A little under a year ago I read an Annals of Emergency Medicine publication by Dr. Isaac Agboola: “The Coats That We Can Take Off and the Ones We Can’t”: The Role of Trauma-Informed Care on Race and Bias During Agitation in the Emergency Department.” In this article Dr. Agboola discusses how his experience as a physician and a person of color impacts his interactions with his patients, especially those of color. He specifically cites a study from 1997 to 2000 that found people of color were less likely to receive opioids than their white counterparts across all years. While Dr. Agboola  uses this example to support his discussion on implicit bias, I can’t help but wonder whether his experiences within communities of color, including the travesties that people of color have experienced, inform his capacity for empathy. 

Does implicit bias preclude empathy, and does lived experience increase the capacity that one has for empathizing with and seeing the needs of others?

Pain is a relatively interesting phenomena. A quick Google search will deliver countless articles and figures investigating the neuroanatomy and electrochemistry involved in the pain response. However, a reading by Kim Armstrong  quotes Claus Lamm, a professor at the University of Vienna, stating that  the idea that “. . . empathy for pain is grounded in representing others’ pain within one’s own pain systems.” This is quite compelling. In essence, we can only empathize with pain that we have experienced or have a “knowing of”, at least tangentially.  This idea seems to overlap with the idea, from Arthur Kleinman’s “Pain and Experience,” that local biology underpins moral experience. What these authors are communicating is that there is a reciprocal relationship between experience and biology with regard to pain. The pain of one’s social experience affects the body systems and may even influence a concept of morality; in a similar fashion, biological pain may affect how one interprets their environment and impact the capacity by which they relate to others. 

As I think about this idea, I can’t help but recognize that there is a cyclical, positive feedback system, with regard to chronic disease, at play. The history of slavery, Jim Crow and more recent redlining practices within the United States provide an example of this feedback system in action through the concept of weathering.  Weathering refers to systematic racism and the resulting stressors that  cause biological manifestations of disease and pain. These pains, biological and experiential, paint a picture of the world for those who experience and observe them. 

Dr. Agboola ends his article by calling on medical providers to be wary that the “coats patients wear” may cause others to view them in a different light. While he does not circle back to an understanding of pain and its relationship to relating to others, the concept of empathy rings true — in order to supersede our experience-informed empathetic understanding, we must actively work to understand, care and meet the needs of our fellow neighbors. 

As members of the Yale, New Haven,and greater Connecticut communities, the lesson taught by Dr. Agboola can be applied to a myriad of contexts: vaccine hesitancy, substance abuse and end of life care, to name a few. The decisions, perspectives and actions that people make are informed by lived experiences and deserve to be addressed gently with dignity and respect. Therefore, the next time you find yourself engaging in a controversial conversation, ask questions rather than jump to conclusions. Assume the best of your neighbor,  and make a conscious effort to better understand how their life-experience, consisting of both pains and joys, informs their position.  In such a way, we can better understand the coats worn by those around us.

JOSEPH WILLIAMS is a YSPH MPH candidate ‘22 in Chronic Disease Epidemiology. Contact him at joseph.williams@yale.edu.