The Importance of Remaining Empathic

The patient-physician relationship has many dimensions––technical, psychological, moral and legal. At its essence, however, it is a professional relationship. As in all such relationships, there exists a set of boundaries between the parties that allow each to act according to his particular role and responsibilities, in a safe environment. The existence of such boundaries implies that the notion of "professional distance" is, in fact, a necessary one in clinical practice. However, "distance" can be mistakenly equated with "detachment" – or the removal of the affective component from the patient-physician relationship. "Detachment" and "engagement" are two discrete approaches to dealing with patients. The latter, in the author's view, is the only approach which truly allows for empathy. This essay will attempt to characterize empathic engagement in the physician-patient relationship, and will aim to reveal the advantages of this approach over detachment. In a famous address given to his students, Osler proclaims that a " judicious measure of obtuseness " – or detachment – should be developed upon entering the field of medicine (1). This so-called " art of detachment " represented for him the way physicians could meet the exigencies of the profession with " firmness and courage " (1). Although Osler is also well known for his superior ability to engage with patients, his teachings on the subject of detachment are not adopted by today's medical schools. According to Carr, " one problem with detachment [...] is that its essential starting point is separation. Rather than communicating care and acceptance to the patient, the physician who begins with detachment communicates impatience, nonchalance, or perhaps even [...] contempt. " (2) Other authors consider that detachment is a flawed model for conducting patient care. Halpern (3) reviews at least two major reasons why doctors themselves might seek detachment from, rather than engage emotionally with, their patients: first, the belief that emotions are inherently subjective and interfere with objectivity; and second, an alleged protection from burnout. Halpern refutes the first point by showing how the arrival of new technologies over the last century have contributed to undermine " humanistic " practice in favour of strictly " objective " measures of care. She then shows that the skill of clinical empathy is in fact "emotional reasoning". In her view, the clinician uses subjective, experiential input for specific, cognitive aims to enhance medical judgement (3). Secondly, she argues that, despite popular belief, detachment does not …