BLethal talk or healthful words? The prescription for empathetic
Jeremy D Graham, DO MA FACP
Providence Internal Medicine Residency Faculty Group, Spokane Teaching Health Center, Spokane, WA, USA.
J Gen Intern Med 33(6):777–8
© Society of General Internal Medicine 2018
n this issue of JGIM, Healing Arts/Materia Medica offers
the poem BLethal Talk^ by Dr. J. Trig Brown.
brief, the poem describes a complex scene: a consulting phy-
sician delivers painful and abrupt bad news, then vanishes
from the scene instead of remaining to comfort, guide, or
console. Physician readers may identify with one or more of
the implied characters, reading the poem from the stance of the
primary doctor saddled with the repercussions of the consul-
tant’s visit, or that of the patient, but we may also read from the
perspective of the consultant.
The poem may touch on a raw nerve, as it raises a question
with both intellectual and emotional implications: Do we
physicians in fact deliver poor communication, leaving pa-
tients to suffer from a lack of perceived compassion? Is our
talk so bad as to be Blethal?^
Such data as exist compel us to take seriously the picture at
hand. BShortcomings in communication^ and low rates of
physician awareness of patient-experienced needs persist across
decades of measurement.
On balance, we overestimate our
own compassion: Lown and colleagues found that B78 percent
of physicians said that most health care professionals provide
compassionate care, but only 54 percent of patients [agreed]^.
To borrow a construction from Redelmeier et al., bad commu-
nication is, like bad breath, often not noticed by its source.
Patient and physician feelings warrant being considered as
important Boutcomes^ in their own right. Understandably, how-
ever, many clinicians will me be more impressed that more
quantifiable outcomes—diabetes and lipid control even bio-
markersofrhinitis(Interleukin-8 in nasal secretions)—correlate
favorably with individual physicians’ empathy.
suggests that since empathy impacts care outcomes, a physician
cannot practice competently without it.
Where empathy is salu-
tatory, perhaps its absence can indeed yield Blethal talk.^
Physician empathy persistently declines during medical
education and training, so actions which cultivate or preserve
empathy are needed.
Grappling with poems like BLethal
Talk ^ maybejustsuchanactivity.Experience trying to interpret
art and literature may engender physicians’ ability to hear, read,
interpret, and utter the right words. Reading literary fiction may
increase the capacity for Btheory of mind^ and better grasp of
others’ inner experience.
Our group found that including
humanities in a medical school curriculum correlated with better
measures of clinical empathy in trainees.
The best metric of empathy is not established, nor is it well-
understood how experience with interpretation of poems and
paintings cultivate it. However, many useful drugs’ efficacy in
use predate full understanding of their mechanisms. While
much investigation remains, Dr. Brown’s poem echoes the
lesson the poet Rudyard Kipling delivered to the Royal Col-
lege of Surgeons in 1923: B…words are, of course, the most
powerful drug used by humankind.^.
Corresponding Author: Jeremy D Graham, DO MA FACP; Provi-
dence Internal Medicine Residency Faculty GroupSpokane Teaching
Health Center, Spokane, WA, USA (e-mail: Jeremy.
Compliance with Ethical Standards:
Conflict of Interest: J.D. Graham attests to having no relevant con-
flicts of interest related to this article.
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Published online February 20, 2018
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