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Traveling in Other People׳s Shoes
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Traveling in Other People's Shoes One of the enduring challenges of being a doctor is learning how to empathize with the predicaments of your patients. Most doctors are healthy and are unable to understand exactly what their patients go through as they deal with acute or chronic illness. Personal experiences with disease can transform doctors' perception of what it means to be sick. In fact, there are many narratives describing how confronting unexpected health problems made individual physicians more appreciative of what their patients endure when they come to them for care. But there is no conceivable way to make it a requirement for medical students or doctors in training to suffer the range of illnesses that they will manage during their careers. This problem, the inability to fully identify with our patients' health problems, is magnified when dealing with children who have congenital abnormalities or cognitive disabilities that are static and irreversible. Over 40 years ago, the philosopher, Thomas Nagel, wrote a famous essay entitled, “What is it like to be a bat?” In it, he asserts that our capacity to imagine what it would be like to use echolocation and fly through the night like bats is limited because we cannot escape our subjective perspective as human beings when we try to picture cave life from the perspective of a bat. According to Nagel, even if we were magically transformed into bats, our human consciousness, which we have had from birth, would prevent us from being able to replicate the consciousness of bats. So what can we do as doctors to escape the limitations of our own private perspectives, to better identify with our patients who are cognitively impaired or disabled and better understand the hardships that they deal with every day? We can read about the experiences of actual children and their families who have coped with their illnesses. We can read literature that depicts the lives of fictional characters and become more aware of the forces that come into play in people's lives. Religious practices can also serve as vehicles to reenact historical events and foster a vicarious identification with the plight of the other. The Passover Seder is designed to encourage the participants to relive the experience of the Jewish people when they were enslaved in Egypt and then dramatically achieved freedom. Similarly we could employ role playing in medical education to foster sensitivity to the lives of our patients. However, all of these techniques are artificial and require suspension of real experience. I think there is a more accessible and practical way for physicians to learn empathy. Recently, I was traveling on vacation with my wife in Croatia. Croatia is a beautiful country blessed with abundant sun and a picture postcard coast. We like to travel off the beaten track. But that means we usually have to ask for directions. The Croatian language uses the Latin alphabet and does not feature the Cyrillic characters used in Serbian and Russian. But on paper it looks almost as foreign as Thai. There is almost no English in the road signs and store fronts. Moreover, most of the people are not fluent in English. Much to our chagrin, after walking for a few minutes, we were forced to ask how to get to X. You have probably been in this position and can picture the scene. There is a lot of yelling, hand waving, finger pointing, and hoping for the best. After we had asked for directions where to go, we were not quite sure if we understood what the person told us. Did we hear things correctly? Two rights, go around the church, and then go up the path by the hill? Or did he say, a quick left, two rights, bear left and look for the hill with the church on top? It all sounds and looks the same. We started walking but there was a nagging anxiety that we would never get to where we wanted to go. We proceeded tentatively, always looking back over our shoulders for reassurance. Finally, after 45 min of extra wandering around in the midday heat, scanning the map, and arguing with each other, miraculously we arrived at our destination and breathed a nervous sigh of relief. I imagine that this is what life must be like on a regular basis for a child with cognitive disability. The world must seem to be moving so quickly and everything is a blur. The signposts must look as if they are written in a foreign Curr Probl Pediatr Adolesc Health Care 2016;46:158-159 1538-5442/$ - see front matter & 2016 Mosby, Inc. All rights reserved. http://dx.doi.org/10.1016/j.cppeds.2016.02.002
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Curr Probl Pediatr Adolesc Health Care, May 2016
language that you never learned. Everyone gets it but you. They try to help you but they are talking too fast and their words are getting jumbled in your ears. The fear that you will get it wrong and end up lost is palpable in your throat. Despite the best efforts of family members and care providers, the child with disability must feel like a perpetual tourist in a strange country. We cannot think like bats or become other people with their own sensibilities and perceptions. And thankfully that is not necessary to be a good pediatrician. But we each have unsettling experiences from day to day that we can turn to in an attempt to gain insight into the lives and feelings of others. There are times when life does feel like it is moving too fast, days when we do not have the energy to go forward, moments of uncertainty about our wellbeing and our place in the scheme of things. These moments are not routine experiences for those who are generally healthy and well enough to feel in control of their lives. And it is all too easy to push these anxious moments aside and ignore when they do happen. But if we could pause and reflect on these disabling moments, we might get a better feeling for what our patients go through every day as they live with illness and limitation. Recognizing the times when we are away from the comforts of “home” in the broadest sense of the word may sensitize us to be good companions as we travel with our patients on the path to health. Howard Trachtman, MD Department of Pediatrics, NYU School of Medicine, Room #102, 403 E 34th St New York, NY 10016 E-mail address: [email protected]
Curr Probl PediatrAdolesc Health Care, May 2016
159
Traveling in Other People's Shoes One of the enduring challenges of being a doctor is learning how to empathize with the predicaments of your patients. Most doctors are healthy and are unable to understand exactly what their patients go through as they deal with acute or chronic illness. Personal experiences with disease can transform doctors' perception of what it means to be sick. In fact, there are many narratives describing how confronting unexpected health problems made individual physicians more appreciative of what their patients endure when they come to them for care. But there is no conceivable way to make it a requirement for medical students or doctors in training to suffer the range of illnesses that they will manage during their careers. This problem, the inability to fully identify with our patients' health problems, is magnified when dealing with children who have congenital abnormalities or cognitive disabilities that are static and irreversible. Over 40 years ago, the philosopher, Thomas Nagel, wrote a famous essay entitled, “What is it like to be a bat?” In it, he asserts that our capacity to imagine what it would be like to use echolocation and fly through the night like bats is limited because we cannot escape our subjective perspective as human beings when we try to picture cave life from the perspective of a bat. According to Nagel, even if we were magically transformed into bats, our human consciousness, which we have had from birth, would prevent us from being able to replicate the consciousness of bats. So what can we do as doctors to escape the limitations of our own private perspectives, to better identify with our patients who are cognitively impaired or disabled and better understand the hardships that they deal with every day? We can read about the experiences of actual children and their families who have coped with their illnesses. We can read literature that depicts the lives of fictional characters and become more aware of the forces that come into play in people's lives. Religious practices can also serve as vehicles to reenact historical events and foster a vicarious identification with the plight of the other. The Passover Seder is designed to encourage the participants to relive the experience of the Jewish people when they were enslaved in Egypt and then dramatically achieved freedom. Similarly we could employ role playing in medical education to foster sensitivity to the lives of our patients. However, all of these techniques are artificial and require suspension of real experience. I think there is a more accessible and practical way for physicians to learn empathy. Recently, I was traveling on vacation with my wife in Croatia. Croatia is a beautiful country blessed with abundant sun and a picture postcard coast. We like to travel off the beaten track. But that means we usually have to ask for directions. The Croatian language uses the Latin alphabet and does not feature the Cyrillic characters used in Serbian and Russian. But on paper it looks almost as foreign as Thai. There is almost no English in the road signs and store fronts. Moreover, most of the people are not fluent in English. Much to our chagrin, after walking for a few minutes, we were forced to ask how to get to X. You have probably been in this position and can picture the scene. There is a lot of yelling, hand waving, finger pointing, and hoping for the best. After we had asked for directions where to go, we were not quite sure if we understood what the person told us. Did we hear things correctly? Two rights, go around the church, and then go up the path by the hill? Or did he say, a quick left, two rights, bear left and look for the hill with the church on top? It all sounds and looks the same. We started walking but there was a nagging anxiety that we would never get to where we wanted to go. We proceeded tentatively, always looking back over our shoulders for reassurance. Finally, after 45 min of extra wandering around in the midday heat, scanning the map, and arguing with each other, miraculously we arrived at our destination and breathed a nervous sigh of relief. I imagine that this is what life must be like on a regular basis for a child with cognitive disability. The world must seem to be moving so quickly and everything is a blur. The signposts must look as if they are written in a foreign Curr Probl Pediatr Adolesc Health Care 2016;46:158-159 1538-5442/$ - see front matter & 2016 Mosby, Inc. All rights reserved. http://dx.doi.org/10.1016/j.cppeds.2016.02.002
158
Curr Probl Pediatr Adolesc Health Care, May 2016
language that you never learned. Everyone gets it but you. They try to help you but they are talking too fast and their words are getting jumbled in your ears. The fear that you will get it wrong and end up lost is palpable in your throat. Despite the best efforts of family members and care providers, the child with disability must feel like a perpetual tourist in a strange country. We cannot think like bats or become other people with their own sensibilities and perceptions. And thankfully that is not necessary to be a good pediatrician. But we each have unsettling experiences from day to day that we can turn to in an attempt to gain insight into the lives and feelings of others. There are times when life does feel like it is moving too fast, days when we do not have the energy to go forward, moments of uncertainty about our wellbeing and our place in the scheme of things. These moments are not routine experiences for those who are generally healthy and well enough to feel in control of their lives. And it is all too easy to push these anxious moments aside and ignore when they do happen. But if we could pause and reflect on these disabling moments, we might get a better feeling for what our patients go through every day as they live with illness and limitation. Recognizing the times when we are away from the comforts of “home” in the broadest sense of the word may sensitize us to be good companions as we travel with our patients on the path to health. Howard Trachtman, MD Department of Pediatrics, NYU School of Medicine, Room #102, 403 E 34th St New York, NY 10016 E-mail address: [email protected]
Curr Probl PediatrAdolesc Health Care, May 2016
159