Practical Wisdom – Part 3: Empathy

The balancing acts of wisdom.  Schwartz and Sharpe, purveyors of practical wisdom, explained it in part as follows:

“Anybody who has raised a child, sustained a friendship or marriage, supervised others in the workplace, or worked to serve others knows the limits of rules and principles.  We can’t live without them, but not a day goes by when we don’t have to bend one, or make an exception, or balance them when they conflict.  We’re always solving the ethical puzzles or quandaries that are embedded in our practices because most of our choices involve interpreting rules, or balancing clashing principles or aims, or choosing between better or worse.  We’re always trying to find the right balance.  Aristotle called this balance ‘the mean’.  The mean was not the arithmetic average; it was the right balance in a particular circumstance.”

A theme that surfaces repeatedly in our practices is empathy, which Schwartz and Sharpe concentrate on heavily as a signpost of wisdom.  They note:  Empathy is a character trait that we value in ourselves and in our friends, colleagues, and the professionals who serve us.  We saw that the know-how to be empathetic is central to practical wisdom: unless we can understand how others think and feel, it’s difficult to know the right thing to do.  But empathy has its dark side: too much understanding and sensitivity, too much seeing things from the other’s perspective, can cloud judgment and paralyze choice.  Edmund Pellegrino, a scholar and chairman of the President’s Council on Bioethics from 2001 to 2009, explains it like this: “If a physician identifies too closely as a co-sufferer with the patient, she loses the objectivity essential the most precise assessment of what it wrong, of what can be done, and of what should be done to meet those needs.  Excessive co-suffering also impedes and may even paralyze the physician into a state of inaction.”

I have a colleague to whom I’ve periodically referred patients for consultation or surgery who clearly tips the scale of detachment too far in the opposite direction.  He is cool and distant toward patients at his best, and downright nasty at his worst.  Though he’s technically a good diagnostician and surgeon, its gotten to the point where I shy away from referring patients to him.  Just last week I had a young woman return to me in tears, pleading with me to never send patients to that doctor’s office.  His technical brilliance is significantly diminished by his lack of empathy.

Though you would think that empathy is something all doctors naturally factor into the balance of practical wisdom, that is clearly not the case.   There’s a nice discussion about this online at Cataract & Refractive Surgery Today Europe.  These ophthalmologists identified time and patience as the biggest challenges physicians face when providing patients with emotional support. “Empathy and efficiency often cannot coexist. The modern market economy and [the business of] medicine has forced doctors to spend less time with patients,” Dr. Wang wrote.  Yet another reason, I would argue, for keeping participation in third party plans to a minimum.

– Leonard J. Press, O.D., FCOVD, FAAO

2 thoughts on “Practical Wisdom – Part 3: Empathy

  1. Len- Thanks for your always interesting views and considerations of what we do and how we do it. There always has to be a balance between all the factors as you’ve suggested. I agree that not participating in all insurances is probably a good idea for the many reasons you’ve shared. I personally really believe we should be involved in the medicaid/medicare area though. I can also understand those that do not feel they should. Probably half of my practice is in this area. We see many developmental delayed children(this week I saw several chromosome deletion cases, hydrocephalus at birth, encephalopathy, Rett syndrome, etc.). We also see patients on the rehab wing at our hospital. These patients are able to recover much quicker and more fully when Optometric care is provided to support the rehab team. This week we had several garden variety cva’s and motor vehicle accidents, Gerstmann’s syndrome and Guillain-Barre on the wing.

    Being a participating provider allows me access to provide care for these patients. These populations are where I really appreciate the value of what we can do for our patients. Many families are financially strapped with these children who are developmentally delayed and acquired brain injuries who have no funding left either, except through government programs. Not only can we provide a great service for them, but we have an opportunity to open doors with other colleagues and professionals on the value of visual rehab/vision therapy and how important it really is. Lastly, I’ve learned so much about development and rehabilitation from these patients, their families and all the other professionals that work with them. This of course leads us to even more efficacious and important contributions that we as Optometrists can develop to help these populations, and it also changes how we now work with our more traditional cases. I enjoy your thoughts on how we should consider participating, but also suggest some of these special populations may be very limited to have access to unless you’re involved as a participating provider.
    Respectfully yours, Curt

  2. Dear Len,

    Thank you for taking the time to put this into words. It is a challenge I face every day– a very difficult balance indeed. I tend to sway in the opposite direction from your dreaded colleague, but I never had considered the “action paralysis” aspect as a direct result of an overactive tendency towards empathy.


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