Posts Tagged ‘Empathy’

Apple World

Photo Credit: W Yuting, University of Oregon

If I were to ask you right now to list the most important qualities you want in a doctor, you would probably start with “Competent” and “Empathetic.” The first word out of your mouth would probably not be “Creative.” And yet, there is a growing trend in the medical literature and medical school curricula toward incorporation of the arts and humanities in physician training. Why?

Dr. Danielle Ofri, in her excellent article in the New York Times points out that creativity in medicine would not be unheard of: “Medicine is a field with a strong history of creativity, but its daily practice feels less and less so.” Creativity is tied to innovation and so should always be welcome if a field wishes to progress. But is getting medical students to read poetry and looking at paintings just a bunch of fluff? Not according to two well respected physicians at the University of Georgetown who offer this concrete example of how humanities sensibilities enhance medical clinical skills:

“Selected viewings of art with trained art historians,” in which medical students “learn context, practice description, and note emotion.” This could help to understand and identify “the different cultural and historical lenses through which images are filtered”—an important way to understand the assumptions they bring to their interpretation of a set of symptoms.”,

But what about at the day to day level, real patient, real person. What difference does it make when a doctor gets creative? Dr Ofri gives a  great example from Dr. Oliver Sacks in which a patient had Tourette’s syndrome with debilitating tics that were negatively affecting his home and professional life. He was prescribed Haldol, which eliminated the tics but also flattened his ability to improvise as a jazz drummer, one of his favorite activities. The non-creative doctor response would have been “You have to take the good with the bad”, as Ofri notes. But the creative doctor proposes “Take Haldol during the week so you can do your job, and hold at the weekends so you can play your drums like you used to.” The solution is not only creative but empathetic. And this is where I think the link is crucial. Because of how much I care about the entire health of my patient, my empathy fuels my creativity.

If there is one clear lesson I learned from my years in Theatre it is that people have many layers. Often, these layers contradict each other. I want to eat healthily, but have you tasted that burger or chocolate mousse? I want to give but I also want to take. I want to create but sometimes, I also want to destroy. Contradictions are part of who we are. That is why I think that Ofri proposes that computers can never effectively treat people:

“If all patients and their diseases presented in exactly the manner of the textbooks, then the algorithms would be sufficient . . . but the human condition is far messier — in health and even more so in illness.”

Anton Chekhov, a doctor, became one of Russia’s most celebrated playwrights precisely because of his fascination with human frailty or weakness, first physical and then psychological and emotional. He wrote characters who were compelling not because they were eloquent, morally outstanding or successful but because they were profoundly human, aspiring to be something greater even if they did not always succeed. The creative doctor is one who looks at this person first and the disease second.

That’s not easy. Using standard treatments and keeping on schedule in a pressurised healthcare environment is far more efficient. Stopping the world to “create” for your patient demands so much more from the doctor, often within a system that does not encourage it. And yet, if we are to stay true to the ideals of medicine, we must swim against the tide and be creative for our patients. Creativity is an act of empathy.

Do you want your doctor to be creative? I hope so.

Ex Machina

Ex Machina (2015)

They say things happen in threes.

One, I watch a movie, Ex Machina, which poses provocative questions about how real an artificially intelligent human can be.

Two, I am in the middle of Neurosurgery research and come across some of the latest applications of Virtual Reality to navigate around the brain as if you were inside it.

Three, I get an email from my medical school about a new project in which students can practice difficult conversations with patients by speaking with virtual humans.

I like toys, but I do not consider myself a techie. Yet, I find myself fascinated by the concept of Virtual Reality. Why?

Then it hits me. I am trained in Theatre. Theatre is, by definition, Virtual Reality! You create a 3-D space with objects that look real but aren’t (as any actor who has had to eat cold mashed potatoes as if it were delicious ice-cream will tell you!). You surround yourself with people who are supposed to be real people  with whom you have real relationships. But of course, the whole thing is made up. The curtain will come down (the “console” will switch off). And just like that, Richard III becomes your cast mate and you go get a drink, no longer having to worry about being impaled on a sword (unless you gave a terrible performance . . .). And yet, your imaginary creation sent a room full of people home feeling new emotions and thinking new thoughts.

And so, the question becomes if the “Virtual Reality” of Theatre can provoke an emotional response, could the computerized Virtual Reality do the same, and perhaps even trigger the crucial emotion of empathy? That question must have occurred to journalist Nony Lapena when she teamed up with technologist Palmer Luckey to create a virtual world to portray the devastating reality of war-torn Syria http://techcrunch.com/2015/02/01/what-it-feels-like/

Her work was presented at this year’s Sundance Festival. So why does Ms. Lapena do it?

“Syria is so far away from most Americans. How do you attract a younger audience who might not pick up the newspaper to think about these important issues? That’s the point of all good journalism.”

Project Syria

All of which takes us back to the medical school project. Can interacting with virtual humans really help me prepare for such conversations with real patients? That depends, I imagine, on how “real” they are. And how do you know that? At what point does a computerized human cross that threshold? The movie Ex Machina proposed The Turing Test in which a human interacts with a machine that she is blinded to. If the responses of the machine convince the interrogator that she is speaking to a human, the machine has passed the test. In developing this test, Alan Turing raised an interesting point. The question, he said, is not can a machine think, but can it imitate human thought?

I have heard this line of reasoning used before in terms of empathy. Do we need to feel empathy to show it? Or is empathy a skill, a craft that should be learned like any other part of the physician’s arsenal?

The neurosurgeon uses Virtual Reality to master the architecture of the brain, through relentless repetition and adjustment. Can empathy be achieved in the same way? Is it trainable?

Virtual Reality Surgery

Virtual Reality Surgery

And, ultimately, when the headset is removed, the electronics shut down, and I am sitting in front of a patient with all our histories, biases and experiences present, but invisible and we begin to talk, into what reality have we just entered?

Have an existential weekend!