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Seeking balance when it comes to power

Yale Medicine Magazine, 2002 - Autumn


As third-year medical and nursing students head for the wards, a day is devoted to art of communication.

For a health care provider, real empathy boils down to whether he or she has genuine curiosity about individual patients, according to Jodi Halpern, M.D. ’89, Ph.D. ’94. Clinicians who adopt a listening stance discover the distinct experiences of the individual patient, and the empathy that follows empowers both the provider and the patient. It also enables clinicians to remain passionate about their work.

Halpern, assistant professor of bioethics and medical humanities at the University of California, Berkeley, was the keynote speaker for Power Day, when rising third-year medical students met with 60 advanced-practice nursing students to analyze how collaboration enhances patient care. Power Day concluded a weeklong program that introduces the students to the hospital wards, with lessons on charting notes, cardiac life support and mastering other essential skills. Years ago, the students had one day, known as Survival Day, to prepare for the wards.

Often, misunderstandings develop because clinicians don’t recognize their own power, said Nancy R. Angoff, M.P.H. ’81, M.D. ’90, HS ’93, associate dean for student affairs, adding that attending physicians, residents, nurses and students need to be aware of their interactions. Halpern urged the students to reflect on their own roles while analyzing their vulnerabilities. She questioned notions in the medical “culture” such as the assumption that patient autonomy means establishing a distance between caregiver and patient, the failure to be open to alternative approaches to treatment and the reluctance to feel or express emotions. Halpern said her own interest in empathy began after being criticized during her third year as a medical student for “feeling too much.”

Empathy requires little extra time and can result in more efficient care, said Halpern. Providers can practice empathy by keeping journals and occasionally writing narratives from the patient’s point of view. Such notes contributed anecdotes for her book, From Detached Concern to Empathy: Humanizing Medical Practice, which argues that the detached, seemingly objective approach does not always lead to the best care. “The goal of empathy is not to share the same feelings, but to allow the patient to regain her autonomy and feel socially effective,” Halpern said.

After six months, the medical students will meet again to analyze their experiences and decisions. “In order to change the culture, we have to change the stories of the culture,” Angoff noted. “The stories of success must be stories of good use of power.”