Quotes from Danielle Ofri

It's so important that your doctor take a patience's values, not his, into consideration, along with the risks and benefits of treatment when there is a question to a doctor "What would you do?".

Empathy--the ability to identify with someone else's suffering--is certainly a prerequisite for a genuine apology.

Thus, whatever the medical student has been taught, and even genuinely believes, about the ideals of medicine, the primacy of empathy, the value of the doctor-patient relationship--all of this is swamped once he or she steps into the wards. [...] It's no wonder that empathy gets trounced in the actual world of clinical medicine; everything that empathy requires seems to detract from daily survival.

Fear is a primal emotion in medicine. Every doctor can tell you of times when she or he was terrified; most can list more episodes than you might wish to hear. [...] It may be sublimated at times, it may wax and wane, but the fear of harming your patients never departs; it is inextricably linked to the practice of medicine.

But I realized that not only did I need to keep tuning my skills as a doctor, I also had to figure out a way to live with the uncertainty of medicine and its attendant anxiety.

Burnout also leads to a large swath of physicians who aren't as empathetic toward their patients as they could be.

The concept of multitasking evolved from the computer field to explain a microprocessor performing two jobs at one time. It turns out that microprocessors are mostly linear and so are really performing only one task at a time. Computers give the illusion of simultaneous action by jumping between competing activities in a complex and rapid-paced algorithm.

Neuroscientist Antonio Damasio describes emotions as the "continuous musical line of our minds, the unstoppable humming."3

The very fact that these doctors continuing to be doctors--highly successful ones--despite their errors and their accompanying assaults on their self-definion would itself be a potent lesson to the students and interns. It is possible to hold one's head up after an error, to admit that errors are part and parcel of human existence, even in medicine. It is possible to see the error as an aspect of oneself, not the defining characteristic of oneself.

To empathize with these patients, to put yourself in their shoes, may be a bit too existentially disconcerting. And so doctors unconsciously try to protect themselves by widening the moat between their own good health and their patients' dauntingly mortal conditions

Grief ate at these doctors, distracting them from both their families and their patients. Many reported withdrawing from emotional involvement with their patients and that their patients had noticed they weren't fully present.

But at the most basic level, doctors need to be able to come forward with their errors and near-misses, otherwise we will never know where the problems lay.

Suddenly, I was plunged back into an avid learning environment, starting at the bottom and working my way painstakingly up the mountain. The thrill of learning and accomplishing stimulated me so much that the work was pleasurable.

I was relieved to come across a more expansive population study of nearly seventy thousand patients that showed that the medical care given to overweight patients is no different than what non-overweight patients receive.14 Despite an ingrained societal bias against obesity—one that affects physicians as well as patients—the medical profession seems to be able to deliver comparable treatment.

Neuroscientist Antonio Damasio describes emotions as the continuous musical line of our minds, the unstoppable humming. This basso continuo thrums along while doctors make a steady stream of conscious medical decisions.

Empathy requires being attuned to the patient's perspective and understanding how the illness is woven into this particular persons' life. Last--and this is where doctors often stumble--empathy requires being able to communicate all of this to the patient.

These younger doctors are the immediate interface with clinical medicine for the students. The students trail their interns and residents every waking minute and absorb from them how medicine is done—how it is spoken, thought, written, performed, attired, and equipped.

In general, empathy is easier the more we can identify with someone. When we can genuinely envision ourselves in a situation, it's possible to intuit what that person's suffering might feel like.

It can be rough going to maintain both composure and empathy in these situations, but a doctor's failure to do that is probably the number one reason why patients feel dissatisfied with their physicians and end up doctor-shopping endlessly.

But while the patient does bear some responsibility, I believe that the onus falls more heavily on the doctor to be attuned to the factors--cultural, ethnic, or just personal style--that influence how patients present their symptoms.

Giving patients the information that they need—not necessarily the standard of care in 1964—goes a long way toward relieving the anxiety and fear that worsen pain. But what was impressive was the magnitude of the effect. The group with the extra discussion needed half the amount of pain medication that the control group needed.

Hospital life--with its byzantine array of moving parts layered atop the unpredictable rhythms of illness--is a permanent state of flux.

It is, of course, laudable that patient satisfaction has become a high priority, but sometimes window-dressing efforts like fancy coffee in the waiting room get priority over things that might have an actual effect on health care, such as giving nurses paid time off for continuing education.