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While Doctors May Hear Patients, Are They Really Listening? — Empathy training can help doctors communicate better with patients, Rosa E. Mino, PhD
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I think the tasks where you use dolls and e.g. put a wall in the way and ask the person to state what one did and what the other person 'saw' (because they couldn't see the right hand of the scene is the sort of foundation stuff in trying to do empathy. Theory of mind (box on left hand side here) is a prerequisite for empathy: https://thebrain.mcgill.ca/flash/i/i_09/i_09_p/i_09_p_dev/i_09_p_dev.html
As people get older they might learn to 'ape' this if they realise it is missing and so think they are doing it because they copy what they see others on the surface doing. But it misses the point is you are just 'ascribing beliefs' without the 'putting yourself in the shoes'.
That last phrase is problematic because really it isn't just 'the shoes' - and I think that is where too many misunderstand empathy. It is putting yourself in their 'whole position' which involves 'being them' a lot more than that, as situations are very complex in the adult world. A choice on the surface that seems wrong (picking sweets instead of vegetables) needs to be informed by knowing that person (clever, sensible, has diabetes or hypoglycemia symptoms).
I think ascribing something using lots of words or lofty terms to these 'adult' situations is a further 'hide' of missing the building blocks - e.g. if noone else knew complex maths and your reply to an equation looked really complex maths you'd 'pass for understanding maths' better than if you wrote something simple. OR if you are learning by 'aping' then you tend to just copy exactly what you've seen others say in seemingly similar situations (which is how the 'women = hysteria' takes hold) - not realising the task at all was not one with a learn by rote response. Worse, in a culture where those with empathy are odd ones out, there is only one right answer so those with it kind of have to ape the norms to survive I guess.
They might also develop processes and excuses why not listening is better e.g. the 'bad witness' excuse.
Good luck to these people if they really are trying to teach empathy. They will need to do these childhood tests from first principles to see what they are working with and then build up I think. Otherwise you'll get 'learning to the test' without anything going in.
This is why I think certain areas of medicine do need these tests in recruitment - I don't know whether you learn it, or there is a good adjustment/alternative way around where theory of mind is missing, or just play to skills and keep away from where those skills are an issue to accommodate it. But it is about information input - and an important one at that, not what it gets misinterpreted as being an 'added extra of niceities'.
As people get older they might learn to 'ape' this if they realise it is missing and so think they are doing it because they copy what they see others on the surface doing. But it misses the point is you are just 'ascribing beliefs' without the 'putting yourself in the shoes'.
That last phrase is problematic because really it isn't just 'the shoes' - and I think that is where too many misunderstand empathy. It is putting yourself in their 'whole position' which involves 'being them' a lot more than that, as situations are very complex in the adult world. A choice on the surface that seems wrong (picking sweets instead of vegetables) needs to be informed by knowing that person (clever, sensible, has diabetes or hypoglycemia symptoms).
I think ascribing something using lots of words or lofty terms to these 'adult' situations is a further 'hide' of missing the building blocks - e.g. if noone else knew complex maths and your reply to an equation looked really complex maths you'd 'pass for understanding maths' better than if you wrote something simple. OR if you are learning by 'aping' then you tend to just copy exactly what you've seen others say in seemingly similar situations (which is how the 'women = hysteria' takes hold) - not realising the task at all was not one with a learn by rote response. Worse, in a culture where those with empathy are odd ones out, there is only one right answer so those with it kind of have to ape the norms to survive I guess.
They might also develop processes and excuses why not listening is better e.g. the 'bad witness' excuse.
Good luck to these people if they really are trying to teach empathy. They will need to do these childhood tests from first principles to see what they are working with and then build up I think. Otherwise you'll get 'learning to the test' without anything going in.
This is why I think certain areas of medicine do need these tests in recruitment - I don't know whether you learn it, or there is a good adjustment/alternative way around where theory of mind is missing, or just play to skills and keep away from where those skills are an issue to accommodate it. But it is about information input - and an important one at that, not what it gets misinterpreted as being an 'added extra of niceities'.
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rvallee
Senior Member (Voting Rights)
I think it can. To a point, but that's besides it. No amount of empathy can overcome a system that makes it impossible, that bullies its employees and stretches every ounce of time and energy out of them, always lacking in time and resources.
Especially a system that cannot even meet at least 1/4 of the common problems they deal with, mostly so that wages remain high. That's one part of the solution, relying more on systems, and much less on individuals who are expected to be fully independent contractors working by their lone selves. Training more but retaining fewer, too many physicians go through the process but are terrible at it.
And physicians have to be trained to be detached from the horrors of the job, this is not compatible. Over time, a similar desensitization process soldiers have over a military career. The stuff that makes people flinch and hesitate eventually becomes second nature. Part of that is the ability to simply disconnect from those problems. Militaries make similar choices, they need to train people who will be able to kill and move on. It naturally must come with dehumanization, of the enemy, but also of anyone who can be made the enemy.
And that I don't think can be trained. People can be trained to be empathetic, or to be able to disconnect from what are normally horrifying events. It's also doubtful that medicine can have such a radical change. It takes a long time to go from decades of "assume the patient is lying" to a healthy functioning system.
I don't think the problem is empathy. Understanding is good enough in most cases. It would be good enough with us, but it turns out that lived experience is one thing that simply can't be taught. No amount of empathy can overcome that, if one simply doesn't even understand the problem, they definitely cannot relate to it.
People in pain don't understand what being constantly in pain is like. They can't do this with us, either, being ill all the time. The problem is more in the blatant lack of respect that even allows something as obviously wrong and self-defeating as "everybody lies". That's mostly cultural baggage, traditions, poor training, all of which can be fixed, but it's unlikely to ever work out without involving patients in a respectful process, that treats us as a source of information and having knowledge they cannot possibly have without experiencing it.
boolybooly
Senior Member (Voting Rights)
As a zoologist I studied social hierarchies, the evolutionary logic which creates them and the variations on aggressive behaviour they result in.
After some reflection I came to the conclusion that much academia, including that which I was part of at the time, is heirarchical in nature and far from rising above the madding crowd, is naked social aggression in action, the depths of the human limbic system ritualised under a pretence of ennoblement.
I came to the conclusion that enlightenment was routinely sacrificed to power and it was a terrible hypocrisy that knowledge was held yet its implications ignored. As the keys to understanding human behaviour in the form of ethological theory were known yet the academic approach even in such ostensibly enlightened circles continued to demonstrate atavistic tyranny, like something from the feudal era, straight out of the dark ages.
Medical academia seems to me, like any other academia including all the schools of sciences and arts, characterised by hierarchies of authority aka eminence based medicine which create schools which are essentially cliques or cabals and tend to brook no disagreement and create a conformity of ideation which exceeds the strictures of pure science and is political in nature, created by the tyranny of tutelage, the raw power of the invigilator.
To my mind this cultish mindset is a form of tribalism, as it has the same neurological roots and so the same impulses apply. Meaning you are either in or you are out and if you are in you are supported, all close ranks about you, if you are out you become the enemy outside the gate and are attacked. Which is particularly the pattern of male philopatry in humans, baboons are different and a fascinating muse as females are territory holders i.e. female philopatric in those species.
Dr Myhill is IMHO an example of a female human doctor ostracised by some less enlightened males acting out instinctive tribal cultishness in relation to medicine. Many good doctors, like good politicians and good police try to rise above the tribal mindset but many others do not, they go along with it, excusing it as the way of the world. It is a society wide problem, born of our evolution and therefore the genetics which control our behaviour, both male and female, as we coevolved to follow these patterns of behaviour, even though the differing priorities of the two genders clash and the battle of the sexes rages on, thinking of Iran today, with sorrow at such barefaced and abusive oppression.
I think the culture of medical academia in particular has a history of treating those not initiated into the cult as outsiders, essentially enemies, not least patients. The schools of medicine have followed instinctive neurological pathways which create the impulses of tribalism because they are intrinsic to human male thought and has developed male philopatric ways of looking at outsiders which diminish their stature in the imaginary heirarchy, excluding them, disempowering them, creating perspectives based in snobbery and a tendency to dehumanise as if they were an enemy. This is because the instinctive purpose of the tribe, in dealing with external actors is, evolutionarily speaking, warfare. This is why one can honestly say it is a matter worthy of debate that schools of medicine teach doctors to make war on their patients.
Where the cult of medicine is trying to teach itself empathy it is likely that for some the seed will fall in fertile ground but for others it will result in an attempt to create the semblance of empathy while retaining the tribal snobbery which annihilates empathy in the first place, i.e. faking it. It seems statistically speaking, likely to create further grotesque hypocrisy.
If you are truely empathic you dont need to fake it because you are aware your perceptions of others are based on the awareness of self.
That is if the perception of another human being is not divorced from feeling by the attempt to project heirarchical superiority and thereby attain dominance.
What medicine needs to do is stop teaching doctors to make war on patients, by all means make war on disease but patients must be treated as entire human beings. They are equal and akin to self, not something other, not outside the tribe, not subdominant dependants, not children nor any other kind of externalised projection of an internally conceived relationship based on heirarchical status.
The difficulty with this is another individual human being is a great mystery and it can sometimes take a long time for one to understand another. In today's world practical and financial pressures conspire to make expedience easier. Still it is better to do better and if we can, encourage others to do better too!
We are still crawling out of the dark ages imho but bit by bit we are making progress. We have several hundred million years of evolution to sort out, so its a big job and we should probably try to be as understanding as we can with each other in the meantime.
It would be hypocritical to lack empathy for those who lack empathy for us.
I am just going to hit the post button now or I will be here all night
After some reflection I came to the conclusion that much academia, including that which I was part of at the time, is heirarchical in nature and far from rising above the madding crowd, is naked social aggression in action, the depths of the human limbic system ritualised under a pretence of ennoblement.
I came to the conclusion that enlightenment was routinely sacrificed to power and it was a terrible hypocrisy that knowledge was held yet its implications ignored. As the keys to understanding human behaviour in the form of ethological theory were known yet the academic approach even in such ostensibly enlightened circles continued to demonstrate atavistic tyranny, like something from the feudal era, straight out of the dark ages.
Medical academia seems to me, like any other academia including all the schools of sciences and arts, characterised by hierarchies of authority aka eminence based medicine which create schools which are essentially cliques or cabals and tend to brook no disagreement and create a conformity of ideation which exceeds the strictures of pure science and is political in nature, created by the tyranny of tutelage, the raw power of the invigilator.
To my mind this cultish mindset is a form of tribalism, as it has the same neurological roots and so the same impulses apply. Meaning you are either in or you are out and if you are in you are supported, all close ranks about you, if you are out you become the enemy outside the gate and are attacked. Which is particularly the pattern of male philopatry in humans, baboons are different and a fascinating muse as females are territory holders i.e. female philopatric in those species.
Dr Myhill is IMHO an example of a female human doctor ostracised by some less enlightened males acting out instinctive tribal cultishness in relation to medicine. Many good doctors, like good politicians and good police try to rise above the tribal mindset but many others do not, they go along with it, excusing it as the way of the world. It is a society wide problem, born of our evolution and therefore the genetics which control our behaviour, both male and female, as we coevolved to follow these patterns of behaviour, even though the differing priorities of the two genders clash and the battle of the sexes rages on, thinking of Iran today, with sorrow at such barefaced and abusive oppression.
I think the culture of medical academia in particular has a history of treating those not initiated into the cult as outsiders, essentially enemies, not least patients. The schools of medicine have followed instinctive neurological pathways which create the impulses of tribalism because they are intrinsic to human male thought and has developed male philopatric ways of looking at outsiders which diminish their stature in the imaginary heirarchy, excluding them, disempowering them, creating perspectives based in snobbery and a tendency to dehumanise as if they were an enemy. This is because the instinctive purpose of the tribe, in dealing with external actors is, evolutionarily speaking, warfare. This is why one can honestly say it is a matter worthy of debate that schools of medicine teach doctors to make war on their patients.
Where the cult of medicine is trying to teach itself empathy it is likely that for some the seed will fall in fertile ground but for others it will result in an attempt to create the semblance of empathy while retaining the tribal snobbery which annihilates empathy in the first place, i.e. faking it. It seems statistically speaking, likely to create further grotesque hypocrisy.
If you are truely empathic you dont need to fake it because you are aware your perceptions of others are based on the awareness of self.
That is if the perception of another human being is not divorced from feeling by the attempt to project heirarchical superiority and thereby attain dominance.
What medicine needs to do is stop teaching doctors to make war on patients, by all means make war on disease but patients must be treated as entire human beings. They are equal and akin to self, not something other, not outside the tribe, not subdominant dependants, not children nor any other kind of externalised projection of an internally conceived relationship based on heirarchical status.
The difficulty with this is another individual human being is a great mystery and it can sometimes take a long time for one to understand another. In today's world practical and financial pressures conspire to make expedience easier. Still it is better to do better and if we can, encourage others to do better too!
We are still crawling out of the dark ages imho but bit by bit we are making progress. We have several hundred million years of evolution to sort out, so its a big job and we should probably try to be as understanding as we can with each other in the meantime.
It would be hypocritical to lack empathy for those who lack empathy for us.
I am just going to hit the post button now or I will be here all night
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Well, yes, people only care about power. It is very obvious. Usually a patient is powerless in front of a doctor, and this is especially true with an illness like this one, you have absolutely no leverage so they will subtly spit in your face every chance they get. Sometimes you meet empathetic people who try to be nice (they are nice to everybody) but you can tell in their mind is somewhere else. If you were a powerful person (like let's say an important politician or a billionaire) they would treat you very differently even if they had nothing to gain from it.
I used to assume that people in academia (especially psychiatrists, since they supposedly study the human mind) knew better but it's very clear that they don't.
Teaching those low on empathy how to better fake the appearance of empathy is not a win for the rest of us. Just makes them better ambush predators.
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Worth bearing in mind that prior to 1908 no monoglot English speaker had a word for empathy, and even the German term Einfühlung (in-feeling) from which empathy was derived, only appeared in the mid 19thC.* In English the word 'sympathy' covered some of what is currently covered by 'empathy' but the two are currently seen as fairly distinct. Compassion and commiseration might serve as substitute terms but also don't seem to adequately cover what is now meant by empathy.
It's an interesting question as to whether one can feel something if there is no terminology for it, or alternatively perhaps explicit behaviour as a signifier for it; certainly without any term or social construct to support it there can't be learning of it.
Having got a terminology, it would seem possible to communicate to others how and what empathy is in a social sense. But as with any terminology which relates purely to the inner world of the self there is no empirical means to know with certainty how an individual experiences empathy, whether there is actually commonality of that experience between individuals, or whether there is simply a set of conventions that are signifiers which allow the deeming by others as to whether an individual is possessed of 'empathy' or not.
In the context of medicine I'd say it was best to concentrate on what achieves most effective outcomes - listening and giving due value to what a patient has to say and how they express it would seem important, whether some ill defined quality such as empathy is need for that is I think debatable. While "Assume all patients are lying" is clearly wrong in that it equates 'patient' with 'dishonesty', a physician should apply the same level of scepticism to what a patients has to say, as is applied to other evidence - all need to be tested within a process of reasoning. Concluding the patient is lying (or psychologically deficient !) without conclusive evidence is clearly going to produce bad medicine.
* The Origin of Empathy
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