Normally, we’d like to think of empathy as an unquestionably good quality. Understanding the why and how of another person’s emotional experience resolves conflict, supposedly moves us away from tribalistic thinking and helps us see each other as human beings. But empathy does not always have these same benefits in a medical context. Clinical empathy, one of the most popular models of empathy adopted by medical schools today, is defined as a tool that has the potential to help doctors harness their own emotions and navigate a patient’s emotions with precision and speed so the work of extracting information for diagnosis becomes more efficient. However, this definition is insufficient for care providers and potentially harmful to patients. Clinical empathy reflects an able-minded assumption that spontaneous emotions disable the rational mind and relies on an unwarranted interpretation of physicians as care workers, meaning their work primarily focuses on ensuring the well-being of a vulnerable person.
In an influential article published in the Journal of General Internal Medicine, medical educator Jodi Halpern argues that clinical empathy enables doctors to strategically regulate their emotions according to their patients’ reactions, and doctors could productively benefit from following the path of when and where a patient’s emotions are most intense, interpreting them as landmarks for how to shape the patient’s diagnosis. She argues clinical empathy is preferable to approaching patients as an emotionally detached observer, not necessarily because it legitimates the lived experience of the patient, but because it enhances the physician’s own rational abilities.
Clinical empathy is problematic because its value is drawn from how it can be used to facilitate the doctor’s rational work when hard logic and intellect fail. While intelligence and craft are celebrated in their own rite in the medical field, empathy must earn its value depending on how well it is utilized to produce knowledge.
Clinical empathy is useful for physicians because it increases the patient’s trust in the doctor, making the patient more comfortable with sharing vulnerable information. But trust gained through clinical empathy is not sustainable when doctors are treating patients who depend on long-term health care services. We can theoretically explore this dilemma by observing care ethicist Eva Feder Kittay’s paradigm of dependency work in her book “Love’s Labor.” Here, Kittay describes how properly executed dependency work is embodied by “care, connection, and concern.” Clinically empathetic doctors do not meet these criteria because their empathy is not genuine. While clinically empathetic doctors care for patients by applying their medical knowledge and connecting with them to create trust, these doctors are actively discouraged from having concern for their patients. Thus, clinically empathetic doctors are not completing sufficient dependency work, per Kittay’s definition.
However, because Halpern excludes concern from her definition of clinical empathy, it is irresponsible to assume that clinically empathetic doctors prioritize the needs of the patient when they make medical diagnoses. As a result, the trust that clinical empathy builds in patients is an artificial and conditional one based on an illusion of true dependency work. Unlike the fast-paced and brief hospital visits that clinical empathy operates best in, many people find themselves terminally dependent on health care institutions due to an “abnormal” condition medicine could not anticipate or alter.
In his column “A Neurologist’s Notebook” for The New Yorker, Oliver Sacks voices his concern at how ill-prepared he was for the work of a physician because medicine did not expose him to knowledge of what is emotionally significant. To fill this knowledge gap, medical students should look beyond medicine to other fields to better understand the diversity of human experience. True care work cannot be taught under the productivity-based framework of professional medicine, especially as long as it operates under the business model of health care. Instead, to appropriately balance our mechanical understanding of a standard body, disability studies is one such humanities field that intrinsically values the study of the body and the human experience. This field offers students the opportunity to create and enjoy dialogues of care empowered by true empathy, in all its unrestricted freedom and spontaneity.
Esther Kang is a freshman in the College. Reconstructing Disability appears online every other Thursday.
