Empathy and Time

When presented with an individual in distress, why do some stop to help while others pass by?

The classic Judeo-Christian parable of The Good Samaritan tells us of a man on the road from Jerusalem to Jericho who, upon encountering a band of thieves, was stripped, beaten, and left for dead. Soon, a handful of individuals pass by on the same path and are forced to make the decision of whether or not to stop and help. 

Upon noticing the man, the first two passers-by, religious figures of the day, make the conscious decision to pass by on the other side. It isn’t until a Samaritan, a political “enemy”, passes by that our journeyman receives compassion. 

We don’t have any insight into the personal lives of the three passers-by or their reasons for being on the road to Jericho that day. Regardless of the reasons, their past, or their current mindset, the parable brings up important questions: When presented with an individual in distress, why do some stop to help while others pass by? Is it something about the individual or are there external forces that influence empathy?

In 1973, a research team at Princeton University set out to answer these questions. Researchers recruited students from the theological seminary, individuals who had dedicated their lives to church service, and recreated a modern day Good Samaritan scenario. 

Thinking that personal background and individual “religiosity” might influence their decision, students were first asked to answer questions regarding their upbringing and reasons for pursuing religious careers. 

On the day of the study, participants were asked to present to a particular building on campus where they were tasked with recording a short lecture on a given topic. Said lecture was to be given in a second building on campus and, in route, each participant encountered a man in distress, slumped over in an alleyway. 

Researchers introduced two other variables by manufacturing both the mindset of the participants and their internal level of urgency. Half the participants were given the task of speaking about seminary jobs while the other half were tasked with speaking on the Good Samaritan itself. In addition, participants were told either they were late and therefore needed to hurry or that they had plenty of time. 

Of all the variables–personal background, mindset, or urgency–which one(s) best predicted whether a participant would stop to help? All three appear plausible. At first glance, I figured those thinking about the parable of the Good Samaritan, at a minimum, would stop and help. 

When all was said and done, only one variable remained standing–time. Those that felt rushed were much less likely to stop despite all other variables. Some in route to speak on the Good Samaritan went as far as stepping over the distressed individual. 

Students of medicine, like students of the seminary, dedicate their lives to serving others. While we come from varied backgrounds, with different reasons to pursue medicine, we share the same desire. We want to solve the world’s medical problems. We want to end human suffering.  We want to take care of people.

The modern physician must try to balance their time between patient care and an ever-increasing list of non-patient centered tasks and duties, many of which promise increased efficiency, better data, and better patient outcomes. In reality, what many of them do is push direct patient care, face-to-face patient care, further down the list of importance. Is our desire to take care of people getting buried along with it?

With so many things biding for our time, with so many tasks to complete and boxes to check, are we becoming less empathetic? Beginning in medical school we are taught that time is valuable, that we must learn how to become efficient history taking, physical exam performing, machines.

I’ll never forget one of my first standardized patients, you know the actors who medical students practice their skills on. This one was a new patient, obese, with uncontrolled diabetes, heart disease and increasing anxiety. My task? Get a detailed medical history, perform a head-to-toe physical exam, address all the preventative medicine guidelines, educate on his list of medical issues, and adjust his medications, among a list of other things. My time? 15 minutes. You better believe empathy was the last thing on my mind.

Like the Priest and Levite on the way to Jericho, or the seminary students in 1973, how many individuals in distress do we pass by because we don’t have the time? How often do we knowingly or unknowingly ‘pass by on the other side’? All too often I’ve witnessed kind, gentle, and compassionate people become cold, hardened, and short, all in the name of time. We would do well to slow down, not only to smell the roses, but to notice those around us in need.

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Heart failure and a 10-year-old: Julio’s story

How modern medicine provided all the answers, but none of the solutions

Everyone has a story. I hear them all day long and while some are humorous and uplifting, others are difficult and downright depressing. It’s my job to listen to these stories. And not just to listen, but to truly hear. When we take the time to do so, we learn amazing things about those we care for. This is one of those stories.

The first two years of medical school are rigorous. Your time is dominated with more material and information than you think can fit inside the human brain. It’s because of this that the transition into the third year of school, when you start to finally see patients, is so exciting. It’s also terrifying, exhilarating, humbling, and rewarding.

My first month outside of the classroom was spent in the general medicine wards at the local county hospital. For me, this was the ultimate “baptism by fire.” Long hours on the wards with patients from some of the most underserved populations around was daunting to anyone, especially someone as green as myself.

Two days into that first month I was assigned my first patients. While medical students are not “in charge” of a patient’s care, they do play a vital role which often means serving as a patient’s first contact in the hospital.

Julio* was a middle aged Hispanic gentleman who was to be admitted for symptoms of heart failure. I was confident I had been assigned to his care because of my Spanish-speaking abilities, though I soon realized this was far from the truth.

Julio was what many refer to as a frequent flyer; a non-compliant, time consuming patient. This was his fourth admission in as many weeks, each time with the same complaints and same symptoms. He would be placed on the same treatment regimen: diuretics to remove fluid, cardiac medications to boost the function of his heart, and a strict diet to prevent further damage. Without fail, Julio would leave the hospital in “pristine” condition, only to return days later short of breath, fluid overloaded, and frustrated. This admission was no different.

Julio would spend 3-4 days in the hospital at each admission while the medications kicked in and his symptoms abated. We would round on him every morning as was customary, rarely making changes or adjustments. From a medical standpoint, Julio was a simple case. We had a solid treatment plan, one that had proven itself not once, but time and time again to work. Why, then, was Julio spending more time inside the hospital than out?

Someone I admire shared with me a valuable piece of advice–spend as much time as possible with your patients. Reading journals and textbooks is valuable and a necessary task for a student of medicine, but the real learning comes from spending time with and listening to the people you take care of.

While many had taken care of Julio throughout this and previous hospital stays, none had taken the time to learn about him. Apart from the few minutes spent at bedside rounds each day, Julio sat alone in his hospital bed. Sitting down with Julio and listening to his story proved to be the difference in his care.

You see, Julio was an immigrant from Mexico, come to the US to work and provide for his family of 4 back home. He spoke no English and was illiterate even in his native Spanish. Living with his brother, sister in-law, and 10-year-old nephew, Julio’s life was dedicated to making the best situation possible for his loved ones at home. He too, come to find out, was just as frustrated and puzzled with his health. More than anyone else, he desired to live life outside the hospital.

Because of their work schedule, Julio´s brother and sister-in-law were rarely home and, thus, not overly involved in his care. As his sole guidance, Julio had a mound of hospital discharge papers and pill bottles full of medications with “perfect” instructions in English.  These items are foreign to many, but completely useless to our illiterate Spanish-speaking only protagonist. The only member of the household around and able to read said items? Julio´s nephew.

Julio’s care, intricate but straightforward for a seasoned physician, was being handled by a 10-year-old. Multiple daily medications, diet restrictions, and exercise/activity prescriptions, each one vital to his health and recovery, had been left in the hands of a child. Was it any surprise why he didn’t improve? It’s more surprising that he had survived.

All the medical advances in the world were not going to improve Julio’s health. He was never going to return to his former life as a hard-working, dedicated, driven father and husband with a stack of unreadable papers and a cabinet full of medications. We had given him all the right answers, but none of the right solutions.

How many Julios are out there? How many are in our hospitals and clinics at this moment? Sometimes, more often than not, the best medicine is a listening ear.

*Names have been changed for privacy purposes

Refined Medicine, It’s About Time

When applying to medical school I reached out to a family friend and physician for advice. I expected to receive words of encouragement and inside information about how to navigate the med school acceptance process. Imagine my surprise when I was told that, although once a noble profession, medicine wasn’t what it once was. ‘Get out now’ were his exact words.

Fast forward half a decade and it’s obvious that I didn’t take that advice, though I have thought about it often. I initially wrote it off as one disgruntled doctor with an unfortunate experience and outlook, though I’ve come to realize that it may not have been as unique a perspective as I thought.

Medicine is still a noble profession, filled with individuals who, at their core, entered the field to do their part in relieving human suffering. We all imagined spending our days at the patient’s bedside creating lasting relationships while helping others restore health.

Unfortunately, for both doctor and patient, medicine has followed suit of the world becoming more and more automated and often robotic. With this evolution have come dramatic changes in what fills each hour of our day. The bedside has been replaced with computer screens, in-depth physical exams with innumerable clicks and pre-authorizations.

Refined Medicine follows my personal journey as I navigate the world of medical training, bringing you behind the scenes to the daily ins-and-outs of a family medicine resident starting from day one. Along the way I’ll share and discuss the barriers and obstacles that have been placed in the way of quality doctor-patient time and the inspiring stories of individuals working to overcome them.