Nancy R. Angoff


From Detached Concern to Empathy: Humanizing Medical Practice. By Jodi Halpern. Oxford: Oxford University Press, 2001. Pp. 188.

The practice of medicine is fraught with emotion. For patients, illness with its accompanying losses engenders fears, anxiety, anger, and suspicion. For physicians, there are many sources of emotion. Certainly the emergency room seethes with intensity with each trauma case, and in the operating room, tempers may flare or despair may reign if all does not go well. But even in the patient's room, physicians may find anger, hostility, sadness, or withdrawal. Yet physicians are taught to remain detached from participating in these emotions in order to maintain the objectivity thought to be crucial to accurate clinical decision-making.

In their often quoted essay entitled, Training for Detached Concern' in Medical Students, Renee Fox and Harold Lief discuss the successful acculturation and professional development of medical students as a journey to achieve what has been termed detached concern. It is ajourney that exposes them to "emotion-laden" experiences, such as cutting into a cadaver for the first time. The student learns through objectifying and intellectualizing these experiences to distance himself from his initial pangs of anxiety and fear. This distancing, or detachment, when balanced with the appropriate amount of concern for the patient, has long been considered a recipe for empathy in the patient-physician relationship. As Fox and Lief note: "The empathic physician is sufficiently detached or objective in his attitude toward the patient to exercise sound medical judgment and keep his equanimity, yet he also has enough concern for the patient to give him sensitive, understanding care."

In her new book, From Detached Concern to Empathy: Humanizing Medical Practice, Jodi Halpern presents a well-reasoned and philosophically grounded argument that moves us from comfortable acceptance of the ideal of clinical detachment towards an understanding of the therapeutic good of the use of emotions in medical practice to establish empathetic and healing clinical relationships. As Halpern points out, emotions are already present in the patient-physician relationship. We cannot deny that they are there even though physicians may be unaware of, or out of touch with, their emotions. But we can learn to recognize them and use them constructively in the service of empathy.