Medical Empathy Training

[Guest guest]

Here are some extracts from a worthy and very necessary article that just

appeared on Medscape:

<http://www.medscape.com/46525.rhtml?srcmp=ms-122801>

Developing Empathy in Future Physicians

Vijay Aswani, PhD

Introduction

One has only to read memoirs of recent medical graduates, such as Melvin

Konner's Becoming a Doctor, Shem 's House of God, and Marrion's

Learning to Play God, to marvel at the anecdotes and stories of tired interns

and residents to whom patients become nameless, faceless obstacles or

interruptions of much-desired sleep. This, coupled with patients' fear that

when they are most vulnerable they will be in the hands of an albeit

competent but callous physician, has led to increased focus on the issue of

empathy in the medical profession.

School Ties

Some of the factors that seem to drive empathy to a low point in

physicians-in-training result from two traditional views doctors absorb

during medical school. One is the " care:cure dilemma. " This usually asserts

that it is doctors who do the curing and nurses who do the caring. The other

is the traditional format of interviewing and the social ethos of medical

training and medical practice, which stress clinical detachment.

Indeed, Nisker humorously refers to medical education as the Yellow Brick

Road, where " from the time the medical school's acceptance letter is opened,

students set off in pursuit of the attributes of the good physician:

intelligence, compassion and courage. " Nisker adds:

The students already possess these traits, just as the Scarecrow, Tin Man and

Lion did before they set out for Oz, but they may dissolve in education

systems that still decree that the initiation to medicine involve tons of

tutored words and consuming call schedules.

The rigors of medical school can take other tolls. Factors that can drain a

doctor-hopeful include:

- Overexhaustion

- Insufficient skills to deal emotionally

- Organizational demands or limitations

- Lack of example or correction of behavior

Scientists who have studied the transformation in medical students during

their clerkships tell us that in a psychological attempt to deal with first

encounters of illness, death, pain, and suffering, students may swing from

empathy to overidentification, or objectivity to avoidance. Those who study

the problem call for a vertical support structure for coping with the

emotional demands and reactions to what one sees and hears in the hospital.

Spiro[5] puts it eloquently when he speaks of the need for " conversations

about experiences, discussions of patients and their human stories, more

leisure and unstructured contemplation of the humanities. Physicians need

rhetoric as much as knowledge, and they need stories as much as journals if

they are to be more empathetic than computers. "

Re-education

A number of investigators have suggested that reading medical prose or good

literature on death, sickness, dying, and the doctor-patient relationship can

help one to sort out one's own feelings. An excellent Web site in this regard

that I can recommend is http://www.medicalprose.com/. Another useful idea is

to rent a video after exams that relates to a class you took. For example, in

our biochemistry class, after studying the lipid disorders, we watched the

movie Lorenzo's Oil (see

http://www.teachwithmovies.org/guides/lorenzos-oil.html for a summary of the

film and some ideas on using it in your classes). It was heartening to see

tears in the eyes of several future doctors as they watched the parents and

child fight the disease. It brought new feelings to the bland text and

equation descriptions of the disease in our biochemistry book.

Finally, in some residency programs, first-day residents are assigned a

clinical scenario to act out and are instructed to pose as patients and

approach their department. The nurses at the triage usually do not know who

they are and they get treated just as any other patient would who is visiting

the department. For most of them, it is an eye-opening experience.

Call to Compassion

Patients in pain, suffering, and illness seek relief from medicine and the

healthcare system, but they also seek human comfort, understanding, and

empathy. Most of the measures can be easily assimilated into the structure of

most medical schools. In all fairness to the overworked, sleep-starved drones

of the medical world -- the interns and residents -- they are there when you

need them. Their compassion is spoken with action and response to call. As

Spiro has so eloquently stated, " Computed tomographic scans offer no

compassion and magnetic resonance imaging has no human face. Only men and

women are capable of empathy. "

Factors shown to enhance empathy in medical students and future physicians

include:

- A liberal and humanistic education

- Exposure to literature and philosophy

- Training in interpersonal communication skills

- Workshops on attentive listening, sensitivity, and empathy

- Early and continued exposure to the hospital environment and patients

- Experience as a patient -- real or simulated

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Dr Mel C Siff

Denver, USA

Supertraining/