As a medical educator, I appreciated the considerable insights in Heidi Julavits’s essay on empathy and doctors [“Diagnose This,” April]. Columbia University’s Program in Narrative Medicine and other efforts to transform future clinicians into better listeners are certainly commendable, but when it comes to the problem of physicians who do not listen, we cannot teach our way out.
Nor are the reforms to the medical-school admissions process Julavits describes sufficient. We must steer our best listeners, from an early age, toward medical careers. We must find a way to encourage children with gifts for empathy and compassion to pursue the biological sciences. In my own experience, I have found I can teach pathophysiology and physical diagnosis to almost any student; teaching kindness and common decency to those not naturally inclined is usually a far less promising endeavor.
Jacob M. Appel
New York City
The dominant methodology of modern medicine — medicine as business — dooms patient and practitioner alike. Treatments based on computer data and “expert” consensus may not be appropriate for every single patient, and the uncritical mass adoption of therapies designed to maximize group outcomes can deny individuals agency and choice. When I was a medical student, it was fashionable to quote William Osler: “A physician who treats himself has a fool for a patient.” In today’s health-care climate, unfortunately, the fool is any patient who does not look after herself.
Frank W. Meissner
El Paso, Tex.
Julavits notes that programs are being developed to improve the “selective hearing” of doctors, so that they can integrate patient narratives into their diagnoses. This surely is a worthwhile goal: patient preference and shared decision-making must be central to any treatment plan. But why didn’t Julavits mention the 190,000 health-care providers who are already trained to assess, diagnose, and treat patients empathically, using just these sorts of methods? We’re called nurse-practitioners!
Lisa M. Thompson
Heidi Julavits responds:
There are many types of health-care professionals who deserve credit for their skills and empathy, and nurse-practitioners are certainly among them. What’s interesting, however, is that we have come to a point where it seems reasonable to say, “If you want empathy and a spirit of collaboration when you’re sick, don’t go to a doctor, go to a nurse-practitioner!” Or to a physical therapist. The idea that empathy and a willingness to collaborate would be more forthcoming from a nurse-practitioner than from a doctor nonetheless underscores the problem.
I Drink Your Milkshake
As an old geologist who has worked for many years in the parched Southwest, I found it quite odd that Christopher Ketcham dismissed as “demented” the notion of building an aqueduct from the Pacific Northwest to our region [“Razing Arizona,” Report, April]. Two decades ago, I flew from Los Angeles to Portland to visit my son, who was then working on his own graduate degree in geology. Having been raised in the Southwest, I was amazed at what I saw as I flew over Oregon: water, water everywhere. I commented to my son that it was obvious we should build an aqueduct to transport some of it. Bringing water to southern California, Nevada, and Arizona would solve many of the problems that are urgently confronting us.
R. C. Gibson
In his Easy Chair column [“Search and Destroy,” April], Christopher Cox argues that the First Amendment has regained its sacrosanct position in American politics. The long list of books banned at the prison where I am an inmate tells another story.
James W. Hall
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