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Doctor:            If you look at how we train physicians, it's not a surprise that patients often complain that they seem cold, uncaring, that they don't have time for us.  One of the first things we do with physicians, early in their training, is that we put them in the anatomy lab.  And you walk into the anatomy lab terrified, but at the same time, none of the young students want to look terrified.  And they learn very early to separate what's happening in your heart from what's happening in your face.  And so there's this split early, and then we also acculturate them during residencies to ignore their own needs, to compete first and relate second, and so there's a certain distancing that happens with patients very early on.  And also a focus on look, I can't address, I don't want to open up your heart when you come into my office, if I open up your heart, you're going to spill it all over the place and I'm not going to get you put back together in the 15 minutes I've got.  So I've got to, kind of- there's a certain distancing.  When I'm a patient and I'm coming to a physician, I want them to look at me with care and go, "I understand.  We're going to get tot eh bottom of this.  I'm there for you.  How are you feeling?" and that's not going to happen. 

Robert:            Your other book, which I loved, about a doctor named Amelia who made a tragic mistake because she cared too much and listened to the patient instead of her medical training.  So it cuts both ways, doesn't it?

Doctor:            Well, absolutely it does, and it does look like empathic physicians suffer more during training, and there's some evidence to support that. 

Robert:            But would you go to a doctor who cries?  

Doctor:            Absolutely.  Now, it's true that if we're in icy waters, I don't' want to look over at the captain and have him going, "Oh, boy... ohhh!" you know- I don't want that.  But that's different than when something horrible happens for them to look at me, out a hand on my shoulder, and say, "Yeah, this sucks.  But we're going to do the best we can in the circumstances."  Which is very different than the distance that I certainly experience a lot as a patient.