Wisdom of Caring and Empathic Practice

Peter Jones Design for Care, Sensemaking, Strategic Foresight

For over 10 years (at least since the 1997 Dorothy Leonard article Sparking Innovation through Empathic Design) design research has advocated the practice of empathic design, listening closely to customers and learning from their behaviors to innovate for unspoken “needs.”  We might consider this common knowledge at this cycle of practice, or even “common wisdom.”

The U of Chicago Wisdom Research project discussed recent research in medical education indicating that medical students significantly lose empathy starting in 3rd year: “Are our medical students failing “Wisdom 101”?

The interpretation suggests the possibility that the education process somehow drives out naturally occurring empathy in young physician trainees. The consideration is also drawn that empathy itself – perhaps defined in a range of nuanced ways – is inherent in wisdom. Yes and no … and maybe.

My response to the article (edited for context).

This is reflective of medical school itself. There are different purposes for the phases of medical education. Third year is the first full clinical clerkship year. This is the year students follow each specialty into their rotations and observe and learn procedures for the first time. Remember, medical students are not practicing and are not even engaging with the patients, nor should they be yet. They are basically shadowing and learning technique. To do this effectively, they may need to separate from the patient-as-person for a little while to learn how to do often-invasive procedures without feeling for the patient too much.

Could we be are over-valuing the purposes of empathy?  Empathy is necessary but not sufficient. Even animals (our pets in particular) have empathy for humans and other animals, or at least highly intuitive sympathy. So I don’t see that empathy is (itself) a marker of wisdom. Empathy is a necessary ingredient of Care, which may be an essential foundation for wisdom. Caring is an active expression of empathic understanding informed by the larger system of interactions. (Perhaps care is closer to wisdom, as it is an informed empathic response that also seeks to restore health or happiness, to repair the situation yielding the need for care).

Going back to the medical students, where empathy should be measured is in third year of residency, where physicians start practicing in earnest and have learned all the procedures. At that point, we have the right to expect a professional sense of caring as well as the humanity of empathic feeling. Could it be that professionals demonstrate a learning cycle of empathy?

Doctors can learn to recover their original empathy as they earn wisdom in their careers. But you do want them to perform their first injections and aspirations skillfully, and that may mean separating from your feelings as a tender human patient so they can do things we all know will hurt.

This is an interesting intersection of research inquiries. We encounter the embedded assumption that good physicians are empathetic, or at least that we – as customer patients – expect them to be empathetic as a matter of training and trait. While those of us not in medicine may believe empathy to be a necessary quality of physicians (certainly of nurses), there may be no relationship between empathy and quality of care. The main reason we seek professional medical care is to recover and restore from a concerning bio-physiological condition or disease. The quality of care may be measured by the best knowledge of diagnosis and quality of procedures to alleviate the condition and the body’s response to it.

Perhaps an active orientation to care, which includes empathy, is the demonstration of wisdom. Performing care requires not just empathy but foresight based on empathic understanding (e.g., how might this patient’s life situation play out in a month or a year?) Care accounts for both understanding of the health-seeking patient’s context (empathy) and the types of treatment and their impact on life (foresight). Care is the ability to take community and relationships into account, not just the individual’s feelings at that time.

Now, is empathy or care a requirement for wisdom? Empathy may a trait we observe in people considered to be wise. Whether that correlation is causative of wisdom or perhaps an outcome of being “wise”, we may not know without research. Which leads to further questions of:

  • How do we define wisdom as a trait, or in behavior?
  • How do we measure or interpret wisdom in persons or in roles?
  • Is the DIKW pyramid of Data-Information-Knowledge-Wisdom really a valid interpretation of the hierarchy of meaning? Does “real wisdom” extend from knowledge as a higher form of knowing?
  • Is wisdom an emergent quality learned from experience, or could people be “born wise?”
  • To what extent is wisdom related to good foresight? Is a person wise if they can perceive possible future outcomes well beyond the present, in the face of resistance from contemporaries? Especially when these outcomes occur (and the original resisters forget?)

Cross-posted on Design for Care.