Empathy: a timeless skill for the pain medicine toolbox.

The timeless appeal of the image of a kindly physician at the bedside, portraying the special relationship of physician and patient sharing an illness experience, transcends more modern images of medicine, such as the masked doctor in scrub suit gloving for a procedure to fix a medical problem, a symbol of the technical isolation of doctor from patient. This empathic relationship, a principal therapeutic tool of the physician in earlier times, is endangered in today's medical culture , opines Dr. John Banja in our Ethics Forum. He carefully examines the value of empathy in medical care, the causes and effects of the loss of empathic expression in the physician-patient encounter, and its particular relevance to the specialty of pain medicine. We, after all, define our specialty by the very suffering for which empathy may provide the only salve when our more modern medical interventions fail to cure chronic pain. Empathy is not sympathy, he emphasizes, but rather our ability to share therapeutically with patients our understanding of their suffering. By virtue of both our unique knowledge about the nature of pain and suffering and our pre-eminent clinical expertise in helping patients manage pain and suffering, shouldn't our core professional attitude be empathic expression? Shouldn't we be the experts, the teachers of other physicians? Dr. Banja does not suggest that we retreat to an earlier time when we had few technical tools for treating pain. The value of his treatise lies in its exposition of the benefit of empathic expression for the practice of modern pain medicine. We all struggle to define common ground with our patients, to establish therapeutic goals consistent with their inner values and conscious desires. The growing literature on disparities in health care emphasizes not just equal access to quality treatment but providing choices to our patients based on their personal preferences, which to some extent are culturally determined in our multicul-tural society. When our treatment clashes with their preferences, a successful outcome of treatment is less likely. Empathic expression improves our chances of understanding these preferences in each of our patients. By doing this well we avoid the scenario in which our authority, as an expression of our own needs, rather than the patient's true desires and best interests, determines medical care choices. The medical context determines the range of choices. A life-threatening emergency such as crushing chest pain presents only one choice for a patient …