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The Empathy Spectrum

empathy medicine Nov 10, 2021
The Empathy Spectrum

I remember having classes in medical school where we were taught lots of so called 'soft' skills of consulting. Things like showing empathy for our patients while they were recounting their history for us, eye contact & rapport, showing emotion and being open and perceptive to our patient's emotions. During these classes I would often be amazed that anyone would need to be taught these skills. To me, these were simply the language with which I got through life. Always one to "wear my heart on my sleeve", my dad often reminds me how much I struggled with the emotional turmoil of my teenage years where I simply couldn't understand the often nasty and two-faced behaviour of my angst ridden peers. My own emotional language was already one of extreme empathy, my "hand" always on display and emotions laid bare.


My teen years were hard.


So when I came to university and discovered that there were people who not only needed to be taught these skills, but who truely didn't experience this constant bombardment of others emotions that I had grown accustomed to, my eyes were opened. Not thinking much more of this back then, I just got on with my task of becoming a doctor. 


Once I hit the hospital system, fresh faced and determined to do good, I gave every day my all. Constantly bombarded with requests from every angle about the many patients I was trying to help care for, my heart sunk every time I tried to triage the never ending mountain of tasks by urgency, only to be berated by disappointed nursing staff when I said I couldn't get to their patient sooner. My spirit gradually broken by a million little blows, I left behind the faceless busyness of a tertiary centre for a much smaller remote hospital in Western QLD. Life was beautiful. Everyone knew you by name and all of a sudden my empathy and wholeheartedness were being rewarded. This cemented my decision to leave behind the huge, churning wheels of the hospital system and seek out the individualised relationships of General Practice.


I had found a place.


I started GP training while pregnant with my first child. All of a sudden (with the heightened emotions that pregnancy inevitably brings) I was alone in a consulting room with the full spectrum of the human experience. From birth to death and everything in between, every emotional high and low that could be experienced I experienced with my patients behind that closed door with my name on it. It was a shock but it felt like the right place for me, I felt like I was making a difference.


Burning out the candle.


Through out my General Practice training I had two children, I took time off for each baby, I worked part time. I lost contemporaries as they did exams and fellowed before me and found myself increasingly professionally isolated, but still I loved the work and I gave it my all. Like a moth attracted to the flame I sought to give everything to each and every patient I saw. My desire to help combined with my deep sense of empathy and feeling meaning that I often found myself thinking about my patients long after hours. It happened so slowly that I almost didn't see it creeping up on me, but I was struggling to switch off from work, I was always following things up, calling patients, writing letters and scripts on my days off. I explained it away by telling myself that it was simply because I was working part-time and that was the price I had to pay for it. But over time, the things I would do on my 'days off' were not urgent tasks, but rather anything asked of me out of my own guilt driven fears of anyone being disappointed in me. I constantly felt the emotions and (perceived) disappointment of my patients and my own emotional barometer started to veer off course.


The candle goes out.


Eventually what happened was there was no switching off from work. I worried constantly about any of my patients having a bad outcome. I gave myself no permission to ever let down my guard, I was constantly on watch checking my results or looking ahead in the appointment book to see who was coming in. It would come as no surprise to you that I burned out. You can read more about that here.


The Empathy Spectrum.


Across my professional life I had received warnings from colleagues and supervisors for me to "care less" and "switch off" to avoid burning out. As well meaning as they might have been, they were incredibly tone deaf to the fact that I now realise which is that for the 'empathy classes' I was given at medical school to exist, for there to be people who do indeed need to be taught how to practice empathy, there must by definition also be people who don't need to be taught this. People like me. And for that to be the case, it struck me that rather than the tap that could be turned on and off (as those well meaning comments would suggest) there must be a full spectrum of how people experience empathy. Some of us deeply, some more shallowly. None better or worse than the other, simply different.


Since discovering this for myself, I have come to characterise what I call the Empathy Spectrum. And as someone who identifies as sitting at the more empathic end of the spectrum, I have begun to change the way I look at my own self development. Having always been taught by seniors and supervisors who (in hindsight) sat at a very different point on the empathy spectrum than I did, I've begun to speak more openly about my own experience of life and medicine in the hope of highlighting to any other doctors who also identify themselves to sit at the more empathic end of the spectrum that it is not a case of "caring less" to avoid burn out, but rather of "caring differently". I now teach the skills of mindfulness & self compassion to doctors in my training  in order to help other doctors to learn how to "care differently". I also run retreats for doctors in mindfulness & self care.


I love my work.


For all my years in medicine, I never expected to one day be helping other doctors to shine and grow. I never gave myself permission to step away from clinical medicine until I unceremoniously had to back away from it unexpectedly. But in this cloud at least, there really has been a silver lining and I really do love this work.

If you want to learn more about my Mindfulness & Self Compassion Training for Health Professionals then check out this link. I'd love for you to join me as we talk even more about how to live, practice medicine and thrive at the deeper end of the Empathy Spectrum.




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