Your correspondent Jill Thistlethwaite1 asks the question: ‘If we learn the techniques of “patient-centred” consulting and demonstrating empathy without really liking patients or agreeing with patient partnership is this a problem?’. I would suggest that it is not a problem at all, that it would be unreasonable to expect a GP to like or feel empathy towards every single patient at every consultation, and that we are required as GPs to behave in a professional way at all times even if it does not come naturally. The evidence comes from sociology and our colleagues in the acting profession.
In 1959, the American sociologist Erving Goffman2 wrote about his enquiries into how motivation manifested itself as behaviour. He concluded that it was quite possible to explain behaviour as a set of ‘fronts’ — pieces of behaviour that people use in order to pursue relationship objectives. The use of such fronts becomes internalised so that they become part of unconscious normal behaviour. He argued that all people in all aspects of their interpersonal interactions use behaviour in a way designed to bring about the required result.
Does this mean that behaviour that is not ‘from the heart’ is immoral or unethical? Not at all. Dr Thistlethwaite also mentions the ‘method’ school of acting, which was prompted by the writing of Constantin Stanislavski3 even longer ago. It was he who also wrote of ‘emotion memory’ — if an actor is trying to express a particular emotion, his advice was for the actor to search his own life experience for a situation when he felt that emotion for real, and then to duplicate the behaviour. The behaviour used is accordingly an accurate demonstration of how that actor would behave when genuinely in that emotional state. If the portrayal is to be convincing, then an actor must be acutely aware of his own life and behaviour and not just that of his character.
Even longer ago, a certain William Shakespeare was moved to include in As You Like It:
‘All the world's a stage,
And all the men and women merely players:
They have their exits and their entrances;
And each man in his life plays many parts …’ (Act two, scene seven.)
So there is not a problem. People, including GPs, cannot on occasion avoid behaving in ways that are inconsistent with how they feel at the time. The problem is when this fact is not accepted, and when the motivation becomes more important than the delivery.
- © British Journal of General Practice, 2005.
