Competence is more important than empathy

[Crayola227]

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It doesn't take being an attending to see the flaws in your logic. There are plenty of people here on both sides of the argument. I hate it when people throw out their titles to win arguments. Yea, you've been practicing but that doesn't mean your logic is all there. Your arguments should stand on their own.

I don't see any reason to act like the experience that one has from practice doesn't make a difference to the argument and isn't reflected here.

 

[Lnsean]

So then explain to me how "competency" matters more than empathy when we have evidence that a lack of empathy leads to less patient adherence and more lawsuits.

I just don't get how people can argue that having this "brilliant" ability to come up with an A/P (and more than one doc here has said that frequently it's less difficult/original than you think) matters so much in a context where the patient never consents to it or adheres to it.

I think you've confused empathy with just good customer service all this time or good communication skills. These are different.

 

[VA Hopeful Dr]

But is that empathy though? Or is it just good customer service. just saying...

They are separate, I think. You can provide great customer service but patient's can tell if you don't really care about them.

 

[Crayola227]

I think you've confused empathy with just good customer service all this time or good communication skills. These are different.

I made it quite clear that there were measures affected by empathy specifically.

What is Clinical Empathy?

This article more importantly cites other studies that relate specifically to empathy and how that affects care and outcomes.

 

[Crayola227]

It was like the first one I grabbed - there's better articles and studies to make the point about specifically empathy and patient outcomes. One of these days I'll create a compendium of them just for these sort of chats.

It's all the more interesting when you consider mirror neurons and what we're leaning there - that's where to some extent you can't *fake* feeling for your patients. There are totally evolved systems of feeling and thought that we can use in improving outcomes for patients.

 

[Lnsean]

I made it quite clear that there were measures affected by empathy specifically.

What is Clinical Empathy?

This article more importantly cites other studies that relate specifically to empathy and how that affects care and outcomes.

This says nothing about empathy being more important that competence. I would even go more to say that those studies would be waytoo subjective and if you read the concusions...it's even funnier. Actually, I wouldn't even call the one you linked a study even. More like a narrative of what the author felt like at that moment. Nice try though.

 

[Crayola227]

I didn't know that not being a serial killer is what qualifies as empathetic now. I think your definition has changed alot since the debate began. I don't know what your position is anymore. Yea, being able to talk to the patient is part of being competent.

I suggest you read the article I attached for a discussion of how empathy relates to improved communication, since you don't see to see the connection.

I was making a facetious example that just because something is a requisite part of a job, such as not being a serial killer and making correct dx and tx, DOES NOT overshadow the importance of other skills, such as empathy. Why are we focusing on the skills that are quite literally a given should you get to attending-hood, are fairly easy to teach and measure, while looking to pooh-pooh other skills that while difficult to measure and therefore enforce as requisite, yet we know matter greatly?

I'm taking it as a given that fully trained board certified doctors aren't murderers and are clinically competent. Is that MORE important than empathy and other skills to being a good doctor?

And my point is no, it is not *more* important. If I seem somewhat dismissive about not being a serial killer - well, most people aren't and don't find that particularly difficult. Regarding correct dx & tx - I think our current system addresses that, and most by attending-hood feel comfortable with their clinical decision-making.

Yes, I absolutely applaud students on their journey to master as much as anyone can, medical knowledge for tx and dx. I would urge them however, not to let that make them lose sight of the human side of medicine.

What a patient sees in your eyes when you look at them, can make or break your encounter. Best to groom a sense of unconditional positive regard and empathy.

Definition of empathy for English Language Learners
: the feeling that you understand and share another person's experiences and emotions : the ability to share someone else's feelings

 

[Crayola227]

This says nothing about empathy being more important that competence. I would even go more to say that those studies would be waytoo subjective and if you read the concusions...it's even funnier. Actually, I wouldn't even call the one you linked a study even. More like a narrative of what the author felt like at that moment. Nice try though.

I specifically said I thought it was more useful if you look at the citations used - that is one method of finding studies, you know.

Why don't you find for us some evidence that empathy is not essential to good doctoring.

 

[Lnsean]

I specifically said I thought it was more useful if you look at the citations used - that is one method of finding studies, you know.

Why don't you find for us some evidence that empathy is not essential to good doctoring.

Yea...I would never claim that. Competence is definitely more important. You're claiming empathy is more important but you're not citing studies either. Seems like moot point to me.

 

[Crayola227]

You're so right, the most important thing a doctor can do is that which is considered the absolute minimum requirement to even be a doctor, which is clinical competency.

Why focus on what can be the delineating factor between a competent doc and a more highly efficacious one?

 

[Lnsean]

You're so right, the most important thing a doctor can do is that which is considered the absolute minimum requirement to even be a doctor, which is clinical competency.

Why focus on what can be the delineating factor between a competent doc and a more highly efficacious one?

Nah, I was expecting something concrete from someone who seems to have such a strong position on this. It seems like the walls of text just boils down to your words against mine in a sense. Just saying...there's nothing you've shown that is supportive of what you're saying or even relevant to the debate that OP started. Yea, I can agree that empathy is good to have, but competence is more important.

 

[Crayola227]

Yea...I would never claim that. Competence is definitely more important. You're claiming empathy is more important but you're not citing studies either. Seems like moot point to me.

I just explained why competence is not more important. Because it's a given. If you are not competent you will not be licensed and boarded as a general rule.

The issue is not creating competent doctors as we have discussed. Med schools and beyond are focusing on things like empathy because among a group of all-competent docs, it can vary greatly and have a big impact on outcomes.

It only stands to reason in my mind to address that which needs addressing because it makes a difference. Medical education churns out doctors that are just dandy at dx and tx. However, it would seem there is room for improvement in other measures.

 

[Lnsean]

I just explained why competence is not more important. Because it's a given. If you are not competent you will not be licensed and boarded as a general rule.

The issue is not creating competent doctors as we have discussed. Med schools and beyond are focusing on things like empathy because among a group of all-competent docs, it can vary greatly and have a big impact on outcomes.

It only stands to reason in my mind to address that which needs addressing because it makes a difference. Medical education churns out doctors that are just dandy at dx and tx. However, it would seem there is room for improvement in other measures.

Again, this is all just what you feel. I feel differently. There are varying degrees of competence. If you are looking for a plastic surgeon or someone to do surgery on your shoulder, competence is very important. Arriving at an accurate diagnosis in IM also allows for better outcomes and I feel that is highly competence dependent. What you are doing is comparing minimal competency to varying spectrums of empathy. Competency has a wide spectrum as well, and it matters...much more so than empathy.

 

[VA Hopeful Dr]

Again, this is all just what you feel. I feel differently. There are varying degrees of competence. If you are looking for a plastic surgeon or someone to do surgery on your shoulder, competence is very important. Arriving at an accurate diagnosis in IM also allows for better outcomes and I feel that is highly competence dependent. What you are doing is comparing minimal competency to varying spectrums of empathy. Competency has a wide spectrum as well, and it matters...much more so than empathy.

And we're arguing that the vast majority of board certified/licensed physician are competent. That's a given 99% of the time.

Since we assume that basically all physicians are competent, then compassion/empathy becomes a big factor.

 

[Lnsean]

And we're arguing that the vast majority of board certified/licensed physician are competent. That's a given 99% of the time.

Since we assume that basically all physicians are competent, then compassion/empathy becomes a big factor.

So all doctors are equal then? Don't think so. Competence is a wide spectrum and a bad doctor can miss diagnoses more often that a highly competent one. That is what we're saying.

 

[Crayola227]

Yes, well, ultimately I reject the notion that there is a "more" in this equation of competence vs empathy.

My medical school took the stance, and I take it as well, that there are MANY skills that are NECESSARY in the making of a competent physician, let alone a great one. Also that the quest for improvement never ends. So assuming you have clinical competence, then one absolutely should seek to improve all their professional skills - from punctuality, to demonstrating empathy, to how cordial you are to your MA.

I understand why people at a certain phase of their training/career may focus more on one skill vs another, such as Step 1. However, I would advise against an all or nothing approach and being too narrow, as much as one might say you shouldn't overextend yourself by looking to master too much all at once.

Also, I think I am championing this notion because I think it's all too tempting to try to boil it all down to the hugely overwhelming task of mastering knowledge, and we also know that measures of trainee empathy go down over time, while the the mastery of knowledge goes up. So that should be addressed since we know it matters as well.

 

[VA Hopeful Dr]

So all doctors are equal then? Don't think so. Competence is a wide spectrum and a bad doctor can miss diagnoses more often that a highly competent one. That is what we're saying.

Not equal but equal enough such that outcomes aren't all that different.

If I'm wrong, prove it.

 

[Lnsean]

Not equal but equal enough such that outcomes aren't all that different.

If I'm wrong, prove it.

Nah, if I'm wrong, you prove it.

 

[Crayola227]

I used to help my dad in construction. Is a floor "more important" than the walls? The floor goes down first, and the walls won't go up right if the floor they're on is built like crap. But a well built floor is pretty pointless on its own without good walls and then a roof.

If competence matters almost not at all without good people skills, than why does it stand to reason that it's more important?

I would argue instead that each alone is sorta pointless, and one's goal should be to excel in both (clinical decision making and "soft skills" such as demonstrating empathy well.)

I also reject the notion that one should not be learning to use those skills right alongside other skills necessary to a good patient encounter.

 

[Lnsean]

I used to help my dad in construction. Is a floor "more important" than the walls? The floor goes down first, and the walls won't go up right if the floor they're on is built like crap. But a well built floor is pretty pointless on its own without good walls and then a roof.

If competence matters almost not at all without good people skills, than why does it stand to reason that it's more important?

I would argue instead that each alone is sorta pointless, and one's goal should be to excel in both (clinical decision making and "soft skills" such as demonstrating empathy well.)

I also reject the notion that one should not be learning to use those skills right alongside other skills necessary to a good patient encounter.

That's not what we're saying though. When it comes to life and death and how fast you can get to an accurate diagnosis, the level of competence matters a lot. A minimally competent doctor missing a crucial diagnosis can cost someone their life.

 

[Goro]

Empathy and competence are far from mutually exclusive. If anything, the finest surgeons I've worked with are also some of the most empathetic, especially those who are truly world class and have patients flying in from all over. Here's a key point: brilliance and competence are the gifts that allow someone the luxury of time for empathy and rapport. I've definitely noticed a trend where the less empathetic docs are generally less competent as well, much like the truly gifted superstar med students also tend to be the kindest most well rounded because they have that luxury.

What OP is describing is a very real aspect of clinical growth - the need to balance rapport and empathy with efficiency. The answer is not to be a douche and blaze through your clinics or else you will quickly see your referrals dry up and satisfaction scores drop. Of course, if you're a super sweet empathetic person but your clinic runs hours behind, you may find a different set of problems! It's all about finding a balance and this really gets at the heart of the "art" of practicing medicine.

One of our attendings is arguably the best example of this I've ever seen. His clinics typically have 50-60 patients per day, always run on time, and he has all his notes done within an hour of the last patient leaving. His patients adore him and laud his bedside manner and personality and he always devotes some time to building rapport and getting to know people on a personal level. Even with resident help, this is a very high volume clinic when you consider that many of these patients get procedures or require some extensive pre-surgical counseling.

So I've made a point to take notes on how her functions because ideally I'd like to emulate that kind of efficiency and empathy when I'm done with training. First, he doesn't typically ask a totally open ended question to begin with, usually alluding to the reason for their referral or their prior surgery or whatever their chronic issue is. He selectively uses open ended questions to elicit key points that really hinge on how a patient describes something, but is quick to focus them in on the key points of information he needs. You can do this politely and patients don't seem to mind since they don't usually want to spend their whole day in the office either. He'll do ROS and some chit chat during his physical exam and then delivers his A&P, answers questions, etc. Then he always ends the encounter by offering to walk the patients out -- I personally and have seen other docs lose time here when patients may want to chit chat, but the walking them out is a very kind and polite way to end the encounter and get them out the door. He then dictates his note immediately which takes him ~1 minute and he's on to the next one.

You'll find it gets much easier to be efficient as you get better at asking questions and knowing exactly what you need to ask for a given issue. Your exams will be faster because you're going for some very key things and either skipping or very quickly blazing through the rest. You'll get better at knowing which patients you have to be more terse with and which you can be more open and still get out the door reasonably fast.

As I'm typing this I remember a gyn attending who taught me more about efficiency in one morning than anything else in med school. I had to have one of those observed and graded encounters, and he did it this way. He told me to go into the room and that if I came out in less than 2 minutes, he'd mark it an honors, 2-3 minutes was a HP, 3-4 a P, and >5 was a fail. He told me the key points he wanted me to get and sent me in --> made it out with 10 seconds to spare and he was true to his word. Even with just 110 seconds, when I presented I realized I had obtained more than enough key information for the visit. This was eye opening to me and he continued to press me for more efficiency throughout the day, always demonstrating it himself as he kindly and personably knocked out visit after visit in just a few minutes, often ending visits with hugs from happy patients and families. Again: empathy and competence are intimately linked and not two disparate concepts that cannot coexist.

Can I hack into the SDN system so I can give this a thousand likes?

Tl/DR: empathy vs competence isn't an either/or thing.

 

[operaman]

Again, this is all just what you feel. I feel differently. There are varying degrees of competence. If you are looking for a plastic surgeon or someone to do surgery on your shoulder, competence is very important. Arriving at an accurate diagnosis in IM also allows for better outcomes and I feel that is highly competence dependent. What you are doing is comparing minimal competency to varying spectrums of empathy. Competency has a wide spectrum as well, and it matters...much more so than empathy.

What I think you may be missing is how ridiculously easy it is to make a diagnosis 99% of the time. Even for surgery, there are very few people who fail to graduate from surgical training programs and become decent surgeons. While you are right that there is a spectrum of technical ability, past a certain point it is largely irrelevant and for most people is a more a function of what they do most often rather than a marker of inherent ability.

You keep coming back to diagnostic ability but it just isn't all that difficult. I could walk down into our ED right now and talk to every random patient in there for <1 minute and get the diagnosis >90% of the time. Add in a bit more time (2-3 minutes) and some labs/imaging and that would push 99%. And there's nothing special about me - anyone else can do it too. It's such an easy part of the job and you'll find it gets increasingly easy for you too.

Where the challenge comes in is managing these conditions and that requires the soft skills. Any idiot can put an ear tube in a kid or shuck out some tonsils, but the challenge is building enough trust and rapport with a family that they allow you to take their child to surgery. They will never see you in the OR and will never know how you compare surgically, but they will know how you treat them and their child, how you respond to their concerns, how you treat them at follow up during a non-reimbursed visit. That's the stuff that gets back to referring docs and gets spread among their friends. Same goes for operating on adults too. For IM folks, diagnosing DM or HTN or CAD or CKD is not hard, but convincing people to make lifestyle changes and keep up with medication and screening that can spare them terrible consequences? Now that's a challenge.

I can understand how the competence and diagnostic abilities would seem the paragon of physicianship in the beginning, but with time that will shift and you will find other things rise to the surface as far more challenging.

 

[Tenk]

Nobody cares what you know until they know you care.

Both matter.

 

[Goro]

Look at the discussion taking place -
Med students that are trying to attain competency on exams and such, thinking that coming to the right diagnosis is most important.
Compared to docs who have passed their licensing exams, gotten licenses, passed residencies and boards, and are practicing. They are taking for granted getting the "right" answer, because the whole system has seen to it that we have that very teachable skill.
The shift in thinking becomes much more about how to interact with people. That's frequently where one doctor shines compared to the next.

I see a common mindset in the pre-med forum often and less so here, but it still pops up. That is, the notion is that being smar is all you need to be a good doctor. This is a mindset common with students whose end goal, it seems, is merely getting into med school, and not becoming a doctor. This was seen up over and over in the thread about "Would House get into medical school today?" not too long ago.

As Crayola and VA are pointing out, medical knowledge is but a single competency you have to master as both a med student and a resident:
ACGME Competencies
Note that five of the six are humanistic domains.

In particular, empathy IS a required skill set:
Patient Care

I'm not going to tread into Burnett's Law territory, but I do see some posters in this thread who I have no doubt would fat shame their obese patients.

Let's put it another way. We all want smart doctors. That's a given. But who would you want to tell you that your dad has terminal pancreatic cancer?

I would love to hear what SDN's three nicest people have say on this subject..calling:
@HomeSkool
@Doctor-S
@gyngyn
!!!

 

[Crayola227]

That's not what we're saying though. When it comes to life and death and how fast you can get to an accurate diagnosis, the level of competence matters a lot. A minimally competent doctor missing a crucial diagnosis can cost someone their life.

Again, and I don't mean to be a dick, but here is where I think understanding actual clinical practice matters.

In the most "high stakes" scenarios where acuity and ambiguity is high and time is low, reliance on algorithms is used to reduce error and improve outcomes.

This is true in most cases of true time-limited emergency. Ask any EM doc, trauma surgeon, intensivist, anesthesiologist. Of course, they are there to provide experience on when to amend or deviate from those guidelines because no algorithm can cover all scenarios.

In the scenarios you describe, it's really not about diagnosis, it's about response, and getting there isn't rocket science.

Honestly, the example of time matters emergencies is a poor one. That's not where correct dx and tx is at its most crucial.

ABCs.

 

[VA Hopeful Dr]

Nah, if I'm wrong, you prove it.

Easy, look at every nurse practitioner study ever. If a group with less than 1/4 of our training doesn't have a major difference in several outcomes, the much smaller variation in physician ability will have even less difference.

 

[VA Hopeful Dr]

What I think you may be missing is how ridiculously easy it is to make a diagnosis 99% of the time. Even for surgery, there are very few people who fail to graduate from surgical training programs and become decent surgeons. While you are right that there is a spectrum of technical ability, past a certain point it is largely irrelevant and for most people is a more a function of what they do most often rather than a marker of inherent ability.

You keep coming back to diagnostic ability but it just isn't all that difficult. I could walk down into our ED right now and talk to every random patient in there for <1 minute and get the diagnosis >90% of the time. Add in a bit more time (2-3 minutes) and some labs/imaging and that would push 99%. And there's nothing special about me - anyone else can do it too. It's such an easy part of the job and you'll find it gets increasingly easy for you too.

Where the challenge comes in is managing these conditions and that requires the soft skills. Any idiot can put an ear tube in a kid or shuck out some tonsils, but the challenge is building enough trust and rapport with a family that they allow you to take their child to surgery. They will never see you in the OR and will never know how you compare surgically, but they will know how you treat them and their child, how you respond to their concerns, how you treat them at follow up during a non-reimbursed visit. That's the stuff that gets back to referring docs and gets spread among their friends. Same goes for operating on adults too. For IM folks, diagnosing DM or HTN or CAD or CKD is not hard, but convincing people to make lifestyle changes and keep up with medication and screening that can spare them terrible consequences? Now that's a challenge.

I can understand how the competence and diagnostic abilities would seem the paragon of physicianship in the beginning, but with time that will shift and you will find other things rise to the surface as far more challenging.

On a similar, though much more negative vein...

We all have those doctors that we wouldn't want to take care of our families for various reasons. Yet their outcomes are going to be very similar (if not essentially indistinguishable) from the good doctors.

 

[Lnsean]

Again, and I don't mean to be a dick, but here is where I think understanding actual clinical practice matters.

In the most "high stakes" scenarios where acuity and ambiguity is high and time is low, reliance on algorithms is used to reduce error and improve outcomes.

This is true in most cases of true time-limited emergency. Ask any EM doc, trauma surgeon, intensivist, anesthesiologist. Of course, they are there to provide experience on when to amend or deviate from those guidelines because no algorithm can cover all scenarios.

In the scenarios you describe, it's really not about diagnosis, it's about response, and getting there isn't rocket science.

Honestly, the example of time matters emergencies is a poor one. That's not where correct dx and tx is at its most crucial.

ABCs.

We'll just have to disagree on this point.

 

[Lnsean]

Easy, look at every nurse practitioner study ever. If a group with less than 1/4 of our training doesn't have a major difference in several outcomes, the much smaller variation in physician ability will have even less difference.

What if these nurses are highly competent in primary care?

 

[VA Hopeful Dr]

What if these nurses are highly competent in primary care?

hahahahahaha

I've supervised many. They're not.

 

[Lnsean]

hahahahahaha

I've supervised many. They're not.

We'll just have to disagree on this issue.

 

[VA Hopeful Dr]

We'll just have to disagree on this issue.

Apparently. I mean, you do have intimate knowledge on this subject that almost a dozen physicians don't.

Logical fallacy? Perhaps. Doesn't mean its wrong.

 

[Crayola227]

We'll just have to disagree on this point.

What is there to disagree with? I don't think you really have an understanding of how true time limited emergencies are handled.

 

[Lnsean]

Apparently. I mean, you do have intimate knowledge on this subject that almost a dozen physicians don't.

Logical fallacy? Perhaps. Doesn't mean its wrong.

I feel competence is probably the most important aspect of medicine because you don't want to harm your patients because you don't know what you're doing. Some of the things you guys talked about are more like customer service and not empathy.

 

[Crayola227]

I remember what a senior told me an attending told them, as a way of reassuring me: codes aren't hard. I mean, the patient is already dead, so you can't really frak it up anymore than it already is. Joking aside, point was that's not the part where intervention makes the most difference. It's when a patient is decompensating that should make you nervous, and your response matters most, because the patient is still alive, they are circling the drain and haven't gone down it yet. It gets harder once they code.

Furthermore, in being taught codes, keep cool. As long as good compressions are going and they're getting bagged, you have the time to take a breath and consider the Hs and Ts - Wikipedia.

Codes are algorithmic, doing them isn't hard, and finding the reason for the code isn't either.

In any case, when you're handling the "circle the drain" part, that's also pretty straightforward.

It's everything before that point that's "hard," but you have time, training, (and before board certification supervision) to deal with it.

 

[Lnsean]

What is there to disagree with? I don't think you really have an understanding of how true time limited emergencies are handled.

Not even emergencies...just a missed diagnosis on something simple that could lead to other complications. Competence is much more important than empathy. The things you've talked about...being able to communicate with patients and such...that's all part of being a competent doctor. It's not empathy. So I really don't now what your position is anymore. I mean you said there are studies to show that empathy is more important but you have linked none. That's why i said we have to agree to disagree.

 

[W19]

I did that when I first got out of school. Cost me a job I really wanted.

This time it was "shape up or we're putting you on a remediation pathway".

So instead I turned in my notice and am on cruise control for the next 2 months.

Someone has to be a martyr for the profession.

I guess it will probably be me.

 

[Lnsean]

What I think you may be missing is how ridiculously easy it is to make a diagnosis 99% of the time. Even for surgery, there are very few people who fail to graduate from surgical training programs and become decent surgeons. While you are right that there is a spectrum of technical ability, past a certain point it is largely irrelevant and for most people is a more a function of what they do most often rather than a marker of inherent ability.

You keep coming back to diagnostic ability but it just isn't all that difficult. I could walk down into our ED right now and talk to every random patient in there for <1 minute and get the diagnosis >90% of the time. Add in a bit more time (2-3 minutes) and some labs/imaging and that would push 99%. And there's nothing special about me - anyone else can do it too. It's such an easy part of the job and you'll find it gets increasingly easy for you too.

Where the challenge comes in is managing these conditions and that requires the soft skills. Any idiot can put an ear tube in a kid or shuck out some tonsils, but the challenge is building enough trust and rapport with a family that they allow you to take their child to surgery. They will never see you in the OR and will never know how you compare surgically, but they will know how you treat them and their child, how you respond to their concerns, how you treat them at follow up during a non-reimbursed visit. That's the stuff that gets back to referring docs and gets spread among their friends. Same goes for operating on adults too. For IM folks, diagnosing DM or HTN or CAD or CKD is not hard, but convincing people to make lifestyle changes and keep up with medication and screening that can spare them terrible consequences? Now that's a challenge.

I can understand how the competence and diagnostic abilities would seem the paragon of physicianship in the beginning, but with time that will shift and you will find other things rise to the surface as far more challenging.

Yea, but what you talked about isn't empathy though. What you are describing is building a relationship with your patient and building rapport. These are not the same. I don't get what some of you guys are trying to say or argue. Building a relationship is part of any doctor/patient interaction.

 

[Crayola227]

Not even emergencies...just a missed diagnosis on something simple that could lead to other complications. Competence is much more important than empathy. The things you've talked about...being able to communicate with patients and such...that's all part of being a competent doctor. It's not empathy. So I really don't now what your position is anymore. I mean you said there are studies to show that empathy is more important but you have linked none. That's why i said we have to agree to disagree.

I do think the article I linked made a good point that empathy actually can serve as a key director for more effective communication that impacts diagnosis and treatment.

Much as you say that communication is part of competency, empathy is part of effective communication.

 

[Lnsean]

I do think the article I linked made a good point that empathy actually can serve as a key director for more effective communication that impacts diagnosis and treatment.

Much as you say that communication is part of competency, empathy is part of effective communication.

I mean everyone here is saying that communication skills are important and building rapport and a good relationship with your patient is important. No one is denying that...but this is not empathy. Like, should we define what empathy is? jfc.

Can't debate with someone that changes positions like that. Are you arguing for empathy or for communication skills?

 

[Crayola227]

FULL STOP -

Empathy is the ability to understand and share the feelings of another, and demonstrating that.

 

[Crayola227]

I mean everyone here is saying that communication skills are important and building rapport and a good relationship with your patient is important. No one is denying that...but this is not empathy. Like, should we define what empathy is? jfc.

Can't debate with someone that changes positions like that. Are you arguing for empathy or for communication skills?

lol, I was just writing my post

I already defined it

BTW, is your status accurate? Are you a pharmacist?

SDN provides the means to not pick a status if one does not wish to disclose or there is not an option that fits.

I'm just curious because aside from being about titles thrown around, on a site that is meant to educate students, being able to appraise the apparent source of information offered here is useful.

I'm finding some of your opinions, like how emergencies and communication should be handled, doesn't seem to reflect actual practice, and I'm sort of just wondering why that's the case.

 

[Lnsean]

FULL STOP -

Empathy is the ability to understand and share the feelings of another, and demonstrating that.

So it's part of a whole set of skills like professionalism, respect, and effective communication? I'd say then that empathy is just one of many factors.

 

[VA Hopeful Dr]

I feel competence is probably the most important aspect of medicine because you don't want to harm your patients because you don't know what you're doing. Some of the things you guys talked about are more like customer service and not empathy.

No one is saying otherwise.

You can be the smartest doctor alive right now, but if the patient doesn't trust you and doesn't follow your treatment plan, you're actually worse off than the random doc down the street who prescribes something that works half as well except the patient takes it.

Let's take something very simple: hypertension. I have a patient that needs to be on medication for it. Best practice is to put them on a thiazide, CCB, or ACE/ARB (assuming non-AA and no comorbidities). I write for Diovan. But, the patient thinks I'm a jerk who doesn't care about them and so never starts it.

The guy down the hall is a bit behind the times. Has an identical patient that he prescribes Toprol for. The morbidity/mortality benefits aren't as good as the Diovan I wrote for, but are better than the nothing my patient is actually taking.

Technically I'm a more competent doctor; however, Dr. Nice Guy is actually getting better results because his patient's listen to him.

 

[Lnsean]

lol, I was just writing my post

I already defined it

BTW, is your status accurate? Are you a pharmacist?

SDN provides the means to not pick a status if one does not wish to disclose or there is not an option that fits.

I'm just curious because aside from being about titles thrown around, on a site that is meant to educate students, being able to appraise the apparent source of information offered here is useful.

I'm finding some of your opinions, like how emergencies and communication should be handled, doesn't seem to reflect actual practice, and I'm sort of just wondering why that's the case.

I am medical student as well as pharmacist. Just because you say it doesn't reflect actual practice doesn't mean it's true. I've worked with minimally competent colleagues before that would miss diagnosis often and lead the patient down a rabbit hole of tests and procedures.

 

[Crayola227]

I mean everyone here is saying that communication skills are important and building rapport and a good relationship with your patient is important. No one is denying that...but this is not empathy. Like, should we define what empathy is? jfc.

Can't debate with someone that changes positions like that. Are you arguing for empathy or for communication skills?

It's interesting to me that you don't seem to think empathy is part of building rapport, a good relationship, or good communication.

I'm not sure why you in particular are having a hard time with this.

I know some physicians on the autism spectrum that struggle with this as well. As well as others.

 

[operaman]

I remember what a senior told me an attending told them, as a way of reassuring me: codes aren't hard. I mean, the patient is already dead, so you can't really frak it up anymore than it already is. Joking aside, point was that's not the part where intervention makes the most difference. It's when a patient is decompensating that should make you nervous, and your response matters most, because the patient is still alive, they are circling the drain and haven't gone down it yet. It gets harder once they code.

Furthermore, in being taught codes, keep cool. As long as good compressions are going and they're getting bagged, you have the time to take a breath and consider the Hs and Ts - Wikipedia.

Codes are algorithmic, doing them isn't hard, and finding the reason for the code isn't either.

In any case, when you're handling the "circle the drain" part, that's also pretty straightforward.

It's everything before that point that's "hard," but you have time, training, (and before board certification supervision) to deal with it.

I’ll just piggy back on here and add that empathy and soft skills are also a critical part of running a successful code as well as displaying the kind of leadership that gets things to happen for your drain-circling patient.

We’ve all seen things run badly and it isn’t that the doc leading the code doesn’t know what to do, but lacks the ability to calm others and delegate tasks and ensure that the room is working effectively and not just a bunch of panicked people standing around wondering what to do.

For the drain circling patient, so many places where soft skills are critical. Bedside nurses need direction and their concerns addressed. Getting an icu bed often requires multiple conversations with icu fellows/attendings articulating your critical care needs, the icu charge nurse to justify your need for a bed versus other potential needs. While it’d be nice to utter a diagnosis and have everyone fall in line, the realty is much more nuanced and requires a soft touch and ability to play well with others in the sandbox. You also have to talk with the patient and their family about what’s happening and what may need to happen. If someone is cruising for a tube, it’s good to have that conversation calmly before things crash and solicit their wishes and questions. Sometimes bad things are inevitable, but if you see it coming and can prepare people, you win the confidence and trust of the patient and family. If things go really bad and it’s time to fall hospice, that rapport and trust is critical in helping a family come to terms with the situation.

 

[Lnsean]

No one is saying otherwise.

You can be the smartest doctor alive right now, but if the patient doesn't trust you and doesn't follow your treatment plan, you're actually worse off than the random doc down the street who prescribes something that works half as well except the patient takes it.

Let's take something very simple: hypertension. I have a patient that needs to be on medication for it. Best practice is to put them on a thiazide, CCB, or ACE/ARB (assuming non-AA and no comorbidities). I write for Diovan. But, the patient thinks I'm a jerk who doesn't care about them and so never starts it.

The guy down the hall is a bit behind the times. Has an identical patient that he prescribes Toprol for. The morbidity/mortality benefits aren't as good as the Diovan I wrote for, but are better than the nothing my patient is actually taking.

Technically I'm a more competent doctor; however, Dr. Nice Guy is actually getting better results because his patient's listen to him.

Look, that isn't empathy. That's called building a solid relationship with your patient. It's part of many factors in having rapport with your patient. So, I don't get how you can single out empathy as being more important than any of the other things like professionalism, respect, and effective communication. If you're talking surveys then it's not even about any of this.

 

[Lnsean]

It's interesting to me that you don't seem to think empathy is part of building rapport, a good relationship, or good communication.

I'm not sure why you in particular are having a hard time with this.

I know some physicians on the autism spectrum that struggle with this as well. As well as others.

I do think its part of it. I just don't think it's more important than any of the other things on there. The only thing that stands out as most important is competence.
Also, why do you resort to personal attacks to win arguments and stuff? Is that what attendings do now days? Almost childish if you ask me.

 

[VA Hopeful Dr]

So it's part of a whole set of skills like professionalism, respect, and effective communication? I'd say then that empathy is just one of many factors.

This gets into the murky water of defining humanistic parts of being a physician. Technically, as @Goro stated, empathy is part of the over-arching "Patient Care" section.