Humor and Empathy
One might find pairing humor and empathy together in the title of an article in a medical journal a bit peculiar. For me as a geriatrician with a particular interest in dementia, ethics, palliative, and end-of-life care, the pairing makes perfect sense.
One hears quite commonly that “having a sense of humor” is key to enjoying life, relating to people, having good relationships, enjoying sex and longevity—depending on who you ask. There is probably some truth to all these statements but like many ideas which appear to be cliché their validity is what makes them cliché and stereotypical. It is accepted as such a clear quality that many people endeavour to “improve” their sense of humor, by equating humor with “jokes." There is nothing as sorrowful as someone who is giving a talk and tries to be “humorous” by opening the talk with a “funny story." Often enough it falls flat or is off the mark and the silent reception by the audience does not bode well for the rest of the talk—however, people generally being relatively polite do often give the person the benefit of the doubt and may attribute to the flatness of the story by its “delivery” or lack thereof. There are even jokes in which that is the punch line.
Most people who are recognized as having a sense of humor will explain that it has always been part of their personality, was not something “learned”, was recognized as an attribute early in their life and had number of key attributes. One important fundamental element of humor is a keen understanding of language and how words, even ordinary words when used in certain ways, with certain variations and combinations results in connections that when made are deemed by listeners to have either an absurdity, audacity, riskiness or recklessness that result in that response which we deemed to be appreciative of humor and of course results in that universal activity known as laughter.
Being facile with words and having the ability to play on them and approach the boundaries of normal societal behaviour are often the underpinnings of humor and those who know apparently humorous people understand that they are the most appreciative or their own humor—how often does someone in the midst of recounting a funny story, have to stop because of their own participation in laughter—sometimes to the point of not being able to end the story without guffawing through it. But the essence of humor appears to most observers to be part of one’s make-up even with a wide variation and range—rather than something one can easily learn and master from external sources.
Empathy, that ability to enter the emotional and experiential space of another person is likely also to be something intrinsic to a person. We all have met people who seem to totally lack empathy—the ability to respond to verbal or nonverbal indication of suffering and pain, other than at only the most concrete level. As physicians it is hoped that one of our fundamental characteristics is having empathy—most people, who will at one point or another will be patients are likely to commend those physicians who are empathetic and condemn those who are not. Fortunately in most interactions between physicians and patients the emotional content of the interlude does not have great emotional content unless by choice the physician is in a field in which emotions are intrinsic to the total medical interaction—examples presumably include psychiatry, paediatrics, adolescent medicine and palliative care. I would add that essential to geriatrics, empathy plays a major role and one that cannot be learned by the mantra of “I hear you” when someone is speaking about a heart-wrenching experience of event, as a means of demonstrating apparent empathy.
The importance of empathy or its lack thereof was highlighted in a very touching article published in the May 10th issue of the Journal of Clinical Oncology, “Acquisition of Compassion Among Physicians: Why Is This Rite Different From All Other Rites?” by Benjamin W. Corn, in which the writer describes one of his first interactions with a physician who seemed to lack all conception of empathy in how he addressed a family that he had just told over the phone that their dear father and husband had died, and then with hardly a pause for a post-mortem. The article was touching as many of us in our lives have had comparable experiences if we have had to address the death of a loved one, especially within the hospital or health care system.
I recall a nursing supervisor in the middle of the night as I was in essence sitting watch for my dying mother who earlier that day after she decided to pull her feeding tube, and then my father, my sister and myself decided to not reinsert it knowing how much it annoyed her while acknowledging and accepting despite hope that her end was clearly in sight. It was with great tears and pain that my father agreed to not re-insert the tube as we huddled together outside her 6 bedded room in a New York City hospital. The nursing supervisor when she saw me said, “How could you choose to starve your mother to death?” I could not believe my ears but rather than confronting her with all the contained venom and disbelief that I felt, merely said, “This is what my father, my sister and I believe is what is best for my clearly dying mother who has suffered and is still suffering." I would hope that in the intervening decade and a half such an attitude to discontinue artificial feeding and hydration would have changed, but the lack of empathy still likely exists among many healthcare providers.
For those responsible for medical education which includes the decisions to result in admission to health care professional education, how does one recognize those applicants with the right combination of intelligence and aptitude and an empathetic personality? It is not only not easy but what appears to have happened in the past decade, especially in medical school admissions, the focus appears to be on what research accomplishments have occurred prior to applying to medical school rather than what evidence is there of an empathetic personal character. When I hear my academic colleagues talk about new physicians one often hears comments about “how smart they are” or “what they have accomplished already in the academic field” rather than “how nice they are with patients." When you ask patients what they want in a doctor they often use the very old-fashioned phrase, “a good bedside manner” which may in essence be a lay expression for empathy, patience and the ability to listen, absorb and internalize the human condition in general, and that of a given patient in particular.
Can we find ways to identify those applicants with the ideal combination of academic and clinical ability and personal qualities of patience and empathy? This should become a focus of determining who is accepted into the fields of health care with a special focus on physicians as in many ways they may set the standard and example of all those that work with them as trainees and as members of health care delivery programs and teams. As for humor, a good pre-medical education and exposure to literature and other aspects of the humanities might be a good start.
