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I discuss the importance of empathy when teaching physicians about that most invisible of conditions: chronic noncancer pain. I show learners a photograph of a trauma patient in the emergency department and ask them how they feel. I share that I feel overwhelmed, horrified, and helpless, while emergency and advanced trauma life support–trained colleagues have said that they feel “pumped” because they know how to help this victim. I point out that technical skills help physicians to maintain their boundaries and to remain effective in uncomfortable situations.
Then I discuss chronic noncancer pain, which is underrepresented in most medical school curricula, leaving physicians with minimal knowledge on the approach to diagnosis and treatment. I discuss the fact that functional magnetic resonance imaging studies have shown that observing someone in pain “activates similar neurons as if the observer were feeling pain himself.”3 Authors of these studies go on to state that “[it is important to] differentiate the observer’s sense of knowing the other’s personal experience and his/her personal affective response to this [experience]. When unsuccessful in differentiating, the observer may get overwhelmed by distress [leading to] further distress and helplessness in both.”3
Studies have shown that empathy declines in medical students as they proceed with their training, yet empathy is a crucial element in the therapeutic encounter and the linchpin of narrative medicine.4,5 Training is required for both technical skills and emotional balance. Without this, physicians remain at risk of becoming overwhelmed and helpless in the face of suffering—or, even worse, cold, detached, and disbelieving.