Reclaiming Empathy

As med students, we are bombarded with daily reminders to be empathetic. In patient presentations, in small group sessions, in practical exams, it’s even snuck into pathology lectures. At my school, they call it FIFE: Feelings, Ideas, Fears, Expectations. It’s almost a joke now. As we leave standardized patient exams, we ask each other, “So, did you get your FIFE-ing in?” We get points if we ask specific questions about each of these, and if we forget the ever-so-important, “How does this make you feel?” we get blasted.

It’s kind of annoying.

I used to be an empathetic, sympathetic, caring person. They made us take this “Empathy Test” at the beginning of med school, and I scored quite high. I was full of empathy. Dripping with it. I wanted to save the world, one sniffly nose at a time.

I think I still am, to some degree. But in some very strange and twisted way, having these attributes forced upon me has made me rebel. I hate FIFE’ing patients. I feel silly, stupid, and dumb when I ask those questions. Part of this is reasonable. It is far less awkward to work empathy into a conversation in a natural way when you aren’t required to ask 12 specific questions that involve obviously artificial phrases like “Now Mrs. Smith, what are your Ideas Concerning your Sore Throat?”

Or even worse, “Mr. Jones, How do you Feel About your Scrotal Abscess?” (This has happened to me.)

But then there are those times when I find myself thinking, “Ok seriously? Isn’t this what psychologists do? This isn’t my job!” …And that’s when I start to get nervous.

For example: I volunteer at a free clinic for the underinsured one night a month. I usually love going there, but for some reason, this past week I was in a bad mood. The stress of boards studying is starting to overwhelm me, and all I could think about was the hours of study time that I was losing. It was a really busy night, and I was there till nearly 9pm. I was tired. I was hungry. I wanted to go home.

We were just finishing up, when the nurse came over and said, “Wait! There’s one more patient!”

The doctor I was helping agreed to take the last patient. He blended right in with our normal clientele: youngish (unemployed), jittery leg tapping annoyingly ceaseless beat on the floor, long greasy hair tied back in a ponytail, untrimmed, dirty nails, downcast eyes.

As soon as we walked in, he jumped up and began to tell us of his pain, (nay, his full-body pain), due to three separate car accidents five years ago. Unexpectedly, he dropped his pants to show us the long scar where a titanium rod was placed in his leg. Then he glanced over at me, seeming to realize I was in the room, and mumbled, “Oh, a lady is present.”

After a thorough explanation of every scar, bump and bruise on his body – he continued to try to impress upon us the magnitude of his pain by pulling out a list of medications that he had been on a few years ago. They were mostly narcotics – fentanyl patches, oxycodon, etc. “All I want is to feel good again,” he kept saying, over and over. “Can you just help me feel good again?”

I admit that the moment he walked in the door – I judged him (drug seeker) and my empathy ended there.

And then he started to tell us about his anxiety. His stress and anxiety levels were so high, he said. He has panic attacks. He can’t be in a room with people for very long. His palms start getting sweaty. He needs something to help him.

“What,” I asked with a condescending sniff, “Are you stressed about?”

“I have a kid,” he said. “And he wants to do things. All the time. And I can’t do all these things with him because I’m in all kinds of pain. And it stresses me out so much!”

At that point, I kind of lost it. In my head, I started berating him. ‘What do YOU have to be stressed about? So you have a kid! I know people who have 10 kids and they are keeping it together! You don’t know anything about stress! Trying going to med school! You don’t have a clue! Get a job! Get a life! Stop wasting my time!’

Wow.

I mean, wow! I am sort of at a loss for words at my own thought process. If I was a patient, and I had even the slightest clue of what was going through my mind at that moment, I certainly wouldn’t want me as my doctor. If I were to hazard a guess, I think the root of the problem is in the comparison. Whatever your profession, comparing your stressors and difficulties to someone else is generally a fruitless endeavor. Why? Well for one, everyone is different. My stress in med school is simply not comparable to that man’s stress dealing with his pain and trying to take care of a child. They are two completely different life situations. And if you start comparing too much, you start resenting other people.

So in terms of finding my empathy… well, I don’t think it was ever really lost. It just got pushed to the side and distorted by my selfish comparisons and stress. Now that I recognize the problem, hopefully I can keep the two separate. Because my stress should never influence the way I approach someone, regardless if they are a patient, a friend, or the Starbucks lady.