word empathy spoken.

From the broadcast to Mayo Clinic's Arizona campus, Drs. Nirusha Lachman and Wojciech Pawlina speak at the 5th Annual Education and Technology Forum

One of my doctoral dissertation mentors, Vitaly Herasevich, MD, PhD, spoke of Challenges, Opportunities, and Implications of Learning Analytics. He cautioned technology is not the solution to all the aliments of our advanced and modern society. The next speaker, Martin Pusic, MD, spoke of Matching Your Challenges to Data. He challenged this assertion. If the data exists, why should we not collect it? Although this deep question, which exists at the core of the philosophy of science, is too complex for me to explore much here, the answer includes at least some discussion of empathy, especially in the context of medicine.

The conclusion of my doctoral dissertation experience came with a variety of labels, such as biomedical sciences, clinical research, and/or clinical informatics. I am once again uncertain precisely what all of these fancy terms mean, but I did spend some time with intensivists, wandering around ICUs, and exploring the workflow of critical care. Even though I spent most of this time building some sort of automated detection and alert system, I found myself less impressed with the technology (ECMO, CRRT, MARS, etc) and more intrigued with the intense emotions surrounding the dying process.

My physician-mentor for the past 7 years, David R. Farley, MD, helped me arrange a meeting with Dr. Pusic in March of 2016, when he visited the Minnesota cornfield-tundra to speak at Mayo Clinic's Education Grand Rounds: "Systematic Practice Makes Perfect: Better Ways to Climb the Learning Curve". We spoke some of the striking absence of trainees from the discussion of education. Hopefully not a shocking aside, I have discussed this matter with Dr. Farley as well, the host of the recent Forum and one of my personal models of empathy.

Twitter: a language beyond the comprehension of my simple mind

At the cost of great angst, I was forced to learn how to use Twitter at this Forum, to ask when the 110 year/2020 update to the Flexner Report is coming. (I do not have Facebook and disdain owning a smartphone.) Written at a time when the internet, computer, antibiotics, and much of modern anesthesia did not yet exist, the Flexner Report also does not reference empathy, or compassion, in 350+ pages. A century later, I ultimately wonder if the fate of medical education—and thus medicine proper—will include deep discussion of the role of empathy, in the context of new technology and personalized/precision medicine, or merely how to increase standardized testing lockdown, in an era when all physicians carry Wikipedia in their pockets.

Note: Each author at Mayo Clinic, from the academic publications I reference above, has taught me empathy in some way. I feel compelled to cite PubMed only, as evidence-based medicine informs me almost all other potential sources of medical knowledge are dubious:

Andrew M. Harrison is a student in the Medical Scientist Training Program at Mayo Clinic, the current Policy Chair of the American Physician Scientists Association, and one of the co-managers of Mayo Clinic’s Diversity in Education Blog.

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