This author believes that empathy and sympathy may not—or should not—be mutually exclusive; they may coexist in the minds of discerning surgeons/physicians. Surgeons are generally capable of recognizing, in the abstract, empathy and sympathy, accepting both emotions, while internalizing sympathy and externalizing empathy to properly recommend courses of therapy that are clearly in the best interests of the patient.
Explore this issue:January 2017
How would this conjoint perspective of empathy and sympathy play out in a clinical scenario? Take, for instance, a situation in which a child has been born with a cleft lip and a cleft palate. As we know from experience, parents may have some internal guilt about the deformity—“What could I have done or not done to prevent this?” We also know how difficult a course the child might have in the years ahead, dealing with speech difficulties, some facial abnormalities until the best result is achieved, and the possibility of unwanted and undeserved negative attention from peers.
For this anguish, real or possible, we are sympathetic. We feel very sorry for the child and the family, knowing they may have to experience such difficulties before things are better. The surgeon should not feel guilty about being sympathetic. At the same time, the action side of this dyad—empathy—informs the surgeon/physician about the patient’s and the family’s capabilities to cope, using their faith, family, or other support systems to contribute in a positive manner in the approach to care, and helps us make recommendations for therapy that utilize our awareness of their social and emotional strengths to maximize the best possible outcome from surgery. In other words, we try to understand the complexities of their circumstances to gain knowledge on how best to help them. To restate, empathy and sympathy need not be mutually exclusive, as long as the physician recognizes them for what they are.
Now, to apply our understanding of the patient and family to the perioperative period, we start with the basic recognition that patients are often at their most vulnerable as they face a surgical procedure. They are likely tired after not having slept well the previous night, are hungry, and are worrying about potential outcomes ranging from pain to death. What patients need at this time is a reassuring, compassionate, caring physician, one who will convey that concern and reassurance by taking the time to speak with them in an unrushed manner before surgery, asking how they are doing, making eye contact, smiling and putting them at ease—in other words, exhibiting the kind of bedside manner each of us would appreciate in similar circumstances. When a surgeon becomes a surgical patient, and has that experience to draw upon later, the notion of empathy and the importance of bedside manner become very real, indeed.
Two issues related to bedside medicine in the perioperative period often are raised in bioethical discussions: Should the surgeon lay hands upon the patient, and should the surgeon pray with the patient? Regarding the former question, this author believes that patients usually welcome a friendly pat on the shoulder or a hand holding theirs as deemed appropriate at the time, particularly at these vulnerable moments. The patient would also like to see the surgeon waiting to welcome her into the operating suite. Reassurance all along the way, through presence, kind words, and a pat on the shoulder, is part of the “art of medicine,” and surely is also a part of the “art of surgery.”