Does authenticity matter when it comes to empathy?

take care of old mother - young female hand giving a red heart to old hand of a mother

by Perry Dinardo

In the past few months we at the Gold Foundation have noticed heightened discussion of the role of authenticity in medical practice. Here, we summarize four recent posts on this topic.

In June 2015, we posted a reflection by guest blogger Sam Schueler, MD, entitled “What happens when you run out of empathy?” Dr. Schueler details his feelings about a particular patient encounter which was complicated not only by the details of the patient’s medical condition, but also by language and cultural barriers. Schueler writes, “I found myself wishing that I was about to see a healthy 30-something-year-old patient who speaks English and is familiar with the United States health care system, while simultaneously being ashamed of having such thoughts.” Regardless of these thoughts, Schueler did his best to care for Mr. P in a humanistic way. He concluded that “humanism is not defined by feelings; it is defined by actions.” This sparked lively discussion among Gold Foundation staff members. Is it better to present as empathetic even when you don’t truly feel it? Or is authenticity required behind the behavior?

Soon after Schueler’s post appeared on our blog, the Washington Post detailed a case in which a surgical team had mocked a patient while he was unconscious, all of which was caught on tape. Two Gold Foundation staff members, Brandy King, MLIS and Liz Gaufberg, MD responded to this incident via a blog post in which they state that respect and compassion must be present in all aspects of a healthcare interaction, whether patients are present and conscious or not.  The unprofessional behavior  displayed in the mocking incident has serious implications for the culture of medicine, not to mention patient safety. The authors present ways to improve this culture and train respectful and professional healthcare providers, one of the main goals of the Arnold P. Gold Foundation.

In September 2015, Rebekah Bernard, MD, addressed the question of authenticity on the popular blog Kevin MD in a post entitled, “Can you fake empathy until it becomes real?”  Dr. Bernard details some of the factors that might contribute to an erosion of a healthcare provider’s compassion, then asks, “So if we know that empathy is critically important, but we just don’t feel empathetic, what are we to do?” To answer this question, she arrives at the same conclusion as Dr. Schueler:“You don’t actually have to feel it, you just have to show it.” She goes on to talk about how studies show that acting empathetic can in fact lead to feelings of true empathy. In this way, her high school acting class was the foundation for developing  the interpersonal skills necessary to foster feelings of true empathy and compassion.

At the same time, it’s important to remember that such acting needs to be extremely convincing, or else it may be worse than not trying at all. In the same month as Dr. Bernard’s post was published,  The Lancet published an essay by Caleb Gardner, MD entitled “Medicine’s uncanny valley: The problem of standardizing empathy.” Dr. Gardner describes interactions with various healthcare providers caring for his father in a cardiac intensive care unit.  In listening to his father’s physician, Dr. Gardner recognizes specific phrases and language taught in medical school lectures about delivering bad news to patients and families.  In speaking about Dr. Gardner’s father, the physician did everything just as she was taught. Unfortunately, as Dr. Gardner writes, “her approach couldn’t hide the fact that she would rather have been looking at the screen of her smart phone than talking to me or my mother; if anything, the rote phrases she used emphasized it.” This experience serves as a cautionary tale about the dangers of trying to fake empathy; as Dr. Gardner writes, “The only thing worse than not having it is being insincere about it.”

We’re curious to hear from our Gold Foundation community. What do YOU think? Can and should empathy be “faked” if it isn’t truly felt? Or does it really come down to needing authentic empathic feelings behind behavior? What implications does your answer have for medical education and humanistic practice?

Perry DinardoPerry Dinardo is a 2014 graduate of Duke University, an employee at Boston Children’s Hospital and a Research Intern at The Arnold P. Gold Foundation Research Institute.  She plans to attend medical school in the future and is excited to contribute to the Gold Foundation’s work.