Friday, December 28, 2018


IS IT A QUESTION OF EMPATHY?

My daughter makes her living as an acupuncturist, of which she is an acknowledged master, with students coming up from New York to study with her. Some 30 years ago, when she was getting started,  she told me excitedly that the great J.R. Worsely, with whom she had studied, was coming to New York,  and that I had the opportunity to be seen by him if I so desired.  She said he was a great master, who by feeling your pulses, hearing your voice, taking in your odor, your complexion around the temples, and sensing your dominant inappropriate emotion, could tell almost immediately what you were like on the inside – invaluable information for an acupuncturist, who works with energetic imbalances.  JR , as they called him, was the man who single-handedly had brought the ancient Taoist discipline of five-element acupuncture to the West.  My daughter had told me much about him, so naturally I was curious and looked forward to meeting him.
But when the day arrived, and the Great Man strolled into the examination room, I took an instant dislike to him, though to this day I  don’t understand why.                                 

He looked me over, felt my pulses and then pronounced:  “You are a self-absorbed person lacking in empathy and compassion. What’s most important to you is what you want at any particular moment.”

I said nothing, but inwardly I flared. How dare he? How could he, when I had spent my life consciously struggling to be none of those things?  Later, after I had calmed down, I asked myself, could one be born with a lack of compassion? 

They say that poor people give to charity a much greater portion of their means than do the rich.  And when a poor person is braving death because she or he can’t afford the care that would cure them, their poverty-stricken neighbors, to help them, are far more likely to offer what little they can than would someone better off.  I suppose the reason is that having suffered hardships themselves, they know what it feels like.  

But people with money have spent their lives trying to distance themselves from exigencies of the poor. They have their own corporate insurance, thank you very much, and the plight of the poor is far from their minds.  As they approach the office buildings where they are employed, they resent being importuned by beggars on the street, and they give a wide berth to the homeless sleeping in corners or on grates.  Evidence of the poor can give a city a bad name, so considerable money is spent  not so much to help the homeless, but to hide them.  To reduce the risk of having them intrude on their peace, people with more money can choose an apartment with a doorman, or even a gated community. 

But while money and empathy seem to exist in inverse proportions to each other, there are significant exceptions.  There are some wealthy people who seem to feel the plight of the poor, and not only write checks, but, if they’re able, set up foundations to support a pet charity.  These are moved by a variety of factors, e.g.  remembering where they came from, wanting to “give back” to the community,  or simply having an active imagination allowing them to sense what it would feel like if they stood in a poor person’s shoes.  These people don’t need to be persuaded to support NYHA; they have persuaded themselves.

And those with businesses big enough to support healthcare for their workers should see the financial advantages for themselves; they didn’t get big without a lively sense of the bottom line.

Likewise, it should be easy to demonstrate to lower and middle income employees that their overall expenses should be less.  When presented with the figures, these folks should need little imagination to see the benefits to themselves and their families.

The big challenge will be to appeal to businesses who currently are not required to pay anything for their employees health care.  Colleges need pay nothing to insure the health of their adjunct professors, nor do real estate agents need to support the health needs of their associates.  And, of course, small businesses who aren’t currently required to pay anything will be very reluctant to start chipping in to NYHA.  In some of these cases, the offset of lower property taxes – which will no longer be needed for Medicaid costs - may be enough  to sweeten the bitter pill; in others, the greater attractiveness of the state as working place may be persuasive.

But ultimately,  a little bit of empathy towards those whom high medical costs have sentenced to death, whose fate could conceivably come to the currently more fortunate or to someone close to them – the sense that there, but by the grace of God, go they – should be very persuasive.

Dio

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1 comment:


  1. Hospitals & Health System
    Thirty years ago, medical schools taught that the most important component of a mental health healing encounter is empathy, human connection, and authentic relationship between a physician and a patient.
    According to the JAMA article, "Empathy in Medicine--A Neurobiological Perspective," , "lack o f empathy dehumanizes patients and shifts physicians' focus from the whole person to target organs and test results." What's more, "evidence supports the physiological benefits of empathic relationships, including better immune function, shorter post-surgery hospital stays, fewer asthma attacks, stronger placebo response, and shorter duration of colds."

    The author Helen Riess, MD, goes on to describe the measurable neurobiological functions that take place between the physician and patient during an empathic encounter and shares a plethora of empirical data supporting benefits of this healing encounter.
    She blames our medical education system for some of the decrease in empathy between a physician and patient and claims that much of this is due to the medical education system's emphasis on emotional detachment, clinical neutrality and an over-reliance on technology limiting human interactions.


    "The... [CURRENT]... "system" continues to rely on short episodic office visits. The funding model still rewards based on production primarily. Our "innovation" of a Patient Centered Medical Home (PCMH) creating a care team consisting of a physician and extenders is still predominantly reimbursed based on production, and still does not position physicians to develop empathy, human connection, and authentic relationship with their patients and in many cases exacerbates the issue by trying to leverage rotating practitioners as a means to improve access, optimize reimbursement and lower overhead."


    "The pay for performance (P4P) component of the PCMH reimbursement model is flawed as well as it is based on flawed clinical outcomes data (but that is a whole other discussion). Even the current medical education system is designed to train physicians to not honor the importance of empathy and relationship in the healing encounter."
    https://www.fiercehealthcare.com/hospitals/how-a-lack-empathy-affects-our-healthcare
    How a lack of empathy affects our healthcare
    by Thomas Dahlborg |
    Feb 8, 2011 2:06pm

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