Tuesday, December 3, 2013

The Med Ed Process Between Sympathy and Empathy

Dangerous words, empathy and compassion.

In the commmunity, compassion would be to ease the pain of an arthritic patient and make life easier for them. The compassion of a doctor is to kick their butts, not accept excuses and get them remobilised to live a longer and more fulfilling life. Societal compassion would put them in a wheelchair.

Empathy understands why an obese patient is obese in theoretical terms, learning attitudes, tastes, lack of exercise and stress coping strategies in childhood and proactively combating them for the sake of the patient’s health. Sympathy would be to accept those excuses, how the patient feels and how hard it is. The belief that the obese should love their body and love themselves as a right is sympathy when reality is that they obviously do not. They do not care for themselves.

A sympathetic medical student will already be offended by that last statement. They will easily get trapped in dependent relationships with patients with a transference of power from the patient. The patient is disempowered. The sick role is encouraged.

Sympathy is to share another’s emotions and be pulled into their point of view in order to be popular. Empathy is to maintain an emotional distance and effectiveness for the sake of the patient’s health. And empathy requires knowledge and experience, a knowledge of the world and experience of what patients are going through with their condition and life. It requires fundamental knowledge of how the mind works, basic psychology.

This is the difference between passive aggressive codependency and assertive relationships. The passive aggressive do not see it because they are blind to the morality of assertivity, objectivity and hard outcomes. And they use the word 'empathy' to describe themselves knowing that it is what they should be. They know they should not be blindly sympathetic. That is a bad word.

Their statement is hollow. They just call sympathy empathy. It does not make them empathic. It just stops them from trying or internally needing to change.

And here is the rub. Sympathy does not lead to empathy. They are opposites. Clinging to sympathy prevents the development of empathy. Paradoxically, the path to empathy is to become first the cold, uncaring scientist and academic in order to erase sympathy and learn a culture of objectivity and live it fully to indoctrinate the subconscious mind. That then forms the basis for the knowledge and experience to change to empathy.

Medical education is a cultural process and much as we would all love to believe that there are short cuts, they do not work. In terms of psychological development, medical school is accelerated aging through the life stages to reach the mental age of the wise traditional matriarch or patriarch stereotype who is assured and confidence enough to be objective and solve problems rather than pander to popularity and blame others. At least two life stages, total reversals of character take place in that process, similar to the reversal between baby and child or child and adolescent. It is the depth of change that new parents often describe.

If you believe that who were are now defines us and that it is an inalienable right to stay as we are, you are wrong. Who you are now is only a lifestage. Personal development is maturing through these lifestages to become a better person on the scale between egoism and selfless altruism.

These are complete changes in personality, worldview and morality. The med student usually arrives sympathetic with the common societal values of a passive aggressive worldview and mindset. They change to cold and academic, rigid assertivity. Then they become empathic. They learn Flexible Assertivity and finally Effective Assertivity. They have become a great doctor.

These are the major internal changes that prepare the doctor for the stress of their future and to carry such great responsibility. It is sympathy that makes the new doctor powerless, lacking in confidence and overwhelmed because they are subjected to a constant tug of war with the patient’s emotions.

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