J Halpern. Oxford University Press, 2001, £29.50, pp 165. ISBN 0–19–511119–2

Is medicine an art or a science? The question was being asked 30 years ago and I hope it will continue to be asked in 30 years time. Today’s climate of evidence based medicine, research, and ever demanding and demanded counting of patients, staff, time, trolleys, and operations suggests that medicine is a science. A few brave people, often working in the field of palliative care, suggest otherwise.

Jodi Halpern, psychiatrist, medical ethicist, and philosopher, argues that the traditional medical stance of detached concern—that is, “not being moved or influenced emotionally by the patient”, rather than aiding the healing process, actually hinders it. Detached concern can lead to avoiding “difficult” patients and difficult issues. Empathy, involving a conscious development of curiosity about the emotional stance of the patient, “imagining how it feels to experience something, in contrast to imagining that something is the case”, will engender trust between the patient and physician and thus enable the healing process to proceed. Halpern recognises the need for objectivity in medical diagnosis and treatment, but argues that this is also possible whilst becoming emotionally engaged with the patient. Emotions are not entirely subjective and irrational, they can be reflected upon and therefore used objectively. If not consciously acknowledged they can influence the clinician’s practice for good or ill, and thus lead to considerable misunderstanding.

In this closely reasoned book Halpern brings together her extensive insights from the fields of psychiatry, psychoanalysis, philosophy, and ethics. In chapter 1 she sets the scene with a case history and overview of the book. Chapter 2 explores the traditional concept of medical objectivity, emotional detachment, and sympathy. Sympathy, seen to be of therapeutic benefit in the time of Hippocrates, has given way to an emphasis on detachment by the twentieth century. Chapter 3 considers emotional reasoning, moods, and the nature of emotions. Clinical empathy is discussed in chapter 4 together with its origins and psychoanalytic views. Empathy is neither detached concern nor sympathy, rather it is a state of understanding another person’s distinct emotional perspective, and is based on emotional reasoning. Chapter 5 looks at the important issue of patient autonomy. Does respecting the autonomy of the patient allow freedom for an interpersonal relationship and clinical empathy to develop? In chapter 6 Halpern discusses the vital issue of medical education and the importance of changing entrenched medical attitudes and practice.

Halpern explores the advantages and limitations and pitfalls of detached concern, sympathy, and empathy, both from her own medical experience, using vignettes of patient consultations, and from a historical and educational perspective. She advocates a change in medical culture and shows how empathy can be taught and fostered among medical students.

This book should be read by all medical educationalists.