EXISTENTIAL MEDICINE

It seems that most doctors literally cannot bring themselves to utter even the most basic and commonplace empathic phrases in response to a patient’s presentation of his or her symptoms –   even though these can have an immediately beneficial and healing impact. Indeed they are taught that empathy as such is a hindrance to maintaining clinical ‘objectivity’ in doctor-patient communication; when in reality it can be the magic key to opening themselves to – rather than defending themselves against –  the patient’s subjective experience of dis-ease. In contrast, maintaining a stance of ‘clinical distance’ is a form of communicative pathology – in the most literal sense of this word – a ‘sick’ (pathos) use language (logos). Nevertheless since empathy is clearly a foreign language for doctors – what follows are the beginnings of a language phrasebook, not in ‘English as a Foreign Language’ (EFL)  but in ‘Empathy as a Foreign Language’ (EFL) – one intended for doctors of all nationalities – and so basic one is amazed that it should be needed at all. So please feel free to print it and hand it out to doctors or consultants in your local practice or hospital.

1. Opening empathic phrases in response to patient’s presentation:

For example, how about simple phrases like:

I’m sorry to hear that. / I’m sorry to hear you’ve been feeling that way/so bad.

That sounds very unpleasant/distressing/painful.

How has that been making you feel?

I can understand why you feel so worried/upset/concerned/distressed.

I can understand why you wanted to see me.

How have you been coping?

2. Some closing phrases to end a consultation:

How do you think you will cope?

Do you have any other worries?

Is there anything else  that you’d like to tell me about/ that is bothering you?

Do let me know how things go. [which the patient could do by leaving a note for their doctor by phone]

The common failure to use this type of empathic language is itself symptomatic of a larger problem – namely the almost total lack of interest on the part of clinicians in the patient’s lived experience of illness and its effects on their life rather than just their presenting symptoms.

“One unintended outcome of the modern transformation of the medical care system is that it does just about everything to drive the practitioner’s attention away from the experience of illness. The system thereby contributes importantly to the alienation of the chronically ill from their professional care-givers and, paradoxically, to the relinquishment by the practitioner of that aspect of the healer’s art that is most ancient, most powerful and most existentially rewarding.”

Arthur Kleinman M.D. The Illness Narrative: suffering, healing and the human condition