Using Philosophy to Write a Prescription for Better Health Care

While several Berkeley professors employ new technology tools to further their work in the humanities, others bring humanistic inquiry into the realm of science.

One such scholar is Jodi Halpern, a medical ethicist and psychiatrist who uses traditional philosophy to enlighten her work in medicine. She earned both a Ph.D. in philosophy and an M.D. from Yale University before joining the Berkeley faculty in 1998, and her title, assistant professor of bioethics and medical humanities, reflects the interdisciplinary nature of her work.

Halpern leans heavily on her background in the humanities as she conducts research that calls for a profound shift in the way doctors relate with their patients. Her studies assert that to practice effective medicine, physicians must do more than understand the science of disease and methods of treatment. They also must be empathetic, says Halpern, striving for "an engaged emotional understanding of each patient's illness experience."

Beyond Detachment: The Role of Empathy and Emotions in Practicing Medicine, Halpern's forthcoming book from Oxford University Press, continues the work she began with her philosophy dissertation, which earned her the 1994 Porter Prize at Yale for the overall outstanding Ph.D. at the university. Challenging Descartes's view of objectivity and Kant's conception of moral impartiality, she argues for a new model of "clinical empathy" that would better enable a physician to understand a patient's emotional experience, which in turn would result in more effective diagnosis and treatment. "Clinical empathy," she explains, is "a unique form of understanding patients that requires physicians to be emotionally engaged, yet also promotes the objectivity that their roles demand."

Halpern began to form her views while a medical student at Yale and during her residency at UCLA. "I didn't like the detached way doctors dealt with patients," she recalls. Her reaction wasn't simply a matter of feeling sorry for patients; rather, she observed patients whose fear, mistrust, or depression prevented them from communicating well with their doctors and adhering to their treatment plans. Doctors who were unable or unwilling to understand a patient's emotions by imagining themselves in the patient's situation were inclined to miss important clues that would lead to a proper diagnosis and recovery.

Challenging
Descarte's view of objectivity and Kant's conception of moral impartiality, Halpern argues for a new model of "clinical empathy" that would better enable a physician to understand a patient's emotional experience, which in turn would result in more effective diagnosis and treatment.

Halpern acknowledges that doctors may resist her suggestion that they "resonate emotionally" with their patients, and their resistance doesn't surprise her. In her book, Halpern examines how depersonalization is built into all medical training, and the attitude of "detached concern" is widely regarded as essential to the doctor's professional role. What's more, in the current managed-care environment -- where bottom-line concerns push doctors to work increasingly long hours and see an average of four patients per hour -- emotions "often seem extraneous, perhaps even threatening to the physician's usefulness," she writes.

Yet, the standard doctor-patient relationship needs to change, she argues, because many signals point to a greater dissatisfaction with health care in America than ever before. A growing number of patients are losing faith in their health care providers and turning to alternative medicine, complaining that their doctors don't listen to them and don't recognize their suffering.

"Patients come to doctors with a subjective experience of illness and suffering that is in need of healing as much as their bodies need to be repaired," says Halpern. "Recovery involves grieving and regaining a sense of autonomy, both of which are emotional processes. . . . We think of autonomy as meaning, 'Leave people alone.' I'm arguing that to recover a sense of autonomy requires being heard and understood, and this hearing and understanding require an emotional engagement on the doctor's part."

To critics who may view her arguments as impractical, Halpern counters that her model of a doctor-patient relationship could be more cost-effective in the long run. For instance, studies show that a significant percentage of patients don't take their medication and don't follow their doctors' advice. At the root of this big -- and wasteful -- problem is a breakdown in doctor-patient communication. "We can manage health care without making doctor-patient time be the thing we minimize," she says.

Empathy for
patients'
sufferings
must
accompany
a helping
hand.
See reference page

Part of Halpern's research was published earlier and highly praised by a reviewer for the Journal of the American Medical Association. Halpern contributed one chapter to Empathy and the Practice of Medicine: Beyond Pills and the Scalpel (Yale University Press, 1993), a text that featured the work of multiple authors. The reviewer spotlighted her work, calling it "probably the best chapter in the book," and noted, "In an era of expanding technology, it is worthwhile to reflect on how teaching traditional values emanating from the humanities and the arts can improve the practice of medicine."

Halpern agrees that her scholarship in the humanities, particularly philosophy, is both essential to and inseparable from her research in bioethics and medicine. "At the core of all my work are fundamental questions about how people live lives they consider valuable in the face of illness and suffering," she says. A medical textbook, purely clinical in nature, would not yield the answers. Those profound questions involve subjective values and emotions, which Halpern seeks to sort out and answer within a philosophical framework.

Her work illustrates that the bridge between the humanities and the sciences is one that goes both ways -- and one that is expanding. A growing number of scholars are crossing over to tap into the creative and scientific wealth of the larger campus community, uncovering new possibilities along the way.

Next: Chapter 3, Affirming the Power of Human Narratives

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	While several Berkeley professors employ new technology tools to further their work in the humanities, others bring humanistic inquiry into the realm of science. One such scholar is Jodi Halpern, a medical ethicist and psychiatrist who uses traditional philosophy to enlighten her work in medicine. She earned both a Ph.D. in philosophy and an M.D. from Yale University before joining the Berkeley faculty in 1998, and her title, assistant professor of bioethics and medical humanities, reflects the interdisciplinary nature of her work.

	Halpern leans heavily on her background in the humanities as she conducts research that calls for a profound shift in the way doctors relate with their patients. Her studies assert that to practice effective medicine, physicians must do more than understand the science of disease and methods of treatment. They also must be empathetic, says Halpern, striving for "an engaged emotional understanding of each patient's illness experience." Beyond Detachment: The Role of Empathy and Emotions in Practicing Medicine, Halpern's forthcoming book from Oxford University Press, continues the work she began with her philosophy dissertation, which earned her the 1994 Porter Prize at Yale for the overall outstanding Ph.D. at the university. Challenging Descartes's view of objectivity and Kant's conception of moral impartiality, she argues for a new model of "clinical empathy" that would better enable a physician to understand a patient's emotional experience, which in turn would result in more effective diagnosis and treatment. "Clinical empathy," she explains, is "a unique form of understanding patients that requires physicians to be emotionally engaged, yet also promotes the objectivity that their roles demand." Halpern began to form her views while a medical student at Yale and during her residency at UCLA. "I didn't like the detached way doctors dealt with patients," she recalls. Her reaction wasn't simply a matter of feeling sorry for patients; rather, she observed patients whose fear, mistrust, or depression prevented them from communicating well with their doctors and adhering to their treatment plans. Doctors who were unable or unwilling to understand a patient's emotions by imagining themselves in the patient's situation were inclined to miss important clues that would lead to a proper diagnosis and recovery.
Challenging Descarte's view of objectivity and Kant's conception of moral impartiality, Halpern argues for a new model of "clinical empathy" that would better enable a physician to understand a patient's emotional experience, which in turn would result in more effective diagnosis and treatment.	Halpern acknowledges that doctors may resist her suggestion that they "resonate emotionally" with their patients, and their resistance doesn't surprise her. In her book, Halpern examines how depersonalization is built into all medical training, and the attitude of "detached concern" is widely regarded as essential to the doctor's professional role. What's more, in the current managed-care environment -- where bottom-line concerns push doctors to work increasingly long hours and see an average of four patients per hour -- emotions "often seem extraneous, perhaps even threatening to the physician's usefulness," she writes. Yet, the standard doctor-patient relationship needs to change, she argues, because many signals point to a greater dissatisfaction with health care in America than ever before. A growing number of patients are losing faith in their health care providers and turning to alternative medicine, complaining that their doctors don't listen to them and don't recognize their suffering. "Patients come to doctors with a subjective experience of illness and suffering that is in need of healing as much as their bodies need to be repaired," says Halpern. "Recovery involves grieving and regaining a sense of autonomy, both of which are emotional processes. . . . We think of autonomy as meaning, 'Leave people alone.' I'm arguing that to recover a sense of autonomy requires being heard and understood, and this hearing and understanding require an emotional engagement on the doctor's part." To critics who may view her arguments as impractical, Halpern counters that her model of a doctor-patient relationship could be more cost-effective in the long run. For instance, studies show that a significant percentage of patients don't take their medication and don't follow their doctors' advice. At the root of this big -- and wasteful -- problem is a breakdown in doctor-patient communication. "We can manage health care without making doctor-patient time be the thing we minimize," she says.
Empathy for patients' sufferings must accompany a helping hand. See reference page	Part of Halpern's research was published earlier and highly praised by a reviewer for the Journal of the American Medical Association. Halpern contributed one chapter to Empathy and the Practice of Medicine: Beyond Pills and the Scalpel (Yale University Press, 1993), a text that featured the work of multiple authors. The reviewer spotlighted her work, calling it "probably the best chapter in the book," and noted, "In an era of expanding technology, it is worthwhile to reflect on how teaching traditional values emanating from the humanities and the arts can improve the practice of medicine." Halpern agrees that her scholarship in the humanities, particularly philosophy, is both essential to and inseparable from her research in bioethics and medicine. "At the core of all my work are fundamental questions about how people live lives they consider valuable in the face of illness and suffering," she says. A medical textbook, purely clinical in nature, would not yield the answers. Those profound questions involve subjective values and emotions, which Halpern seeks to sort out and answer within a philosophical framework. Her work illustrates that the bridge between the humanities and the sciences is one that goes both ways -- and one that is expanding. A growing number of scholars are crossing over to tap into the creative and scientific wealth of the larger campus community, uncovering new possibilities along the way.