Um. Try Not to Be a Psychopath With Your Patients

26 Aug Um. Try Not to Be a Psychopath With Your Patients

I just spent such a delightful weekend with the Kripalu School of Ayurveda students, who should be graduating, like, any minute now. It was truly, madly, deeply enjoyable for me to spend time with them. Hopefully it wasn’t lousy for them either.

I am also aware that the Ayurvedic Institute students have graduated, or should be, any minute now. My thoughts are with them , and the other recent graduates of Ayurvedic programs around the globe.

Anyway, at Kripalu, we talked about important stuff. It was a clinical weekend. So we talked about being clinicians.

We talked about what Charaka thinks is important. He thinks 16 things are important for good therapeutic outcome. Well. Really, four things. Four things that each possess four qualities. That makes 16 qualities. The four main things are: the physician, the medicine, the attendant or nurse, and the patient. Each of those things should have four qualities in order for the outcome to be really positive. (My second book, How the Art of Medicine Makes the Science More Effective: Becoming the Medicine We Practice goes into each of the four qualities of the physician and the medicine in depth). We talked a bit about what qualities Charaka says the medicine, patient and attendant should have, but we mostly talked about the four qualities a physician should have.

First, we talked about the picture that comes to mind when you think about the kind of physician that seems to have been promoted in some circles, at least until recently. This physician might look a bit like Dr. House—a popular character on a TV show. A really smart physician with a lousy bedside manner. Here’s a to-do list for that type of physician:

• Be detached. That is– empathy is not seen as a virtue
• Maintain a lack of remorse
• Do not be emotional with your patients
• Think very highly of yourself. Lots of confidence
• Be charming but not loving. Your patient isn’t there for love. He or she is there for fixing
• Be wicked intelligent
• Be very rational

I should back up a little. On my drive from New York to Western MA, to Kripalu, I listened to an episode of NPR’s This American Life.

Okay. I listened to THREE episodes. What, me addicted?

Anyway, one of the episodes was called, “The Psychopath Test.” Here are the top qualities of a psychopath:

• Lack of empathy
• Lack of remorse
• Shallow emotions
• Grandiose sense of self
• Incapacity for love
• Also: arrogant, callous, irresponsible, can exhibit superficial charm, good intelligence, not irrational, failure to learn from experience

Do you know where I’m going with this? Yes. Probably you do. And you are right. Perhaps because I was heading for this “clinical” weekend, I was struck by how many of these qualities can be associated with the Dr. House brand of physician.

So. When you put it that way, let’s, um, not be psychopathic with our patients.

Instead, we looked at the qualities Charaka says are important in a physician. He says a physician should have:

1. excellent theoretical knowledge.
2. loads of experience. (If you don’t have it, time to get some).
3. dexterity (Actually an interesting quality that we kept returning to over the course of the weekend).
4. purity. This sound boring and, er, puritanical, but is also actually very interesting.

Now, I know Charaka doesn’t list anything really touchy feely there in terms of loving your patients, but this is just his list in his self-admittedly brief chapter—(chapter nine in Sutrasthanam) and, it definitely comes into play in the, “purity” bit. In the next chapter he elaborates on the qualities a physician should possess. And, while even there he doesn’t devote much page real estate to how loving a physician should be, he does say that a, “doctor should be sympathetic and kind to all patients…” And if we look deeply into the quality of, “purity,” we will find it incompatible with psychopathic behavior as well.

So there. Proof that we should not be psychopathic with our patients. If we do have psychopathic tendencies, it would be wise to park them outside the consultation room.

This, naturally, does not mean we need to swing to the other side of the pendulum either, and have a co-dependent, emotionally-laden, syrupy relationship with patients. Given a choice between a physician with empathy sans skill, and one with skill sans empathy, I’d have to take the latter any day. But, ideally we can have both skill and empathy, and maintain our own emotional health in the balance.

There is a lot more that could be said about all this (and I do say it in, “How the Art of Medicine Makes the Science More Effective: Becoming the Medicine we Practice,”) but this is just a post, after all, not a book or even a lecture or a weekend workshop.

In the end, let me just say that it is a great pleasure to work with serious students of Ayurveda, and students of life in general. I count it as one of my great blessings that I get to spend time with these people and, all you graduates, I’m glad you are out there. I expect the world will be a better place for it.

Congratulations.

In Love,

cw

1. Hugh Laurie, I find you very entertaining & talented. This is not about you.

(this is repurposed from a blog originally posted by Dr. Welch on June 14, 2012. It was this post that prompted Jessica Kingsley Publishers to request Dr. Welch to write her book, How the Art of Medicine Makes the Science More Effective: Becoming the Medicine We Practice)