The exam room is a sacred space, one in which people bare themselves both emotionally and sartorially. It is a secular confessional, a chapel for the examination of sinew and sin, pain and disbelief, intimate failings and mortal fears. Sometimes it is a place to share joy, but more often it is a place to explain one’s physical and emotional imperfections in hope that someone will hear and understand in a concrete way.
The interaction between patient and doctor isn’t that well-studied. There are strong suggestions in the literature that the more we allow our patients to set their own agendas and to answer open-ended questions completely, the more likely the patient’s problems are to be addressed. But what takes place in the exam room? What is it that allows a patient to bare soul and body and allows a physician to really understand what a patient is saying and feeling?
One popular notion is that empathy, like good looks, is something some people just happen to have. I perceive myself as being an empathic physician (which of course may not be entirely true) and I’m curious what makes me so. When I think of my own interactions with patients I notice a few things. In addition to standard listening techniques, I try to imagine how a patient feels—viscerally, literally, physically. If a patient describes chest pain, I try to imagine what it feels like as described. I try to imagine the emotions they felt when they had it, the fear, the uncertainty. And I try to gauge the patient’s reactions to my reactions. My facial expressions and posture can promote fear or give comfort. If I want the patient to continue to be concerned, my words and actions can purposely fail to give them complete reassurance (always telling them, though, that we will do whatever we must to get to the bottom of things).
I don’t presume that this always works out for me and my patients—this is necessarily an empiric exercise, a muddy one that goes on from minute to minute and is measured in subtleties. I’m also not sure how deeply this should be studied formally. While I’m certain that empathy can be taught (or at least a reasonable facsimile of empathy), I’m also certain that there is not one sort of “empathy” that works for all doctors and patients. There will always be some mystery in the exam room, and that is what makes it sacred.