Journal club: Empathy as Emotional Labor

The article.

Now this article is old news, it was published in JAMA in 2005. But our psychiatry tutor brought it up this morning and I just had to look it up.

For those of you who don't feel like reading, it's basically an article that examined the "work" involved in displaying empathy for your patients when you may or may not actually feel it and whether practicing your ability to act empathetic is a valuable component of medical education and training.

The conclusion they came to:

Although deep acting is preferred, physicians may rely on surface acting when immediate emotional and cognitive understanding of patients is impossible. Overall, we contend that physicians are more effective healers—and enjoy more professional satisfaction—when they engage in the process of empathy. We urge physicians first to recognize that their work has an element of emotional labor and, second, to consciously practice deep and surface acting to empathize with their patients.

My favorite part of the article is the flowchart demonstrating the effect of actually caring about your patients. Okay, I'm being cynical. But seriously, we now need a flowchart to show us that actually caring about patients is better than pretending to care about patients? (And that pretending to care about patients is better than nothing at all)?

The article then goes on to detail methods of acting empathetic when you're not particularly inspired to feel empathy.

I had two instant and absolutely contradictory reactions to the article.

My first reaction:
Really? We need an article teaching us how to pretend to care about patients? Really?

Because isn't this, theoretically, the entire reason most of us go into medicine? And isn't there something very very wrong that we need an article teaching us how to fake compassion for our patients?

My second reaction:
Wait a minute. Actually, we desperately need this article.

Maybe what this article means, maybe it isn't about acting, pretending, faking. Maybe this is about professionalism.

When I worked at Starbucks I smiled at every single customer no matter what. And I recommended our drink of the day with enthusiasm and cheer regardless of what I actually felt inside for said beverage. (Egg-nog latte. ::shudder::)

And isn't medicine, in its own way, customer service. We're here to make people feel better. And a hand on the shoulder, an understanding look, a sympathetic nod, is undoubtedly as important a part of healing as the medicines we prescribe (to my mind anyway).

So perhaps, who cares what you're feeling inside? Maybe it's 100% right to practice your best understanding head-tilt in the mirror. If you make the patient feel understood and cared for and that facilitates their healing and well-being, woo-hoo!

So I'm ambivalent. As much as I agree that this is the most essential, integral component of what we do, it just rubs me the wrong way that we need an article of "tips" for tricking patients into thinking we care when we don't.

What do you think?