Jodi Halpern's From Detached Concern to Empathy is a seminal work on developing an understanding of the importance of clinical empathy in medical practice. Halpern's book makes an important contribution within the current literature on clinical empathy which is epitomized by authors such as Ellen Singer More, Maureen Milligan, and Howard Spiro, just to name a few. However, no author so far has presented a more cogent, intuitive, coherent, and persuasive account of clinical empathy. Thus, Halpern's account of clinical empathy should be taken seriously by physicians since her account is not merely a theoretical defense of empathy; she also shows how empathy can be applied in clinical situations.
Throughout the book, Halpern argues that physicians can be more helpful to patients if they empathize with them rather than detach from their emotions. Learning how to empathize is as important for physicians as learning how to perform technical medical procedures. There is increasing evidence in medical practice that emotional interactions with patients are fundamental to patient healing. Medical effectiveness does not merely rely on technical expertise but also on interpersonal communication between the patient and physician. Doctors who practice detachment seem to miss important cues about what patients were thinking and feeling with regard to their diagnoses and treatment and this wastes time, leads to missed diagnoses, and an inadequate adherence to treatment. Thus, physicians should strive to be empathic and engage in emotional communication with their patients as soon as possible. Halpern's book challenges the traditional assumptions that empathy is either purely intellectual or merely an expression of sympathy. Emotional engagement is neither detached reasoning nor untrained sympathy. For Halpern, emotional reasoning is the core of clinical empathy. Empathy involves being able to resonate emotionally with a patient's experience In order to imagine how it feels to experience that patient's illness. When a physician sympathizes with a patientís feeling, he need not understand it nor do anything about it. However, empathy requires more than observing; it involves noticing what is important for the patient from within the patient's perspective. Thus, empathy is an experiential way of knowing a patient's emotional states with the purpose of better understanding the patient.
Therefore, what is needed is a paradigm shift from detachment and objectivity to emotional engagement and subjectivity in medical practice. There are three important benefits of clinical empathy. First, a correct diagnosis involves an empathic understanding of the patient's emotional experiences in relation to his/her illness. Empathy helps a physician understand the patient's health habits, psychological needs, and social situations. Second, empathy helps patients to process difficult information about their diagnosis and treatment and to gain autonomy by participating more fully in their medical treatments and decisions. Third, empathy can transform moments of emotional irrationality into positive therapeutic influences, especially in situations in which a patient receives a negative diagnosis. Empathy can help the patient feel less frightened about the future by ensuring that the physician will never abandon the patient but will stay with the patient for the duration of the illness.
Halpern's book also deals with the means of cultivating empathy. One way of cultivating empathy is by developing and retaining an engaged curiosity about a patientís experience of illness which involves suspending judgment and allowing oneself to be uncertain. This curiosity is grounded in an affective experience of connecting and wanting to relate to the patient as another self. Cultivating curiosity develops empathy over time. Curiosity presupposes a physician's ongoing attentiveness and openness to the patientís experience of illness. Halpern holds that medical practice involves more than mending physical bodies; it involves healing emotional states which can best be achieved through empathic communication between physician and patient. Thus, emotional receptivity is necessary if physicians are to acknowledge the pain and suffering that patients cannot put into words. Through clinical empathy, physicians allow a patientís suffering to be real.
In conclusion, Halpern's book is insightful, well-reasoned and a joy to read. In addition, Halpern's book is well-balanced in that she does not merely present the advantages of clinical empathy but also some of the drawbacks to being overly empathic, such as over-identification. Halpern's book provides a guide for cultivating empathy for reflective physicians. This book will be of interest to physicians in diverse fields of medicine, medical educators, and students. Perhaps it is time for physicians to rethink the scientific and objective paradigm of medicine in favor of a more subjective and empathic paradigm. Both physicians and patients would benefit from such a paradigm shift.
Irene Switankowsky, University of Waterloo