Increasing emotional support for healthcare workers can rebalance clinical detachment and empathy

Luke Austen

doi:10.3399/bjgp16X685957

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Detachment and empathy
Roger Neighbour

Published on: 21 July 2016
Empathy, compassion, and kindness
Chris Godwin

Published on: 13 July 2016

Published on: (21 July 2016)
Page navigation anchor for Detachment and empathy
Detachment and empathy
Roger Neighbour, Past President, RCGP
I thought this was a very impressive piece, not least because its author is still undergraduate, i.e. still at the stage of having his head crammed with facts. It prompted recollection of T S Eliot’s lines from The Rock:

Where is the wisdom we have lost in knowledge?

Where is the knowledge we have lost in information?

Sooner or later – and it’s often while at medical school – all doctors experience situations that are unforgettably shocking or traumatic. Many of us respond self-protectively by detaching our human responses in order to cope. It’s as if a switch is thrown, disconnecting our clinical skills from our emotional intelligence. (In my recent book The Inner Physician I call it ‘Crichton’s switch’.) And in some of us that switch never gets reversed.

Luke Austen suggests there needs to be a balance between empathy and detachment. But I think it’s a bit more complicated than that. There are some clinical situations where hard-nosed clinical skill is all that is required, and others where the very best we can offer is our ability to understand and to empathise. The novelist E M Forster I think gets closer when (in a different context) he writes, ‘The businessman who assumes that this life is everything, and the mystic who asserts that it is nothing, fail to hit the truth. No; truth, being alive, was not h...
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I thought this was a very impressive piece, not least because its author is still undergraduate, i.e. still at the stage of having his head crammed with facts. It prompted recollection of T S Eliot’s lines from The Rock:

Where is the wisdom we have lost in knowledge?

Where is the knowledge we have lost in information?

Sooner or later – and it’s often while at medical school – all doctors experience situations that are unforgettably shocking or traumatic. Many of us respond self-protectively by detaching our human responses in order to cope. It’s as if a switch is thrown, disconnecting our clinical skills from our emotional intelligence. (In my recent book The Inner Physician I call it ‘Crichton’s switch’.) And in some of us that switch never gets reversed.

Luke Austen suggests there needs to be a balance between empathy and detachment. But I think it’s a bit more complicated than that. There are some clinical situations where hard-nosed clinical skill is all that is required, and others where the very best we can offer is our ability to understand and to empathise. The novelist E M Forster I think gets closer when (in a different context) he writes, ‘The businessman who assumes that this life is everything, and the mystic who asserts that it is nothing, fail to hit the truth. No; truth, being alive, was not halfway between anything. It was only to be found by continuous excursions into either realm.’

In other words, Crichton’s switch is a toggle switch, with no midway position; it alternates between being on and off. The professional skill, if there is one, is to be in control of it, able to engage or disengage our empathy according to clinical circumstances.

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Competing Interests: None declared.
Published on: (13 July 2016)
Page navigation anchor for Empathy, compassion, and kindness
Empathy, compassion, and kindness
Chris Godwin
July’s BJGP had articles on empathy, compassion and kindness.^1–3 In the same month I received an invitation to apply to join the interview panel for prospective medical students. The invitation says that these 17 year olds are going to be assessed for their social awareness, caring ethos, and empathy. I wondered which of these unfortunates were going to be rejected for not feigning these attributes as convincingly as their competitors. And I wondered what sort of god-like creatures might exist among the pool of senior doctors who would be willing to dispense such judgements on the innocent. Perhaps none with any vestige of empathy, compassion or kindness.

References

1. Austen L. Increasing emotional support for healthcare workers can rebalance clinical detachment and empathy. Br J Gen Pract 2016; DOI: 10.3399/bjgp16X685957.

2. Fernando AT, Arroll B, Consedine NS. Enhancing compassion in general practice: it’s not all about the doctor. Br J Gen Pract 2016; DOI: 10.3399/bjgp16X685741.

3. Mathers N. Compassion and the science of kindness: Harvard Davis Lecture 2015. Br J Gen Pract 2016; DOI: 10.3399/bjgp16X686041.

Competing Interests: None declared.

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