Book Review

Empathy and the Practice of Medicine: Beyond Pills and the Scalpel

N Engl J Med 1994; 330:296-297January 27, 1994

Article

Empathy and the Practice of Medicine: Beyond Pills and the Scalpel
Edited by Howard M. Spiro, Mary G. McCrea Curnen, Enid Peschel, and Deborah St. James. 199 pp. New Haven, Conn., Yale University Press, 1993. $20. ISBN: 0-300-05840-3

This collection of 15 essays, almost exclusively by physicians, explores the nature of empathy, how it affects the lives of physicians and patients, and (especially) how it can be taught and nurtured as a part of medical education.

Empathy has been so neglected and misunderstood in the field of medicine that the adequacy of a new book on the subject can be tested in large part by its success in explaining and overcoming two fallacies. The no-transference fallacy holds that faculty members can treat students like scum and they will nevertheless grow up to be compassionate physicians. The idiot-with-the-stethoscope fallacy -- taken from Robert Coles's interview with William Carlos Williams, as recounted in Coles's The Call of Stories: Teaching and the Moral Imagination (Boston: Houghton Mifflin, 1989) -- holds that empathy and compassion automatically turn physicians into blobs of emotion incapable of taking effective or thoughtful action.

On the first test, this book scores high. All the essays that address teaching emphasize that the teacher-student relationship ought to model the empathy and compassion that we desire in the physician-patient relationship. Howard Spiro, Michael LaCombe, Shimon Glick, Stanley Reiser, and Rita Charon are especially strong on this theme.

On the second test, the results are more mixed. Richard Landau (who has little use for empathy and whose essay seems to be included here for no better reason than to provide a counterbalance) and Richard and Enid Peschel set up a false dichotomy between empathy and medical science, claiming in effect that empathy must be administered in homeopathic doses lest it contaminate medical practice. Other essays paint a more positive view of how empathy and medicine go hand in hand. Jodi Halpern goes to the root of the idiot-with-the-stethoscope fallacy by pointing out that the real danger is not too much empathy but self-absorption masquerading as empathy, and that the proper attitude of curiosity toward the patient can prevent this: “I argue that since the aim of clinical empathy is to understand the patient's distinct experience, emotional resonance is only a first step. Physicians must also be guided by curiosity that decenters them from their own reactions and their own presuppositions about patients.”

Halpern's insights show why the definition of empathy in the lead essay by Spiro is basically flawed: “Empathy is the feeling that persons . . . arouse in us as projections of our feelings and thoughts. It is evident when `I and you' becomes `I am you.”' Spiro here seems to be inviting the sort of uncurious self-absorption that Halpern and others warn against. Similarly, George Bascom's moving recollections of his life as a surgeon blur the distinction between empathy and sympathy and ultimately reveal Bascom much more than his patients.

Another important conceptual theme recurring in these essays concerns the extent to which empathy is emotional or cognitive. Jeanne LeVasseur and David Vance tilt toward the cognitive, whereas Halpern insists on the importance of the emotional. Joanne Lynn's important essay reminds us that true empathy may often lead to anger at injustices in our health care and social-support systems.

Although any thoughtful physician (especially one infected with either of the above fallacies) would find much food for thought here, the book is of particular value for medical educators. In that regard, since Spiro states in his epilogue that good doctors must be as well trained in the social sciences as in physics and biology, it is unfortunate that these disciplines are not represented in the book.

Howard Brody, M.D., Ph.D.
Michigan State University, East Lansing, MI 48824