Enfants en soins palliatifs. Des leçons de vie

Abstract

L’empathie a bonne presse. Elle est reconnue pour avoir un impact positif dans la pratique clinique. Cependant, la profession médicale se débat pour parvenir à un équilibre entre la distance clinique et l’empathie. Trop de sensitivité aux émotions exprimées par les patients, sans régulation appropriée, peut conduire à de l’anxiété, au stress et à une détresse personnelle chez les médecins, nuisant à leur bien-être et pouvant être au détriment de leur fonctionnement cognitif. Trop peu d’empathie pourrait mener à sous-estimer la douleur des patients et à de moins bonnes relations avec eux. Cependant à mesure que le champ de l’empathie se développe, le manque de cohérence conceptuelle et de clarté entrave les progrès. Dans certains cas, l’utilisation du terme même d’empathie, par nature multidimensionnelle et interpersonnelle, n’a guère de valeur théorique ou clinique ajoutée. Les travaux récents en neuro-imagerie fonctionnelle avec des médecins et des professionnels de la santé mettent en lumière les mécanismes neurocognitifs qui sous-tendent la sensibilité interpersonnelle, l’empathie et la motivation pour se soucier de l’autre. L’article conclut par une perspective nuancée et plus sobre du rôle de l’empathie en médecine et propose que cultiver le souci de l’autre est plus important que de partager l’état émotionnel d’autrui ou de se mettre à sa place.Empathy is everywhere. It has become a major topic of interest in many disciplines and professions. Cultivating empathy has been prescribed as a solution to numerous social ailments and political problems. One reason for such a proliferation of attention is the lack of a clear conceptual taxonomy and the use of empathy as an umbrella under which definitions vary enormously. It is widely acknowledged that empathy plays a critical role in the physician-patient relationship and has a positive impact in clinical practice. However, the medical profession is struggling to achieve an appropriate balance between clinical distance and empathy. Too much sensitivity to negative affect expressed by patients, without proper emotion regulation, may lead to anxiety and personal distress, which is detrimental to efficient cognitive functioning and can take a toll on the well-being of physicians. Too little empathy may lead to an underestimation of the pain of others and poor rapport with patients. As the field of empathy expands, the lack of conceptual coherence challenges advances in medicine. Moreover, in some cases there is little added theoretical or clinical value in applying the broad/all-encompassing term of empathy, which is by nature multidimensional and interpersonal.The number of competing conceptualizations of empathy circulating the literature has created a serious problem by making it difficult to keep track of which process or mental state this neologism refers to in any given discussion. Multiple definitions limit progress in the role of empathy in medicine, and which instruments are appropriate to assess its function and utility. Keeping track is important because the different conceptualizations refer to distinct psychological processes that vary, sometimes widely, in their function, phenomenology, biological mechanisms, and effects on interpersonal relationships. In this article, after considering the polysemic nature of empathy, I briefly review the functions attributed to empathy in medicine. Then I explain how theoretical clarity may be improved by examining knowledge from empirical investigations in psychology and social neuroscience which has led to better define the different components of empathy as well as their neurological mechanisms. One section critically reviews the functional neuroimaging studies that have been specifically designed to examine patterns of brain response in physicians and health professionals. A separate section addresses how social and relational factors, particularly group membership, may impact the expression and effect of empathy in medical care. This new perspective, based on advances in scientific psychology and social neuroscience, has the potential to reduce confusion and ambiguity. This critical and informed analysis of empirical studies in functional neuroimaging with health professionals calls for a nuanced assessment of empathy's functions, that are not necessarily a panacea as some seem to think.A provocative and more sober view on the value and the very interest in the notion of empathy in medicine is proposed. Ultimately, cultivating empathic concern (sympathy or compassion in today's medicine) seems more important than other aspects, particularly affect sharing or putting oneself in the patient's shoes.