“Please grab a chair and sit,” I told my resident, who was preparing to discuss a procedure with a patient. She smiled. Her confusion was evident in the gentle lift of her upper lip, showing just the tip of her incisors. A touch of surprise was also flitting across her forehead and eyebrows. As surgeons, we are conditioned to be efficient and laser-focused bullet-point communicators with patients and other medical services.
In residency, we quickly learn the language to elide, what to say, and how to say it. Efficiency allows us to juggle different things and roles in and outside the hospital with ease. The perilous caveat, however, is somewhere along the way, we risk severing the human connection. We become, as Foucault might say, mere purveyors of the “medical gaze,” treating maladies, not the people who experience them. This is a behavioral aberration in our noble profession. However, just as scientific knowledge finds its way through pedagogy, so too can behaviors.
The power of empathetic communication resonated throughout my residency. One such instance was with my then senior resident who treated the peri-operative care discussions and instructions, be they for minor or major surgery, with a seriousness similar to that of using his scalpel. He’d painstakingly transcribe them onto a board or paper using inviting language. He never departed a room without a final “Do you have any other question?” even after fielding a barrage of inquiries.
Another moment I keep revisiting now and then was on an internal medicine rotation, known for its long rounds and copious notes compared to surgery. We had a patient with hepatitis C who several residents and attendings tried to proselytize for the treatment’s merits, or so I thought. Alas, he continued to refuse. No one, however, thought to ask, “But why, sir, do you not want to get the treatment?” Everyone tried to convince him, or maybe just proposed the treatment, without getting to know him. And that was the problem. Everyone, by conventional metrics, was performing their duty.
Then one day, a senior resident rounded on him, and the first thing he did was perch beside the patient on the bed, right side, one leg slung over the mattress, the other anchoring him, and opened with this, “Alors,” his French lilting, “I hear you don’t want to get the treatment, is that right?” The patient confirmed. And there was your pivotal humanistic and genuine question: “Why is that, sir?” The patient poured out his reasons, including homelessness and hopelessness. The resident was unfeigned and wanted to probe further and ask questions imbued with genuine amiability. It took about twenty minutes in the room, a lifetime in the surgical and sterile world of medicine, but it did get the job done, and well, it saved his life, if you want to add that. I realized that this resident played an equally crucial role in saving someone’s life as an internal medicine resident running a code or a surgical resident managing a patient in a trauma bay or an operating room.
Our zeal for treatment often places emphasis on the treatment itself and almost neglects how it is delivered. Cultivating empathy is challenging, and I dare say it is an uphill struggle, given time constraints and the ways in which the health care system operates. But one particular issue is that we don’t dedicate time to training residents in empathetic communication. If they develop this skill naturally, that’s great; if not, that’s just how it is. We’re leaving it too aleatory. There are, however, practical steps to embed empathy training into curricula, including illness narrative readings, role-plays, museum and art-based education, storytelling, reflective and perspective-taking practices, mentorship programs, and even AI finds a role here.
During my exploration of this topic, I stumbled upon SOPHIE (Standardized Online Patient for Health Interaction Education). Dr. Ehsan Hoque’s work at the University of Rochester with SOPHIE initially struck me as paradoxical- a machine teaching human social skills and empathy. Reservations nagged at me, so I reached out to Dr. Hoque. We met, and through our conversation, I discerned that teaching and learning empathy, just like any other skill, including surgery, requires training. The trainer has to be proficient in what and how to observe, prompt, and give feedback. Also, because this is a skill, it requires more than just a one-time encounter. Hence, there is a need for a scalable and sustainable training strategy.
SOPHIE provides structured feedback. It teaches how to empathize, empower patients, and be explicit. Empowerment translates to less lecturing and more genuine open-ended questions and turn-taking. Explicitness implies articulation with cadence, readily understood language and the absence of hedging or jargon. You will still be efficient, but you will also be proficient at care provision. They can coexist.
In today’s health care ecosystem, where we sense and quantify a significant drop in empathy levels among clinical-year students compared to preclinical years, initiatives like SOPHIE, museum and art-based education programs, mentorship, and grassroots efforts are paramount.
I told my resident what a trainer during our surgery boot camp told us, “Never stand over the patient; it reeks of condescension.” This advice stemmed from the trainer’s own experience. She suffered in the health care system when she was being treated for cancer, and she wanted to train future generations of surgeons differently. Empathetic communication is a learned skill, not an innate trait. It’s indispensable. Delivering care devoid of empathy may leave scars deeper than any surgical incision. We must make the concerted effort to sit down, listen, and truly see eye to eye with those we are privileged to care for. In doing so, we uphold the highest tenets of our profession-not just as caregivers, but as stewards of human dignity and compassion. And it’s equally important that we teach it.
Razan Baabdullah is an oral and maxillofacial surgeon.
