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Note:  The following was written in January 1997 and printed in the February 1997 issue of DermWorld as an essay for the “President’s Message” column.  As I re-read these lines today (April 27, 2007) the message is just as relevant as it was 10 years ago.

W. Mitchell Sams, Jr., M.D.                                   


Empathy is the ability to reach inward with another human being---the ability to share their joy and their pain.  As caring physicians we do both with patients, although it may be more often their fears and concerns than it is their successes.  But doing so effectively requires either an intimate knowledge of the other person’s inner being or your personal experience with the same event.  Cassell has written: “It is possible to know the suffering of others, to help them, and to relieve their distress, but never to become one with them in their torment”1.  Even under the most ideal of circumstances, our abilitities to empathize are limited.


This type of empathy requires time---time with the patient over many visits to your office.  It cannot be developed with an office visit lasting only a few minutes.  This is one of the reasons to be concerned with the health care revolution which is forcing the conscientious physician to spend less and less time with each individual patient.  In a system which requires that we see more patients per unit time in order to meet office expenses, how can we spend the time necessary to express our empathy or our compassion?


Our abilities become even less effective when we permit our own bias to come between us and the patient.  I doubt, for instance, that as individuals we are equally empathetic for patients of all social classes or races.  Do we show the same empathy for a patient whose disease is due to his own abuse of his body (the smoker or the obese) as for the patient whose disease was totally unpreventable?  What about our empathy for those whom we inherently dislike or those whose experiences, customs and beliefs differ from our own?  


And even where we, as the physician of record, may feel deep empathy for a patient, what about those to whom we delegate responsibility for some or all of the care, such as our nurse?  Nadelson wrote:  “We expect that they will be empathetic with people whose experiences, values, and needs differ from theirs, and make clinical and ethical decisions accordingly”2.  Sometimes, of course, these individuals may, because of their particular life experiences, demonstrate more empathy than even the physician.  This could create its own set of problems within the office environment.


There is also the very real likelihood that we become “hardened” by multiple encounters with the same disease.  For instance, are we as understanding of the 100th patient with severe psoriasis as we were with the first?  Do we still empathize with the social and personal adjustments he must make in his professional and home life?


I ask these questions, not because I know the answers, but solely because they are the questions that concern me and must inevitably concern all caring physicians and must be thought about and asked.   We must constantly guard against losing our ability to be compassionate and empathetic physicians, because,  should that occur, we have lost the most fundamental imperatives of the patient-physician relationship.


1.  Cassell E.J.: Recognizing Suffering.  Hastings Cent Rep 1991:21;24-31

2.  Nadelson CC: Ethics and Empathy in a Changing Health Care System. The Pharos. 1996:Fall, 29-32

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