BEYOND EMPATHY: "Is COMPASSION More Effective Than EMPATHY in Healthcare?"

In this episode of 'Stories, Labels, and Misconceptions,' hosts Val Barrett and Dr. Jeremy Anderson explore the complex role of empathy in healthcare. They delve into the arguments presented in Paul Bloom's book 'Against Empathy,' discussing the distinctions between cognitive and emotional empathy and the importance of compassion in providing consistent care. 

The conversation touches on how empathy can be impacted by personal biases and the potential benefits of prioritising compassion over empathy for better healthcare outcomes. Whether you're a healthcare professional or just interested in the nuances of empathy and compassion, this episode offers valuable insights and thought-provoking discussions.

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🎵 Music: Dynamic
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🎬 Podcast Produced & Edited by: Val Barrett

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Transcript

INTRO: [00:00:00] Stories, labels, Misconceptions NHS remains a blessing Created in 1948 We want it to remain great A podcast where we share our stories Explore solutions in all their glories They say it's broken, but it's not done With your host Val Barrett, Dr. Jeremy Anderson

Val: Welcome to Stories, Labels and Misconceptions. With Val Barrett. 

Dr Jeremy: Dr. Jeremy Anderson. 

Val: And this week we are talking about empathy in healthcare. Empathy is a word we hear everywhere, from medical schools to media headlines is it always helpful in healthcare?

Val: Should doctors really [00:01:00] feel what their patients feel, or can that backfire? In today's episode, I'm asking Dr. Jeremy. for his thoughts. He's read the book against empathy by, Paul Bloom? 

Dr Jeremy: Paul Bloom. 

Val: I haven't, but I do have my views. This is us raw and honest

mhm.

Dr Jeremy: I've been bursting at the seams to talk about this for a long time. Because I think this, this book, it's getting a bit older now. I think it's been out for about 10 years. I read it many years ago and it really changed the way I think about empathy. The title of the book is very, provocative against empathy, the case for rational compassion. The idea of being against empathy sounds completely weird, 

Dr Jeremy: right? Counterintuitive because empathy is supposed to be a good thing, right? Why would anyone be against empathy?

Dr Jeremy: Paul Bloom is a very [00:02:00] famous Canadian psychologist. I believe he taught at Harvard or MIT. He's a research psychologist, developmental psychologist, language development and babies, I think.

Dr Jeremy: He's at the tail end of his career. When academics get to that stage they start writing books for. The public rather than scientific journal articles. This book is, although it's written, by an academic, it's aimed at the general public.

Dr Jeremy: And so against empathy, it's it's challenging popular assumptions. So if we're against empathy, let's first start with what is empathy, right? 

Val: Yeah. I remember we had a conversation some time ago and you mentioned some people get empathy and compassion.

Dr Jeremy: Yeah. 

Val: When I looked at the definition, empathy is feeling with someone sharing in that emotional experience. I feel your pain. 

Dr Jeremy: We tend to think empathy or [00:03:00] sympathy is a good thing. It's good to feel sympathy, isn't it?

Val: It's say there's a counselor that specialises in abuse and became a counselor because she had abused herself she counsels women that have been abused so she can say, I feel your pain. Some people take a certain profession because A, they've been through something or a family member has.

Dr Jeremy: Absolutely, although if someone was a counsellor who'd been through that, they'd want to be careful to say, I know what my pain was like, and I think it was similar, right? Probably feel something like what you feel, more personal lived experience of a similar phenomenon. 

Val: Yeah. 

Dr Jeremy: I think that's where, we have this idea that, empathy is really going to help healthcare professionals or mental health professionals do their job.

Dr Jeremy: Because or even just, other people [00:04:00] just in their relationships, it's going to help you, relate better to the people that you're working with or talking to or whatever. And the idea that you'd be against empathy seems strange. And so I think Bloom makes the caveat at the beginning.

Dr Jeremy: If being empathetic or being an empathic person is free, if that's just synonymous with being a good person. 

Val: Yes. 

Dr Jeremy: If you mean by this, like I care about people, fine. He has no problem with that. That's not the kind of empathy he's having a problem with.

Dr Jeremy: He's defining empathy. In a very specific way, the way psychologists define empathy. Psychologists talk about empathy in two ways. Cognitive empathy. 

Val: Yes, 

Dr Jeremy: Cognitive is just a fancy way of saying thinking. It's the thought you have of, this person is feeling X. If this happened, a person would feel this, it's the knowledge or thought that someone. Is feeling something. 

Val: Yeah. 

Dr Jeremy: The second kind [00:05:00] is emotional empathy. It's the idea that, when, let's say you look at someone and that they are sad.

Dr Jeremy: You generate feelings of sadness in yourself. Psychologists talk and I think it became very popular a few years ago to talk about mirror neurons. The idea that in our brains we have a specific part of our brain that is designed to mimic the emotions that other people are having.

Dr Jeremy: Or at least the other, the emotions that we perceive them to be having. So if someone is sad, , we feel sad. If they're angry, we feel angry. If they're happy, we feel happy. 

Val: But you wouldn't want your doctor crying all over you. You wouldn't want your nerves breaking down.

Dr Jeremy: No, that's a good point.

Val: That part of empathy, I wouldn't want. Yes. Whether I'm bawling my eyes out, somebody has to be in control and measured. Do you see what I mean? And that ain't going to be me. 

Dr Jeremy: No, you don't want to overdo [00:06:00] it.

Dr Jeremy: Can you imagine if you went for grief counselling because your spouse or parent died you're upset and the therapist burst into tears and can't function. You don't want that.

Val: As a psychologist, we're all human beings.

Dr Jeremy: Yeah. 

Val: And no matter what status we are, we've all been through something. How can another human being just switch off their emotion? Just flip a switch. We're not robots.

Val: It doesn't matter how much training you've had, you're not a robot I remember when I did some, valuation at the Royal College of Gynecology and I asked this, consultant. What made you become a gynecologist? And she said to me back in India, when she was growing up, pregnant women around her dying or dying in childbirth or dying after unnecessarily.

Val: And [00:07:00] she was seven years old and told her mother, I'm going to do something about this. She became a consultant. She goes back there. She sets up a clinic. So she had that emotional empathy from a very young age. 

Dr Jeremy: She had a direct experience, right? 

Val: She may not have, had it directly, but seeing it in her village impacted her to say, I'm going to do something about this.

Dr Jeremy: Yeah. 

Val: So that's emotional empathy. Even though it didn't affect her directly. She had emotion. 

Dr Jeremy: I think she's got, the whole package thinking about other people. Recognising what they're going through. She imagined what that would feel like if she was, pregnant and having a hemorrhage or birth complication, wanting to make a change.

Dr Jeremy: Doing good things. That's where Bloom would, make the distinction between empathy and compassion. That is that the compassion part, that's [00:08:00] really the wanting to, make the world better to actually do something about it. 

Val: This is the definition of quick definition I found compassion, caring for someone with a desire to help without necessarily feeling what they feel. I see your pain and I want to ease it. 

Dr Jeremy: Yep. 

Val: So now that we're getting into this. I hate to say, am I started to change? I know I've always wanted compassion.

Dr Jeremy: Yeah. 

Val: But I've always had the thing about, I want empathy in healthcare. Want clinicians to be more empathetic.

Yeah. 

Val: I don't want them bawling their eyes out. 

Dr Jeremy: Yeah. 

Val: Want them to be more understanding. 

Dr Jeremy: You want the same thing. Maybe a different label for it. Maybe you still want the same thing, right? 

Val: I was always stuck on empathy. 

Dr Jeremy: Yeah. And again, I think people often use the word empathy synonymously with compassion. And I think bloom [00:09:00] is making that distinction, right? I 

Val: think so. Okay. So what about this? You have a patient, she's got cancer. The nurse has had a mother gone through cancer and passed away. Then she has another patient with cancer, but hasn't had, I know what I'm trying to say, but hasn't had a mother that passed away.

Val: She just has cancer. Is Bloom trying to say The empathy is going to be different with the one that's directly had the same experience as the nurse versus the person who's got the condition, let's say, but hasn't had the exact same experience. Do you think the compassion and empathy would be different?

Dr Jeremy: Yeah, I that's Bloom's first criticism of [00:10:00] empathy. It leads to inconsistent decision making or care. 

Val: Exactly.

Dr Jeremy: It's easier to feel Empathy for people more similar to you, it's easy to feel empathy. If they're different if the experience is different it's harder. Bloom talks about structural inequalities and racism in healthcare, it's easier to feel empathy for people who look like you. 

Val: Yes. 

Dr Jeremy: People who talk like you 

Val: Exactly.

Dr Jeremy: Speak the same language who have similar problems 

Val: Yeah. 

Dr Jeremy: Who are closer to you. 

Val: Yeah. 

Dr Jeremy: If empathy can motivate someone to behave compassionately. 

Val: Yeah. 

Dr Jeremy: Great. Narrows your focus people who are like you. If you're dealing with people who aren't like you, it's harder to behave compassionately relying on empathy, 

Val: That happens a lot. We're human beings at the end of the day, we are human and we do have differences in outcomes. Inequalities, why is it black [00:11:00] pregnant women are treated different to white pregnant women?

Val: At the end of the day, they're both women and they're both pregnant. So the downside of that is the outcome. It's got to be empathetic. One is more listened to and heard and seen. Black women often say they are not seen

Dr Jeremy: yeah. 

Val: That's the only difference. So it has to come down to that. The languages are spoken, the English, they speak it, so there has to be another reason. So I think across the board, let's take empathy away for a second 

Dr Jeremy: OK 

Val: just look at compassion. 

Dr Jeremy: Yeah. 

Val: I remember watching the news They said they want to train or teach clinical staff compassion. I burst out laughing because if you don't have compassion, you should not be a [00:12:00] nurse.

Val: It's as simple as that. I wouldn't be a vet because I'm scared of animals. I don't like all animals. Some are.

Dr Jeremy: You like junkile don't you? 

Val: He's on the screen, Jeremy. I

Dr Jeremy: adorable. 

Val: Sure he is. I'll take your word for that. But what I'm saying is, why would I want to be a vet? Yeah. It's like, why would you want to be a nanny if you don't like children? Makes no sense. 

Dr Jeremy: Yeah. I think the vast majority of people in healthcare got into healthcare because they want to help people. They want to cure disease. They want to make a difference. They have compassion. 

Val: Then what the hell has gone wrong?

Dr Jeremy: There's a thing called compassion fatigue and I think this is a bit counterintuitive but it might be that empathy that felt empathy might actually contribute to compassion fatigue. So if you're in a profession where people are really suffering and you're just dealing with that [00:13:00] suffering day in and day out.

Val: That's what you signed up for. 

Dr Jeremy: That's what you signed up for. Not that you necessarily knew but 

Val: come on, they're not kids. If I'm going to work in IT I said, I've had enough of bloody computers. No, sure. 

Dr Jeremy: Sure. But you might not know how the job is going to affect you.

Val: True. Then it's best to leave. Rather than allowing patients to suffer because if you're at that state, you will not give in your best. And you're dealing with sick people in the most vulnerable state, and you're not giving your best or you don't want to be there.

Val: I wouldn't want a doctor or nurse treating me. And then carried on, they don't want to be there. It's not nice. I had that once when I was really ill. I was barriered. I couldn't leave the room and nobody was bringing my dinner.

Val: When [00:14:00] I buzzed, the nurse walked in. And she stood there. She huffed and puffed and put her hands on her hips I cried. 

Dr Jeremy: Yeah. 

Val: And she gave me dinner cold. I didn't complain me with a big gob, but when you are ill, you are vulnerable. . And you don't realise how disempowering you are. And then somebody comes along that is supposed to. Care for you and have, compassion. One nurse did. He said, I was upset and he said, I'm not supposed to do this. Can I give you a hug? I said, needed it. 

Dr Jeremy: Yeah. 

Val: I needed it. And you do, you get good and bad,

Dr Jeremy: certainly in some situations, like in healthcare. The easiest thing might be to leave, but there's [00:15:00] also gonna be other situations where, you know, just because you leave doesn't mean that people are gonna get better care. Do you remember the stories of the Romanian orphanages? After the fall of the Berlin Wall and the fall of Ceaușescu. 

Val: Yeah, go on. 

Dr Jeremy: Romania was full of these orphanages. And, they were cared for. Like the staff were, making sure they were fed and watered and had a place to sleep. But they were overworked, completely fatigued, had no emotional connection. To these kids. Had no time the kids just kinda sat there? They were permanently disabled. Yeah. Developmentally disabled.

Val: They were in big cots. Weren't they?

Val: They were in cot. Remember seeing that 

Dr Jeremy: Yeah. It was a story. You could say, the staff members should just leave, but it's not there's. a lineup of people who are gonna care for these kids. If one person was fatigued and they all left, those kids would have just died.

Val: But is it just fatigue

Dr Jeremy: just burned out, right? Burned out, depressed. They just can't handle it. Overwhelmed. [00:16:00] 

Val: Yeah. 

Dr Jeremy: And when that happens, it used to be we need to teach people empathy, but that was multiplying the problem because they were giving people the burden of trying to think about how the other person was feeling was just making it worse. The research is showing 

Val: I've mentioned that to you before. And I know another doctor that does not agree with me, but I'm standing firm on this. 

Dr Jeremy: Sorry, you disagree with what? 

Val: Teaching. 

Dr Jeremy: Teaching. 

Val: Empathy or compassion. As a qualified teacher.

Val: I can teach you an application. I can teach you how to use word processing. Is it word still? Excel spreadsheets, whatever. Sure. Cause that's something that you're going to use to me. I just think there's certain things that are just in your DNA. You can come to a classroom. I can show you slides of vulnerable people.

Val: Bring in someone who's been [00:17:00] abused or living with an illness. They can tell you their story and once blah, blah, blah, feel sad because you're living in that moment. Don't forget. We go through a lot. How many times have you watched the news and you live in that moment and you see some really bad, horrific story going on in another place in the world.

Val: In that moment, after that is over, you get on with your life. 

Dr Jeremy: Yeah, 

Val: that's what happens. So we live in that moment four o'clock comes training's over. Everyone goes back to work. Everybody goes back to who they are. I just believe that whoever you are, that is already been shaped.

Val: You can go and learn how to be a doctor. A nurse, take people's blood, all of those things. But when it comes to you, your personality, all those things that [00:18:00] make you, some people are just nice. Haven't you met someone that is just so nice? They're a doctor, an electrician, whatever. They are just a lovely human being. 

Dr Jeremy: Just really kind, considerate people. 

Val: Then you've got some people that shouldn't leave their house. Shouldn't mix with another human being ever. Yeah. Yeah. Yeah. And you think, how the hell does that person, why are you so wicked and mean?

Val: Wicked and mean wherever they go. So to teach these things I, that I just can't get, either you want to be a nurse because you are a kind, nice person and you want to help or you don't. You're just not nice. You have zero empathy. Some people, you tell them a story and they look at you with a blank stare. And you think, Are you feeling anything and there's you stopping yourself crying and that person's just looking blank like what is she upset for they just don't have [00:19:00] that.

Dr Jeremy: Certain people are just oblivious and there's people who, you know, obviously people with personality disorders, they're just incapable of caring about other people, things like psychopaths , narcissists or something. Actually psychopaths are a good example, right?

Dr Jeremy: Because we often think of people as psychopaths as lacking empathy. But have a lot of that cognitive empathy. Like they understand that, , if I pull a knife on someone and say, give me all your money, that person will feel scared and they'll be more likely to give me their money.

Dr Jeremy: So that's why they do that. And in fact, the research showed when they tried to teach psychopaths empathy it backfired it made them better manipulators.

Val: Exactly.

Dr Jeremy: They're still evil. And they're just using the skill for evil. That's what you're trying to say. Yeah. Yeah. So . teaching people to feel what other people's pain doesn't necessarily make them a good person. 

Val: No, it doesn't. 

Dr Jeremy: If they're not a good person, they're just not as 

Val: You've been more knowledge of how to exploit people.

Dr Jeremy: Yeah. So that's definitely [00:20:00] one of the problems with thinking about empathy. Another is that Just the way human beings are built, certain stories resonate with us more. It's easier to feel empathy for one person in need versus multiple people in need. This is weird. 

Val: There's a saying, when you have so many deaths, it's a statistic. You have one death. it's a story. 

Dr Jeremy: It feels more personal. It resonates. And the same thing in science or medicine, like anecdotes, individual case studies, single stories, it has more weight to it. Right. An example, Bloom gives is vaccines. If you hear one story about a bad reaction that's scary. 

Val: Nobody wants it. 

Dr Jeremy: Wants the vaccine. Nevermind the fact that millions of lives have been saved by the vaccine. There was that one person who got screwed. So these single stories carry way more weight than large [00:21:00] numbers. That's a way our empathy might be leading us astray. So these are the kinds of things bloom is suggesting is a problem.

Val: There is this quote by Maya Angelou that I love is I've learned that people will forget what you said. People will forget what you did, but people will never forget how you made them feel. 

Dr Jeremy: Yeah. 

Val: I think about my father I miss him, but I laugh because he was funny. Do you know what I mean? That feeling you have, , you never forget, whether it's a negative feeling that person has left you with or a positive one. You don't forget the feeling, do you know what I mean? 

Dr Jeremy: Absolutely. And I think, one of the reasons why psychologists are so interested in empathy is, a big part of therapy of what we do with people is about more than [00:22:00] words, it's the feeling. 

Dr Jeremy: And I was talking to my supervisor yesterday about, there's, there was a lot of research comparing physiological, markers, like heart rate breathing and blood pressure of the therapist and patient in therapy.

Val: Yeah. 

Dr Jeremy: What they find is when the two are in sync, the bond is stronger. The patient feels. More understood. I don't know if it leads to better therapy outcomes. I 

Val: it might be something else. Yeah. Yeah.

Dr Jeremy: And that's why, it's called the intimate hour.

Val: Really? 

Dr Jeremy: Yeah. That's the thing. It's these moments where you're having deep conversations, maybe the most profound you'll ever have with anyone. That's what we're doing now. If you hooked up a blood pressure monitor our blood pressure would be insane.

Val: Yeah. 

Dr Jeremy: But yes. When these parameters are in sync, the patient and therapist are feeling more bonded, and that's important for their therapy outcomes. Our ability to empathize and [00:23:00] synchronize our feelings does allow us to relate better.

Dr Jeremy: If my wife came home and said, this guy at work, said something rude, and she's really angry, I've got two options, I could get really angry or, I could say, give me his address or, I'll hunt him down. Or, I could just be like, try not to think about it. How do you think she'd feel with each reaction? In relationships, it probably helps that, when you're with someone and you're angry and tell them something. You want them to feel something in common right? 

Val: Yes. It helps 

Dr Jeremy: you feel closer. 

Dr Jeremy: So in relationships I think, empathy does play an important role. 

Val: That's different. That's a personal relationship.

Dr Jeremy: That's a personal relationship. 

Val: Do you think now that we've been talking a bit about compassion as well and the difference, does compassion offer a more sustainable path in healthcare? Yeah. 

Dr Jeremy: I it's more consistent. If [00:24:00] the goal is for a health care provider to provide the same level of care to everybody, empathy is not going to get you there because it's easier to empathize with some people

Dr Jeremy: I had a discussion with a patient once. And she related a conversation she had with a nurse. And she was asking, they were having a heart to heart and she was asking the staff member, what do staff really think of us that people with sickle cell disease? The nurse revealed that with some patients the feeling is disgust.

Val: god's

Dr Jeremy: disgust absolutely kills empathy. Think about that for a moment. Is it but that's what I don't know who this was. I didn't have the conversation. I'm just relating it, but is it even possible to feel empathy? For someone who disgusts you, 

Val: so you wouldn't even have compassion. I I really don't think you would. 

Dr Jeremy: I [00:25:00] think it would take a saintly person to be able To really want somebody to feel better. Yeah. 

Val: Somebody disgusts you. And this is why we get these complaints. These inequalities, these unequal outcomes. In health care, 

Dr Jeremy: and that, 

Val: that one word just sums it up because you can bet your bottom dollar, that person, that nurse isn't the only one that thinks that, 

Dr Jeremy: and I think that's really important to think about in healthcare. I think, Paul Bloom, I think, gives the example of I think they did a study with nurses, asking their thoughts about people with.

Dr Jeremy: with HIV. And so one person, contracted HIV through a blood transfusion, right? No, no fault of their own. And another person contracts HIV through intravenous drug use. 

Val: Okay. Yeah.

Dr Jeremy: And basically what they found is people had less empathy for the people with HIV who contracted through drug use.

Dr Jeremy: So keep in mind, so these are people with the exact same illness. They're suffering, they're both suffering equally. They've got, they've both got the same illness, 

Val: right? 

Dr Jeremy: But one person did something that they're not supposed to do. So they get less [00:26:00] empathy and, if you want people to give consistent care, they need to give care based on need, not on deservedness.

Val: Talking about that. I remember watching a documentary about suicides. And there's a gentleman went into A& E, they sent him home with a noose still around his neck. 

Dr Jeremy: Oh. 

Val: Yeah. 

Dr Jeremy: I've had that experience of going into, an A& E. with one of my patients who was very suicidal. And they just said, go sit down over there.

Val: Yeah. 

Dr Jeremy: And the attitude was like, we're busy here with people who want to live. We don't have time for you. 

Val: Yeah. 

Dr Jeremy: And that's, that is a, is compassion fatigue. If you ask me, that's just people who are overwhelmed and they just don't have 

Val: any compassion. I'm going to disagree with you. 

Dr Jeremy: Okay. I'm 

Val: going to disagree with the doctor.

Val: Dr. With a PhD. Can you say it's fatigue? 

Dr Jeremy: Yeah. 

Val: [00:27:00] No, they're showing you who they are showing you what they truly believe. That's all. We have to remember anyone that works in health, in healthcare, whatever role that they do, they are from communities. They are human beings. People that live in communities. We have racists.

Val: We have people who are going to think differently to us. We have some people that don't like particular groups, don't like, particular genders. We're going to have all of that mix. Working in healthcare. 

Dr Jeremy: Yeah. 

Val: We can't assume just because they put a uniform on that suddenly all their belief system, all their discrimination.

Val: Yeah. All that negativity is shrugged. Is shrugged off. No, they take it to work. I remember watching this drop, this drama. It was just a drama. 

Val: It really opened my eyes. I forgot what it was called. And there was, they had to choose who was going to get care first. Okay. The lady who would, who overdosed on drugs.

Val: or someone else, but it was the [00:28:00] language that they used. 

Yeah. Are 

Val: you going to take this woman? You're going to take this druggie over this woman? Language. 

Dr Jeremy: Yeah. 

Val: So you can imagine we are forgetting they are human beings. This is language. They probably speak at home language. They speak amongst their friends.

Val: When somebody comes in, and they're Gentlemen, I was telling you about with the noose around his neck, he'd been in there quite a few times. Oh God, him again. When is he going to get on and just bloody do it? You can imagine the conversation that's been at. 

Dr Jeremy: Yeah. 

Val: Where there's something deeper going on.

Val: It needs help. 

Dr Jeremy: Of course. Because 

Val: some people some people say, if you're going to do it, you do it. If you don't, it's a cry for help, we do have people that do say things about certain groups, about certain illnesses, whether somebody is obiest through unhealthy eating. Can you imagine what's said about them?

Dr Jeremy: Yeah. 

Val: People that drink and they need a new liver. [00:29:00] Can you imagine what's said? 

Dr Jeremy: Yeah. That's another thing. I watched another, it was it was hospital, it was a documentary that was filmed at, in, at at one of the London Trusts. Oh. Where, I think it was an example of surgeries being bumped and bariatric surgery.

Dr Jeremy: That is the. The surgery where people who are morbidly obese, get, either bending or a bypass to help them lose weight. That surgery was being bumped because it was considered less important than. Yeah. other surgeries, even though it's, medically critical. The reason you do bariatric surgery is because it has immediate health improving effects in terms of blood pressure and diabetes, and your heart for sure. And there's this idea that people who are obese, they got their way, through their own 

Val: Yeah. 

Dr Jeremy: Why should the healthcare system Help them. Or 

Val: smokers. Or drinkers. Or smokers. 

Dr Jeremy: Exactly. If people smoke cigarettes, should they be given as much compassion?

Dr Jeremy: Because it's a vice. 

Val: So it is. It's not as easy as you think because people come with their own [00:30:00] judgment, their own prejudices that you cannot conquer. There's nothing that you can do about that. Yeah. When people say, Oh, we've got to fight. Racism and it's always going to be there.

Val: It is. But the only time it, when it really bothers me, it's when it will impact on me getting a service because of my skin color. I cannot. Help Joe blogs down the road if Joe blogs doesn't like me. Yes. I'm a black woman. I can't help That's his business.

Val: There's just some things I think we believe as a Society that we can Eradicate we can't Measles You know People have believe not everybody does, but some people do. I hear with some people, they don't even want a black nurse. They want a black doctor. I remember telling my son the other day, when a [00:31:00] racist comes in and they actually need a, is it a donor?

Val: Need a new organ. I'd specifically look at a black person, show them the picture of the person's. organ. That they've received. Let me know if you're going to give that back.

Val: Honestly. So there are things that we're not going to get rid of. That's not going to get any, but if anything, the world's getting worse, anything is getting worse. And people aren't afraid to say it anymore. They're not afraid. Where before it was a bit undercover, a bit, now it's out there in the open for all its glory.

Dr Jeremy: Yeah. It's 

Val: out there. 

Why do you think that is? 

Val: It's like they've been at last given permission, but it's okay. Say I'm a racist, I'm a fascist. I don't, I don't want immigrants here. It's like they've been given permission. These aren't new feelings that they've had. Yeah. 

Dr Jeremy: Yeah. 

Val: They've kept it between themselves.

Dr Jeremy: It's yeah. It's, but it's being fueled. Yeah. And of 

Val: course, I think every generation has it. My father, when they came here, Oh, getting our jobs, taking our women, they do it again and again. If you wanted the job apply. 

Val: And then when supposing, 

Dr Jeremy: [00:32:00] yeah, 

Val: imagine this and England without.

Val: immigrants. Imagine that. And that's including yourself. 

Dr Jeremy: Yes. 

Val: Imagine every person that you know already that works in healthcare as an immigrant. Imagine them all gone. Transport would probably stop. 

Dr Jeremy: Oh yeah. It's the vast majority of the people who work in healthcare. Yeah. Yeah. I was thinking about, this issue.

Dr Jeremy: Earlier in relation to empathy, I was actually thinking about, the stabbings of the little girls and the riots that followed. So what do you see there? Like we had a picture of a little girl, right? A little toddler. 

Val: Is that the one in Southport? 

Dr Jeremy: Yeah, I think there were three girls.

Dr Jeremy: There were many people stabbed, they just show like one picture, maybe a couple pictures of just little girls who've been stabbed and killed. How much empathy was triggered there that caused outrage, right? I 

Val: remember watching the news. And the newsreader could barely contain herself.

Dr Jeremy: [00:33:00] Yeah. 

Val: Now, I get that. But there was also opportunists. 

Dr Jeremy: Yeah. 

Val: That decided to use that as a way to, support their agenda. 

Dr Jeremy: Right. 

Val: Of immigration. 

Dr Jeremy: And the opportunity was we were all feeling emotional. There are these 

Val: destroyed the area. 

Yeah. So there was 

Val: none of them went there with any flowers.

Dr Jeremy: No, 

Val: I bet. None of them went there with any. What can we do for you? And I bet when it all died down, I bet none of them went back to say, okay, it's all dark, all died down. Cause don't get these, but these families have still lost their kids. The hoo ha has died down. The media has gone away. I wonder how many of them went back and said, what can we do for you?

Dr Jeremy: I'd be amazed if any of them did, right? It's much easier to protest and, get into trouble, but the actual hard work of supporting victims or their families, 

Val: do you know how sad this is? 

Dr Jeremy: Yeah. 

Val: When you hear on the [00:34:00] news, there's been a stabbing or a rape, something really bad.

Val: You literally close your eyes and hope it's not anybody black. That's stunning. You really do. You hope it's not an immigrant because some people can't tell the difference when the South Port killings happened, some people a lot of people were being attacked.

Val: So the people you heard were pulled out their cars, they were trying to burn down, I think, an asylum seeker place. I think. 

Dr Jeremy: Yeah. 

Val: It gives them like that red light to say they all want, compare that to what happened at the I think it was when Liverpool, I think it was the end of the season.

Val: I think. I can't remember. And they had the parade and a driver and those people were mowed down. 

Dr Jeremy: Yeah. 

Val: Do you know how many people went, cause I went on Twitter, said on Twitter, they slowed down the car. Nah, they're lying. It's black. [00:35:00] It's a black man. They're lying. They're lying. And then all of these  commentators.

Val: We're quick to say, why do they have to say the ethnicity? Because if they didn't, the default ethnicity is always an immigrant. That's why the police put it out so quick and it's always a non immigrant that uses that statement. It doesn't matter what color the, it does if you are that color, 

Dr Jeremy: Yeah 

Val: always a white person that says that.

Val: But when you have innocent men being beaten up and abused that had nothing to do with it. 

Dr Jeremy: Sure. 

Val: It does matter when something is done by a white man. black people don't go out and beat up all white men. 

Dr Jeremy: No. 

Val: Nobody marches. the gang in Glasgow, that rape gang in Glasgow, there's no marches there.

Dr Jeremy: Yeah. Even in this, in the Southgate, was it Southgate stabbings? South, 

Val: Southport, I think. 

Dr Jeremy: Southport. 

Val: Sorry. Southport. 

Dr Jeremy: Okay. I think the way the story went there is they declined to talk about the ethnicity of [00:36:00] the attacker. And in that by not saying something. Yeah, in that case, that's actually what fueled the riot, because people just said, oh, it was an, IM a recent immigrant from Syria or something.

Val: But I think the riot would've happened regardless. 

Dr Jeremy: Oh, it would've, in this case, it would've, 

Dr Jeremy: would've, but I guess what I'm saying is, by not saying it, that vacuum is filled by rumor and lies. 

Val: But don't forget, I think the police had to have time to get the family.

Dr Jeremy: Yeah. That's true. 

Dr Jeremy: Yeah. That's true. 

Val: Because they are also innocent. Yeah. I hate it when people think, Oh, the family must've known the father tried so many times and there was an incident where we tried to get and the father went out to the cab man and said, don't take him. 

Dr Jeremy: Yeah. 

Val: But you always get the blame.

Val: I always get the blame. So I think they had to think quick. They had to do something for the family. Cause we know in this day and age, it's easy to find who people are, where they might live. So I don't know. It's empathy for somebody that looks like you. You hear time and time again, I'm a mother.

Val: My child is the same age. [00:37:00] 

Dr Jeremy: Yeah, 

Val: you always hear that. How many times do you see or hear a newsreader when there's a knife? Crime? My son is the same age as that young black man. . And got killed. You don't hear it. There's the empathy. There's no likey. Likey. 

Val: Don't look like your son. Maybe the same age.

Val: . But they don't look like your son, which is sad. It really is, because if we are truly only reliant on empathy and compassion for how someone looks, you

Val: know how is that going to make things better? 

Val: Yeah. It just isn't. 

Dr Jeremy: Yeah. I think what just getting back to to Bloom, I think what he's arguing is we need to have a kind of. He's not a, Mr. Spock, a Vulcan or something like that. But he's arguing that some of these moral decisions we make need to be related to cold calculating, like what is going to do the most good. Example, if you were going to give to charity, there's the kind of thing that, empathetically, it might resonate with you, right? I don't know, giving to, little girls who are victims of violence, but is that going to do the most good? It'll do some good. [00:38:00] But what if the way to save the most?

Dr Jeremy: Given the amount of money that you have to give to charity, what if you could save the most lives by, buying mosquito nets, buying mosquito nets is really cheap, not sexy, but you save a huge number of lives if you do that. So I think that's the kind of approach that Bloom would argue.

Dr Jeremy: If you want to do good and you might want to target your giving or to, to something that's based on reason and evidence. Rather than your feelings because your feelings are not reliable or at least not fair, right? Yeah Sorry, you are you picking up my wife talking on the phone here?

Dr Jeremy: Yeah, sorry Let me let you're getting a French cake Let me just Close the door here

Dr Jeremy: She must be talking to her family. It always gets loud when she's talking to the family. 

Val: Oh, okay. 

Dr Jeremy: Okay. Anyway. So I think that should be better now. 

Val: Yeah. So since you read the book. 

Dr Jeremy: Yeah. Yeah. 

Val: Did your views change? 

Dr Jeremy: Yeah, I would say, I think it just, it clarified for me the difference. between empathy and compassion.

Dr Jeremy: Empathy is good. It's the cornerstone of compassion. You need to have some empathy. It's like an umbrella, right? But compassion is the whole package. It is actually what we want, which is the wanting to help the actual caring part is better described as compassion. 

Val: It's called care.

Dr Jeremy: It's care. Yeah. And I think empathy on its own, it probably has a role in in helping in some ways in relationships. And it's part of compassion, but but [00:39:00] on its own, it can lead us astray. It can cause some problems. Probably better to think about compassion. 

Val: I must say I started off With my view, need more more empathy,

Dr Jeremy: more empathy. Yeah. In 

Val: healthcare. I must admit. I 

Dr Jeremy: make a compelling argument, huh?

Val: I must admit, oh God, it has changed. It has. Yeah. Because I now fully understand. 

Dr Jeremy: Yeah. 

Val: I was probably more leaning towards compassion. 

And 

Val: now it's been fully explained and we've had this nice talk, nice debate. It is compassion. 

Dr Jeremy: Yeah. 

Val: I don't want my doctor crying. Yeah. I need my doctor to have compassion. I need my nurse to have compassion for my son, 

Dr Jeremy: of course, 

Val: ever the illness is the illness. It shouldn't be the thing that provokes discrimination. I don't know. I know what I'm trying to say. I know the illness matters, but it shouldn't be the thing that discourages the clinician from having compassion for that person. [00:40:00] That person on that hospital bed. is a human first. 

Dr Jeremy: Yeah.

Val: Whatever illness they have, cancer, 65 braces, sickle cell, whatever they have, whether you yourself know somebody with it, you've had one of them or whatever it is irrelevant. 

Dr Jeremy: Yeah. 

Val: Or for God's sake, we can only employ clinical staff that have been through every single illness known to man. That makes no bloody sense.

Val: No, no politicians. 

Dr Jeremy: Yeah. 

Val: Are we honestly going to have politicians from working class background that a are being broke B brought up on a housing estate C know what it's like to live off income support or universal credit is a carer has an adult child in care is that realistic?

Val: It's not going to be [00:41:00] realistic. So when they say, Oh, they don't understand, they don't get it. I get them saying that, but then it's their job to surround themselves. Yeah. With the right people. 

Dr Jeremy: Yeah. To 

Val: have the right voices around the table. Yeah. So when one thing, when you don't have the right voices, just like in COVID.

Dr Jeremy: Yeah. 

Val: There was no one there speaking for, from what I heard when I listened to the inquiry. The inquiry. . When we were in lockdown, some people were locked down with their abusers. 

Dr Jeremy: Yeah. 

Val: Can you imagine that? 

Dr Jeremy: Yeah. 

Val: The only respite you had from your abuser was school. 

Dr Jeremy: Yeah. 

Val: Covid comes along. 

Dr Jeremy: Yeah.

Dr Jeremy: Really? That's if you could go to school. Yeah. 

Val: Yeah. So there was no voices around the table. Yeah. Yeah. To think of 

Val: those things. 

Dr Jeremy: Yeah. That was a huge problem. And, some of the of the traction I sometimes get when I talk to people Is, this idea that, you need to be able to feel, so there's two messages, right?

Dr Jeremy: Uhhuh, , there's this idea that, in order to care for me, you have to be able to feel what I feel. But the other message is no. Okay. You'll never feel what I feel. 

Val: I know , 

Dr Jeremy: right? . So where does that leave you as a patient? Yeah. If you buy into this idea that a person has to feel what you [00:42:00] feel. But nobody feels what you feel. Now you're helpless. 

Val: Yeah. 

Dr Jeremy: I think the truth is, doctors and nurses. Okay. Sure. If some of them had sickle cell, it would probably be somewhat helpful in some ways. 

Val: We don't know that. 

Dr Jeremy: We don't know. I'm just guessing. We don't know that. We 

Val: assume that.

Dr Jeremy: Yeah. Because 

Val: sometimes some people say the worst ones are the ones that are not like you. 

Dr Jeremy: That's actually really good example, and I'll just make reference to my, my wife's experience with menopause, goes to a female GP. 

Dr Jeremy: It's just suck it up.

Dr Jeremy: Don't everyone has to go through this. So she's projecting her experience. That's her felt empathy. She's relating, not what my wife was experiencing. She was relating what she thinks my wife is experiencing based on her experience. But the male GP she went to just went.

Dr Jeremy: Oh, okay. Let me write you a prescription for something that will help. He didn't have to feel what she was feeling. He just had to want to help her. That's all you 

Val: notice. Is that a man thing? Cause at times your wife might come home and say, they want to talk about certain things.

Val: Oh, it's women's property. Okay. Okay. You want to close it down. You don't want to talk about 

Dr Jeremy: it. Sure. Sure. There's that too. Yeah. 

Val: Yeah it's, I think with [00:43:00] most patients to sum it up, I think it is compassion. You really want, and it's compassion that we all deserve to have, irrespective of who you are, where you come from, who your family is some people get treated differently because of fame.

Val: I've heard of that, so we don't want that to happen. Yeah. Because, we already have an inequality in life and you think the one place where we might all be the same is when we're sick if you're unfortunate enough to be living with cancer and from a housing estate and then here comes.

Val: A woman who's living with cancer, she lives in a mansion. You both got cancer. 

Dr Jeremy: Yeah. 

Val: Do you see what I mean? They both deserve the same level of compassion. 

Dr Jeremy: Absolutely. 

Val: Yeah. Their outcomes shouldn't be different, but we know in [00:44:00] reality, health outcomes are different based on those things. 

Dr Jeremy: Yeah. Yeah. 

Val: Because all those characteristics, all those things all added up together, combined together states out where you live, your postcode, blah, blah, blah, all of those things adds up to your outcome.

Dr Jeremy: Yeah. And even across illnesses, it's, take cancer versus sickle cell. You 

Val: can never. It's like saying, David and Goliath. You just can't do that. That's not 

Dr Jeremy: well. Yeah. I guess just in terms of what elicits. Empathy. 

Val: Oh, yeah. Of course. You just need to say the C word.

Val: It's just 

Dr Jeremy: easier for the staff to say, yeah, oh that's, that person's probably scared because if I had cancer, I would be scared. Exactly. Everyone can imagine themselves getting that diagnosis. Yes. Everyone has imagined. 

Dr Jeremy: But, you might look at someone with sickle cell and say, I'll never get that.

Val: Because we know cancer doesn't discriminate, we can all get it, but sickle cell is different. 

Dr Jeremy: Exactly. I think if we rely on empathy, it's it leads to more of these things. Inequalities, right? 

Val: People. No, but people do empathize with [00:45:00] certain illnesses that they are confronted with.

Val: People have empathy with things, say child, they've lost a child. They empathize. So they do have empathy. When it's to do with a feeling is something that they have personally been through, but they don't have empathy for everyone. So the bottom line is compassion, but there again, they might use compassion the same as they have empathy.

Val: Do you see what I mean? Some of them don't see it differently. They will care more for the person that they have empathy with because. Like you, I had breast cancer, like you, I lost a child, like you, I have a parent with dementia, so the empathy will always lie [00:46:00] that way with a personal experience.

Val: And I think that is just a human thing. 

Dr Jeremy: Yeah. 

Val: It's just a human thing. And I, and I think it's too hard to ask. People to go to work. We're not that vampires where we can switch off our humanity. We can't there's not a switch. You can switch it off unless you want to inject everybody with some kind of AI.

Val: It's not going to happen. So it's not that humans are flawed. It's just the way humans are built is the way we are. So I think it is, I don't know if it can be learned. I, like I said before, I don't believe it can be learned. Yes. You can bring them to a classroom. You can show them videos of people in pain, sickle cell pain, telling their stories and you Oh, that's so bad.

Val: Oh, I didn't know that happened with people with sickle cell. All of that and then you go back to type because you're just being you at the end of the day, not a horrible you. 

Dr Jeremy: Yeah. I think probably like a one off training session. That's not going to do it. I think [00:47:00] if you want it to become more compassionate, hopefully you don't need brain surgery but I think regular practice and there are whole, societies that practice, what they call it, like a loving kindness So it's regularly daily thinking about the suffering of others and how you want them to feel better.

Dr Jeremy: You can train kids to do this, right? There's, there's whole societies that are focused on this. And so I think it can be trained, but that's a societal level thing. It takes a long, it takes consistent effort to get over those things. It's not going to be done in a weekend. 

Val: No, it never will be.

Yeah. 

Val: So we'll leave with the fact that I don't believe anyone can change. You are who you are, whether you are really a nice human being. Or you're just a human being that's, you're okay. Okay. Or just a human being. Or you're just bloody horrible. Either way, you're being you. 

Dr Jeremy: [00:48:00] Okay. 

Val: That's it. 

Dr Jeremy: If I believe that I'm in the wrong profession, if I thought no one can change.

Dr Jeremy: Well, 

Val: there's change and then there's change. 

Dr Jeremy: certain kinds of changes are impossible. 

Val: You, you can grow as a, you can grow, you can evolve. But as for changing that fundamental bit of you, that DNA bit of you that makes up you and all of the yous, no, I could be wrong.

Val: I could be talking a load of rubbish, but I just don't think you can. You are who you are. If you go back into your childhood. And try and reflect on who you were as a person, even though you've grown, you were always Jeremy. 

Dr Jeremy: Yeah. 

Val: You were always this person and you was always going to be destined to do something like this because of the way you were.

Val: Do you see what I mean? 

Dr Jeremy: Yeah. 

Val: You weren't a serial killer. You didn't go killing animals at seven. You were shaped as a psychologist. They say, you see the man, you see the woman. So you're [00:49:00] shaped. There's certain bits of you that I believe that are already shaped. 

Dr Jeremy: Yes. 

Val: You're destined, your part is destined to be the best at this because this is the way you are.

Val: You're just a nice person. 

Dr Jeremy: On that note. Cause, cause I agree. 

Val: Oh, you do agree. You agree the part I said that you're nice. 

Dr Jeremy: That I'm nice and yeah, I'm lucky to not be born with the mind of a serial killer.

WHOOSH: Mhm.

Dr Jeremy: But should we, do you want to end with a joke?

Dr Jeremy: Okay I heard a joke. I saw it online, so I can't, I don't know who made it up. But I'll repeat it here, but I thought it was hilarious. So I'll I'll try to do it without bursting at laughing at the bunch line. So the joke is there were these three retired surgeons and they're just, they get together and they're reminiscing and bragging about their work with their patients.

Dr Jeremy: And so the surgeon says, I saw this one guy, he'd been in a accident. He lost a leg or something and I fixed him up and he became like a world famous Marathon runner, right? So that's great. And the second,

Dr Jeremy: second, the second surgeon says, Oh, that's nothing. I saw a guy once who was attacked by shark.

Dr Jeremy: He lost both arms and I fixed him up and he became a famous. Basketball player or something, and and so the third surgeon says, okay, [00:50:00] so you know, I saw this one guy, he was in a horrible car accident and it was so bad that all they could recover from the accident was his asshole and a bag of Cheetos.

Dr Jeremy: And he became the president of the United States of America. 

Val: Oh my god! That 

Dr Jeremy: was an actually 

Dr Jeremy (3): funny 

Dr Jeremy: joke! What I love about that joke is that you don't have to say which president it is. Everybody knows.

Val: That was funny, that 

Val: was funny. 

Dr Jeremy: So That 

Val: was 

Dr Jeremy: good. Yes. Yes. Some people just are what they are and they're not going to learn compassion. Exactly. 

Val: Exactly. What I have really enjoyed today. I have, because we've been talking about this for such a long time that we were going to do this episode.

Val: And I must admit, I have learnt a lot, so thank you for that. And I hope those that have listening, have listened, have learnt anything too, because there is a big difference between empathy and, compassion. Yeah. So let us know what your thoughts are. Yeah. Give us some 

Dr Jeremy: feedback.

Dr Jeremy: Let us know what you like about this episode or any other episode. 

Val: Yeah. But yeah, especially if you do work in healthcare, 

Dr Jeremy: Yeah. 

Val: Great to know. 

Dr Jeremy: Yes. It's great to get some feedback from healthcare [00:51:00] workers or people who are, or even if patients, what you think about empathy or help or compassion.

Val: Brilliant. Okie dokie. Follow us on our socials and we'll see you soon. 

Dr Jeremy: Thanks.

Val: Thank you. Bye. 

Dr Jeremy: Bye. Bye.

You