Lessons on empathy from a medical actor

Empathy is a lot more nuanced and complex than people sometimes assume. There are many theories about what empathy is, what it looks like and how to foster it.

Brené Brown’s work on empathy, including the The Power of Empathy video and her TED talk, has brought this topic to a larger audience, and encourages people to think about empathy in the context of their own relationships.

There is also increasing attention (and lively debates) on teaching students in the healthcare professions communication skills, and, in particular, how to foster empathy in future healthcare providers.

I gained a new perspective on this topic from Leslie Jamison‘s collection of essays The Empathy Exams. This book is based partly on her experiences as a standardized patient (SP for short).

As an SP, Jamison is a medical actor who plays the role of patients in the service of training future clinicians. SPs are given a script that outlines the patient’s back story. A student clinician might be assessed on whether they “voiced empathy” for a patient’s concern.

As an educator, I’ve worked with SPs to teach students counselling skills. I have also worked with SPs while learning to be a facilitator for the Institute for Healthcare Communication. SPs are well-trained in the art of communication. Perhaps the most valuable part of working with an SP is the immediate feedback they offer about how they felt during your conversation.

The line between fiction and reality is blurred in these interactions. It’s a kind of willing suspension of disbelief — both parties agree to play their part as the story unfolds in unpredictable ways. Jamison describes an encounter with a medical student saying:

We make small talk about the rural Iowa farm town I’m supposed to be from. We each understand the other is inventing this small talk, and we agree to respond to each other’s inventions as genuine exposures of personality. We’re holding the fiction between us like a jump rope.

What her stories illustrate is that there are no generic checklists or easy formulas that do justice to the messiness and complexity of empathy. As Jamison suggests, empathy is about “reading” a person and their situation. Sometimes empathy means expressing words of concern. Sometimes it means being calm and reassuring. Sometimes it means being together in silence. As she suggests, respect and tentativeness can be unexpected forms of empathy.

Other students seem to understand that empathy is always perched precariously between gift and invasion. They won’t even press the stethoscope to my skin without asking if it’s okay. They need permission. Their humility is a kind of compassion in its own right. Humility means they ask questions, and questions mean they get answers… Empathy isn’t just remembering to say “that must be really hard” – it’s figuring out how to bring difficulty into the light so it can be seen at all.

Empathy isn’t just listening, it’s asking the questions whose answers need to be listened to. Empathy requires inquiry as much as imagination. Empathy requires knowing you know nothing. Empathy means acknowledging a horizon of context that extends perpetually beyond what you can see…

In the end, it is the humility of the students that moves her the most. It is their willingness to acknowledge they don’t know. I think that’s one of the most surprising, but valuable, lessons from her journey as a medical actor.

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