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Empathy and the Literary Imagination

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Abstract

What good is empathy? The closer we get to the feelings of our patients, goes the argument, the better we can understand them and the more likely we will be able to diagnose and treat correctly. This is what novels, stories, and other works of art are supposed to help us with. As a physician and writer I both believe and doubts this.

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... Studies examining the effects of reading on attitudes suggest that reading can promote prosocial attitudes toward (typically, minority) others (for a summary of examples, see Hakemulder 2000 andPaluck andGreen 2009). Literature as a pathway to empathy also has a long tradition within medical education for patient care (see, for example, Schneiderman 2002). Thus, it would seem that the reading of literary fiction offers the possibility of an intentional intervention to promote empathy. ...
... Studies examining the effects of reading on attitudes suggest that reading can promote prosocial attitudes toward (typically, minority) others (for a summary of examples, see Hakemulder 2000 andPaluck andGreen 2009). Literature as a pathway to empathy also has a long tradition within medical education for patient care (see, for example, Schneiderman 2002). Thus, it would seem that the reading of literary fiction offers the possibility of an intentional intervention to promote empathy. ...
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In the field of organization studies, little consideration has thus far been devoted to the study of literature. The lacuna in the extant scholarship is unfortunate insofar as there is much to be gained for researchers interested in understanding organization to critically engage with literature. As an illustrative example of how literature can inform myriad pertinent discourses in organization studies, in this piece we study the question of empathy. That is, we describe just some of what may be gleaned about empathy from literature using anecdotes from a pedagogical exercise. Finally, we close this piece with a brief overview of the articles selected for this special issue.
... Los informes atestiguan que el potencial de las humanidades médicas es importante para incrementar el aprendizaje de la empatía con los pacientes. 29,30 Además, existen comunicaciones de que esta inclusión parece especialmente importante durante el tercer año, cuando tanto las experiencias anecdóticas como estudios empíricos muestran problemas con las habilidades de comunicación y empatía de los estudiantes. 31,32 Sin embargo, existe poca información sobre cómo introducir las humanidades en varios niveles, 33 desde el pregrado hasta el posgrado. ...
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This article deals with key aspects of the Social Sciences and Humanities that improve the professional practice in Health Care, and presents some of the challenges, projects, and advances of Latin American scientific publication, especially those of the journal Humanidades Médicas. Later on, it describes the scientific and social impact of an organizational strategy to contribute to the integrated formation of human resources in the Health Care sector through the journal. The strategys prospective results and main tasks within the editorial process and those to increase the journals impact as an editorial product are taken into account, as well.
... Poetry not only demonstrates the work of the profession, but it also provides a medium for nurses to explore the complexities of their profession, to manage the frustrations and stressors that they encounter in their day-to-day working lives and to communicate this to each other, and to people outside of the profession (Bonebakker, 2003;Colquhoun, 2006;Hunter, 2002;Kidd and Tusaie, 2004;Marchand andKushner, 2004, Meites et al., 2003;Olsen, 2002;Peterson, 2002;Phillip et al., 1994;Raingruber, 2004;Rudolf and Storr, 2003;Sargent, 1979;Schneiderman, 2002;Wagner, 2000;Willms, 1999). ...
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This article describes the practice of a ‘poet-in-residence’ in a tertiary hospital in New Zealand, a country with a unique bicultural foundation. During her residency, the poet worked with hospital staff to gain insight into how nurses and midwives contribute to health outcomes. As well as creating 12 poems which make the work of nurses and midwives more visible, the poet provided poetry readings in two clinical areas and conducted a reflective practice exercise using the co-creation of poetry, with a group of newly graduated nurses. This residency demonstrated the importance of connecting the world of science and technology with the world of lived experience and how poetry can help nurses and midwives to express the complexity of human care practice. Copyright © 2007 John Wiley & Sons, Ltd.
... Na seminarium "Dobry lekarz" (A Good Doctor) literatura była punktem wyjścia do pisania krótkich opowiadań, w których narratorem była osoba inna niż lekarz. Celem tej aktywności było wyobrażenie sobie oraz przedstawienie punktu widzenia pacjenta lub też członka jego bliskiej rodziny, przyjaciela lub partnera [20]. Natomiast na fakultatywnym seminarium "Sztuka leczenia" (The Art of Doctoring) studenci czytali opowiadania i poezje odzwierciedlające przeżycia i doświadczenia związane z opieką nad chorym. ...
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Literature, theatrical performances, films and the arts could be used to enhance empathy among students of medicine and residents. The use of these media enables them to learn how feelings are expressed. Through study of literature and the performing arts students can also gain new insights into their own emotional responses to illness and suffering as well as into the moral and ethical issues posed by medical practice. The objective of this paper is to describe ways in which literature, film, drama, and the arts are used in medical schools to enhance empathy in students of medicine. We also want to show the rational purpose for the inclusion of these media in medical school training. We searched PubMed, ProQuest, ERIC, MedLine, and Polish Medical Bibliography (Polska Bibliografia Lekarska) published from 1990 to the present--for studies that address use of literature, drama, film and the arts for teaching empathy to medical students. Analysis of papers reporting use of different forms of literary, artistic, and performing arts productions within the context of medical education indicates that exposure to these types of media, when used properly, may trigger attitude change, foster understanding of the illness experience and enhance empathy for the patients.
... Los informes atestiguan que el potencial de las humanidades médicas es importante para incrementar el aprendizaje de la empatía con los pacientes. 29,30 Además, existen comunicaciones de que esta inclusión parece especialmente importante durante el tercer año, cuando tanto las experiencias anecdóticas como estudios empíricos muestran problemas con las habilidades de comunicación y empatía de los estudiantes. 31,32 Sin embargo, existe poca información sobre cómo introducir las humanidades en varios niveles, 33 desde el pregrado hasta el posgrado. ...
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This article emphasizes on the importance of including literature as a subject in the medical curriculum and particularly in the teaching of medical humanities. It underlines the importance of the physician-writer and the non-physician writer, who may become patients at the same time, justifying why to include this subject in teaching medicine. Finally, the article suggests four steps to create a course in this field: text selection, definition of the content, time of inclusion within the curriculum, and distancing as a methodological strategy.
... Physicians intrinsically value the activities-storytelling, learning about humanity-and their positive impact on physician empathy. 24 Such curricular initiatives may impact medical outcomes such as patient safety, and may contribute to more successful physician recruitment and retention. The ESWIM survey presented here provides a quantitative method for evaluating physician attitudes that may lead to enhanced medical care. ...
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The emphasis in medical education on viewing the patient as a whole person addresses current concerns about the negative impact of standard physician training that may lead to impaired patient-physician relationships. To assess self-ratings of empathy, spirituality, wellness, and tolerance in a sample of medical students and practitioners to explore differences by gender, age, and training. A survey was created that assesses empathy, spirituality, wellness, and tolerance in the medical setting. Surveys were completed anonymously by medical students and practitioners from the medical school. The youngest groups scored highest on empathy and wellness and lowest on tolerance. Participation in medical school wellness sessions correlated with higher empathy and wellness scores; participation in both empathy and spirituality sessions correlated with higher empathy scores. Exposure to educational activities in empathy, philosophical values and meaning, and wellness during medical school may increase empathy and wellness in medical practice.
Book
This welcome updated and expanded edition offers new findings and insights into this cornerstone of practice as well as effective tools for its clinical use. Spanning psychodynamic theory to neuroscience and evolution to medicine, the book defines empathy in the context of patient care, and both in its critical role as a human attribute and in its necessity in promoting change and healing. Theory and data link practitioner empathy with patients’ positive outcomes in areas such as provider trust, treatment adherence, clinical improvements, and quality of life. Author also provide convincing evidence in support of validity and reliability of the Jefferson Scale of Empathy for measuring the empathy of practitioners and students in the healing professions, and detail obstacles to developing and strategies for enhancing empathy among care providers. Among the topics covered: • Definition of empathy in patient care. • Conceptualization and consequences of empathy and sympathy in patient care. • An evolutionary perspective, sociophysiology, and heritability of empathy. • Measurement of empathy in the general population and in health professions-in-training, and in-practice. • Interpersonal dynamics in clinician-patient relationships. • Ten approaches to enhance empathy in Health professions education and patient care. • Exploration of neurological underpinnings of empathy. • Plus in-depth discussion of development, psychometrics, and correlates of the Jefferson Scale of Empathy. An essential text in theory and applications, Empathy in Health Professions Education and Patient Care enhances the work of health professions students, faculty, and practitioners in a variety of disciplines such as medicine, nursing, dentistry, psychology, clinical social work, and other health professions.
Chapter
Empathy is viewed as an important element of professionalism in medicine; however, a few obstacles to the development and implementation of empathy exist in medical education and practice. Health professions education and the health care system have become very reliant on computer-based diagnostic and therapeutic technology that may limit students’ and practitioners’ vision about the importance of human connection and empathic engagement in patient care. Given the findings that medical students tend to develop a certain cynicism as they progress through their medical education and empathy erodes in medical school and postgraduate medical education, it is timely and important to pay serious attention to enhancing and sustaining empathy in the health professions education and patient care. Enhancing and sustaining empathy in health profession education and practice should be considered a mandate that must be acted upon by leaders and educators in the health professions academic centers and heath care institutions. Research shows that empathy is an attribute that is amenable to change as a result of targeted educational programs and educational experiences. Some approaches used to enhance empathy in the health professionals-in-training and in-practice are described, including improving interpersonal skills, audio- or video-taping of patient encounters, exposure to role models, role playing (e.g., aging game), shadowing a patient (patient navigator), hospitalization experiences, studying literature and the arts, improving narrative skills and reflective writing, theatrical performances, and the Balint method. More empirical research is needed to confirm the effectiveness of programs designed to enhance empathy, to examine the long-term effects of such programs, and to develop strategies to sustain enhancement in empathy for a longer period of time.
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Empathy in patient care is addressed in this chapter with regard to the World Health Organization’s (WHO) definition of health, consistent with the notion of a biopsychosocial paradigm of illness. Empathy in the context of patient care is defined as a predominantly cognitive attribute that involves an understanding of the patient’s experiences, concerns, and perspectives, combined with a capacity to communicate this understanding and an intention to help. The importance of the four key features (cognition, understanding, communication, and an intention to help) used in the definition of empathy is elaborated and suggestion is made to make a distinction between cognition and emotion, between understanding and feeling, and between empathy and sympathy because of their different consequences in patient outcomes. Because of its cognitive nature, an abundance of cognitively defined empathic engagement is always beneficial in the context of patient care, whereas excessive sympathetic involvement (akin to emotional empathy), because of its affective nature, can be detrimental to both the clinician and the patient, leading to exhaustion and burnout. In the context of patient care, empathy bonds the patient and the health care provider together, whereas sympathy blinds them to objectivity and reason. Thus, efforts should be made to maximize empathy and regulate sympathy for optimal patient outcomes. To achieve optimal patient outcomes, communication of understanding in empathic engagement between physician and patient must be reciprocal, confirming the patient’s significant role in the outcome of patient care.
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Objectives: The objective of this paper is to discuss suffering in general, the criticism against fibromyalgia and other central sensitivity syndromes [CSS], the deleterious effects of disease-illness dualism, a new unifying paradigm for this duality, and then to suggest a remedial model for better patient care. Methods: A review of the literature using Medline and other sources, and an amalgamation of known knowledge with author's own ideas and inquiry. Results: Bias against CSS are harbored by many physicians, thwarting the progress for a better understanding and treatment of these syndromes. Most physicians believe in disease-illness dichotomy and pay more attention to the structural than the functional pathology, e.g., neurochemical endocrine [NCE] abnormalities. Both types of pathology are likely based on biology. Even psychosocial distress is mediated by neurochemistry. A model is suggested for proper care where patients and physicians work together with a common satisfying goal, each fulfilling their individual responsibilities. Conclusion: Most physicians treat CSS with a negative attitude. The outdated model of diseaseillness dualism should be abandoned in favor of a fresh approach to medical education that fosters compassionate care irrespective of the disease label.
Empathy is defined as a predominantly cognitive attribute that involves an understanding of experiences, concerns and perspectives of another person, combined with a capacity to communicate this understanding. Empathy in the context of clinical care can lead to positive patient outcomes including greater patient satisfaction and compliance, lower rates of malpractice litigation, lower cost of medical care, and lower rate of medical errors. Also, health professionals' wellbeing is associated with higher empathy. Enhancing empathic engagement in patient care is one of the important tasks of medical education. In this article, I briefly describe 10 approaches for enhancing empathy in the health care environment: improving interpersonal skills, audio- or video-taping of encounters with patients, exposure to role models, role playing (aging game), shadowing a patient (patient navigator), hospitalization experiences, studying literature and the arts, improving narrative skills, theatrical performances, and the Balint method. I conclude that empathic engagement in the health care and human services is beneficial not only to the patients, but also to physicians, other health care providers, administrators, managers, health care institutions, and the public at large.
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The medical humanities are concerned with "the science of the human", and bring the perspectives of disciplines such as history, philosophy, literature, art and music to understanding health, illness and medicine. The medical humanities are designed to overcome the separation of clinical care from the "human sciences" and to foster interdisciplinary teaching and research to optimise patient care. Medical humanities have become part of the mainstream in medical education in North America and the United Kingdom, and are now integrated into many medical curricula in Australia. The Australasian Association for Medical Humanities was inaugurated in November 2004; a postgraduate program in the medical humanities began at the University of Sydney in 2003.
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This project introduced medicine-related poetry and prose to a Year 3 family medicine clerkship with the purpose of determining students' perception of the usefulness of such materials to enhance empathy, improve patient management, and reduce stress. Although humanities are represented in the curricula of many medical schools, we need more information on how best to incorporate them during the clinical years. In 2000, we used a needs assessment survey to identify learner perceptions of medical humanities. Using this information, in 2001-03 we developed and implemented a humanities-based curriculum consisting of readings linked to clinical vignettes, comments about humanities reading in required clinical Subjective, Objective, Assessment, Plan (SOAP) notes, and either station-specific or general poetry accompanying student end-of-clerkship objective structured clinical examinations. We collected both quantitative and qualitative data assessing student reactions and examined the data using non-parametric statistics and content analysis, respectively. Students showed moderate interest in incorporating humanities in medical education as a way of enhancing empathy, improving understanding and reducing frustration. Assessment of the clerkship humanities curriculum suggested a positive influence on students in terms of empathy for the patient's perspective, and a lesser, but still positive, impact on patient management. Responses from this group of learners suggest that there is receptivity toward introducing medical humanities into family medicine curricular venues and that such effort can have a generally positive effect on learner empathy, awareness and understanding toward patients and doctors.
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"Literature and medicine" is increasingly common in medical schools but not within medical education research. This absence may relate to it not being problematizable in the quantitative way in which this psychometrically-oriented community tends to conceptualize research questions. Databases were searched using relevant keywords. Articles were evaluated using methodologies appropriate to their fields. The resulting information was structured around a framework of construct-appropriate assessment methods. Literature and medicine is intended to develop skills as potential proxy outcomes for important constructs. Proposed tools to assess these skills are difficult to evaluate using the field's traditional quantitative framework. Methodologies derived from the qualitative tradition offer alternative assessment methods. The medical education research community should take on the challenges presented by literature and medicine. Otherwise, we run the risk that the current evaluation system will prevent important constructs from being effectively taught and assessed.
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The terms professionalism and humanism are sometimes confused as being synonymous; even more confusing, each is sometimes regarded as a component feature of the other. The author argues that, in the context of medicine, the two terms describe distinctly different, albeit intimately linked attributes of the good doctor. Professionalism denotes a way of behaving in accordance with certain normative values, whereas humanism denotes an intrinsic set of deep-seated convictions about one's obligations toward others. Viewed in this way, humanism is seen as the passion that animates professionalism. Nurturing the humanistic predispositions of entering medical students is key to ensuring that future physicians manifest the attributes of professionalism. Medical educators are encouraged to recognize the role of humanism in professional development and to incorporate into their curricula and learning environments explicit means to reinforce whatever inclinations their students have to be caring human beings. Chief among those means are respected role models who unfailingly provide humanistic care, ceremonies that celebrate the attributes of humanism, awards that honor exemplars of the caring physician, and serious engagement with the medical humanities to provide vivid insights into what a humanistic professional is.
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