I’ve been on a quest for a doctor who will listen to me. Fortunately, I have several specialists who take good care of my various body parts/chronic conditions. But the all-important internist—or primary care doctor—the one who will see me as a whole person and look beyond my stomach and migraines, etc—the fine diagnostician who will tell me whether a complaint is worthy of further investigation—that person has been eluding me for several years.
And it seems—post-Covid—that such doctors are wildly oversubscribed. Repeatedly, if I received a promising recommendation and called for an appointment, I was told: “Sorry, Dr Terrific isn’t taking new patients. Try back after the first of the year.”
In October, I tentatively visited a new internist who was available because she was the youngest member of a highly regarded practice. Maybe, I thought optimistically, what she lacked in experience she’d make up for with attentiveness.
But the exam she gave me was cursory at best. She seemed indifferent to my primary complaints, and the blood work she ordered read “Fulfill by April, 2022.” She’d just dismissed me for a year unless I became ill. At this stage in my life, I felt my October internal chemistry deserved scrutiny before the crocuses bloom.
So my quest continues.
That’s why yet another Alan Alda Clear&Vivid podcast caught my attention–“The LaPook Effect: Empathy for Doctors.” (Sorry; my hyperlinks still aren’t working. Fortunately, Google will help.)
Jon LaPook, MD, a Professor of Medicine at New York University’s Langone Medical Center, is also the Medical Correspondent for CBS News. Good; he’s a physician who knows how to communicate.
LaPook said his approach to delivering on-air scientific info is to imagine he’s “talking to my one precious patient. Be empathetic; don’t be cocky. If you’ve been a doctor for five years and you’re still cocky, you’re in the wrong profession.” When you begin to practice medicine, he claims. “you learn humility right away.”
But he clearly recognizes that though he may have learned humility and empathy right away, many clinicians aren’t so enlightened. That’s why he founded The Empathy Project to train medical students and sensitize other physicians to better see and listen to their patients. The other audience for The Empathy Project is all of us patients, who must learn that we’re entitled to physicians who treat us accordingly.
Voila!
As a not-insignificant aside, Alda often speaks of the meshing of art and science. Though he and LaPook didn’t specifically discuss this point, the genesis of The Empathy Project illustrates how well the two disciplines enhance each other.
LaPook was inspired to begin what became this project in the year 2000, when he viewed the Broadway show WIT. Actress Judith Light starred as a woman dying of ovarian cancer, and the play illuminated how dreadfully she was treated by the clinicians assigned to care for her.
LaPook was so moved by what he’d seen that “I spoke with the producer, bought 150 tickets to the show, and took every member of the first-year medical school class at Columbia Physicians and Surgeons.”
Thirteen years later, he received an email from one of those former students saying: “You took us to WIT; that was the most important thing I learned in medical school.”
Aware that he’s in a wheel with “spokes” of influence encompassing medicine, business, journalism, and even entertainment (he’s married to the daughter of famed TV and film writer/producer Norman Lear), he brought together a team of professionals to make short “Hollywood quality” films “to make doctors more empathetic, sensitive, and competent, and to make patients demand it [empathy].”
One of the films arose following the awakening to institutional racism 1-1/2 years ago, when people at Langone began talking about diversity and the need for greater health care equity. They felt a sense of urgency: “Let’s do a film about implicit bias and racism in medicine.”
The film they made was written by Philip Johnston (who wrote “Zootopia,” produced by Walt Disney animation) and features Whoopi Goldberg and Ed Helms. Interviews and contributions were gathered from more than 100 people, including many people of color and particularly Black Women. It’s based on the real life experience of Janelle Stephenson, whom LaPook had interviewed on “60 Minutes” after she became the first person to be cured of sickle cell disease by gene therapy.
Prior to that happy event, Stephenson had paid an emergency room visit during an attack of the disease. She was on the floor, writhing in pain, when a doctor who knew nothing about her stood over her and accused her of faking the pain to get drugs.
Appallingly, Stephenson’s mother had undergone a similar experience years before when she’d sought help for a burst appendix. Remembering that episode, Stephenson thought of matters no one in her situation should ever have to consider: What should I be wearing so the doctor takes me seriously? How can I keep my voice from showing the anger I feel so he doesn’t dismiss me as an “angry Black woman”?
The film’s theme, LaPook explains, is that the physician “doesn’t know what he doesn’t know.”
Its goal is not to point fingers, but to help the physician realize that “like all of us, he has implicit bias.” Prior to this event, he’s depicted as a good person who’s trying his best. The message, of course, is that he can do better if he recognizes the implicit bias affecting his actions and learns how to behave differently.
You can watch this film and others at https://empathyproject.com. In truth, I felt the animation undercut the importance of the message. But many people from various backgrounds and with far more expertise in these matters than I approved it—and medical students have responded to it very well. According to LaPook, at the premiere showing to first year med students, he found the subsequent discussions “thrilling.”
LaPook points out that third year students reacted differently from those in their first year. “I can be empathetic, but I’m in a system that gives me 6-7 min to see patient.” LaPook sees the need for systemic change—making empathy a subject on which students are graded, and even changing reimbursement to allow more time.
Students don’t just watch these films once. “It’s not enough to just put the film out there. We learned they want to know the right way. We did a film the way the episode originally occurred. Then did it again showing a better way.” The discussions follow.
I did enjoy watching the students’ discussion following a film titled “Listening.“
“I’m in this for the rest of my life,” LaPook says. Though he’s focused on increasing empathy in medicine, he points out that this field isn’t the only place it’s lacking. “The whole world right now is shy of empathy.”
What’s needed is “trying to understand where someone else is coming from…and listening.”
I know from some of my fellow bloggers who contend with ongoing illnesses that the absence of empathy among those who care for them is a major concern. I hope you’ll let us know how important it is to you, and how a clinician might have better handled your situation. And if you’re a clinician, please let us hear your perspective.
Annie
annieasksyou... 
I guess I’ve been lucky, because most of the doctors I’ve dealt with have been good. They take their time and make informed decisions and recommendations. Knock on wood.
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That’s good to hear, Neil. Keep knocking on that wood!
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While researching a Medical Economics article on doctor/patient communication, I learned that physicians can get most info about what is troubling a patient if they let that person speak uninterrupted for one minute. However, many doctors interrupt patients after just a few seconds. In addition to being more empathetic, many physicians need to be better listeners.
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Thanks, Gail. That’s an interesting finding that means the kind of education LaPook is talking about may really make a difference.
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Annie, this is truly an excellent idea. Thanks for sharing it. Keith
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Thanks, Keith. I appreciate your comment.
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Thank you for this post, Annie, which I will take as an opportunity to carp. With time marching on and my need for what I call “old man doctors”, I’m feeling that they are overextended across the board. After hurdling the feat of getting an appointment that is usually weeks if not months away, I anxiously show up on time and usually find there are several others that I’m sharing that appointed time with! Act III frequently leaves me feeling rushed and frustrated. I have yet to understand the benefits of those “my chart” sites which you mentioned in your last blog. Thanks to you I have become a fan of “Clear + Vivid, and after reading your summation here, I could give Dr. LaPook another listen.
Love 💕, “Fretty”
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Thank you for sharing your well-earned “carp,” Fretty. As I recall, that’s your Inner Critic’s name, but this seems like a gripe against what may be evolving trends in medicine that bear scrutiny/criticism.
Then again, they may have been exacerbated by Covid, so perhaps they’ll lessen when/if? the pandemic ‘s impact diminishes.
Glad you’re enjoying the Alda podcasts as much as I am.💕
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That was informative Annie. I’m mulling it over….
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It would be interesting to hear your perspective as someone whose country provides what I think of as a more humane health care system.
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I’m not sure our system is more humane? How humane is it to make people wait so long for health care, especially when they are facing a fixable diagnosis, or waiting to hear if it even is fixable. (I know someone who has been waiting 6 weeks for a biopsy report on a polyp) Our waiting lists are long (as in many months/years) just to get into any kind of specialist. I do think it’s a good idea to try and teach empathy to med students. I suspect most doctors/health care professionals lacking empathy are burnt-out, or suffering from a certain level of detachment as a coping mechanism. It’s not an excuse, and it’s certainly frustrating to wait a long time to see someone and then feel you are not being heard. They need to listen more. I liked the comment from Gail above about listening for the first minute uninterrupted, because they patient will often give you the diagnosis themselves. I find some doctors are so dependent on treating the tests that they do not listen. I worked with many excellent old school rural family doctors and nurses they were a whole different breed, and just took excellent care of their patients, but then you do in smaller communities, because everyone is often related or knows everyone else!
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PS. I would like to add that one of the best doctors I ever worked with was a man of few words…..but he was an excellent diagnostician and took good care of his patients……so having a nice and friendly doctor is not always necessary. I would chose quiet competence over a chatty type any day.
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PS Two: The issue of lack of time is also a factor here, as only being allowed 5 minutes per patient due to a long roster of patients to see in a day, (not exactly quotas but similar) is not conductive to listening well. One of the reasons I retired, the quota volume was just impossibly high for the number of employees working and you could never get all of the work done so things got carried over to the next shift – we were never ever caught up.
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We all need to work at where someone else is coming from and truly listening. This is vitally important in the doctor-patient relationship.
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For sure, Kristie. Thanks.
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I am very fortunate to have found a primary care doctor over 40 years ago who has been terrific. He listens! Sorry to say that since we moved we are going to start with another doctor. I can only hope he is as empathetic.
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Yes, I believe you are fortunate, Joseph. Hope you find another in your new locale.
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Thanks, Joni. Important comment. I’m aware of the long waits, which I know are a problem. And physician burnout is real. I’ve written about the need to train physicians in compassion, rather than empathy. The difference is more than semantic. The brain actually processes the two states differently—and compassionate docs are moved to act, whereas overly empathetic docs are immobilized and May withdraw.
It’s a complicated topic.
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Wow, love this! Sending it on to the Dean at our Med School. I’m always humbled to see how some people note a problem, create a solution, and put it into gear. Among all the take-aways here, I’m pondering that! Thank you.
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You’re very welcome, Denise—and I’m pleased you’re forwarding to the med school dean.
Yes, I appreciated LaPook’s awareness that his position in life made him uniquely qualified to bring together people with diverse talents and experiences to develop a new way of approaching physicians—and patients.
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Joni,
Right; chattiness isn’t necessary, but listening and acknowledging what the patient says and feels is.
And I think one of the reasons I’m having trouble finding a good internist is that many docs are leaving medicine due to burnout, work-life balance, etc.
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Unfortunately when one does find a good doctor that is open to new patients it quickly becomes a vivid example of Yogi Berra’s comment that nobody goes to that restaurant because it’s always too crowded.
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So true, anynameleft!
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