My Problem with Empathy in Med School

27 12 2010

In Physician Apprenticeship, which is a fantastic program in medicine that pairs small groups of us with senior medical students and a practicing physician (we have a wonderful general surgeon as our mentor), the point is to have meaningful conversations about the human aspects of being a doctor outside of medical facts and diagnosis. I see it as a safe place where I can discuss my fears, frustrations, and struggles with the medical program, and learn from the amazing stories (both rewarding and horrifying) of my senior colleagues, which show me what I get to look forward to: once we get through these lectures, we get to go into the hospital and actually practice medicine and contribute to saving lives.

Until then, Physician Apprenticeship is like a delicious taste of the world that we will get to be part of, the carrot that keeps us moving.

In our last meeting, we watched a couple of clips from the tv show ER (this is part of why I love this course so much: we get to watch tv!), and we discussed a couple of scenes at length.  One scene was a young resident spending hours of his personal time connecting with a pediatric patient who had cancer and was taking out his frustrations on his older sister, who seemed to be the sole caretaker of the young boy.  For me, the scene was about whether or not it was appropriate for the young doctor to take hours (during his time off) to play video games with the patient, bond with the patient, and eventually tell the young patient a very personal story about his experience with his own brother’s cancer, and how his brother lashed out against his relatives as well.

This simple clip opened up many topics of dialogue.  For me, I tried to articulate to the group that I don’t think that a doctor should be expected to do what the young doctor did, because the doctor’s goal was to mend the patient’s relationship with his sister, which didn’t directly treat the cancer (the way that chemo and other treatments can), so if every doctor was expected to heal families as well as the patient’s specific disease, then wouldn’t that take up every hour of a doctor’s day?  (Plus, wouldn’t psychiatrists then be out of jobs?!!)  I didn’t feel like it should be part of the job description for a doctor to spend all his free time with patients or wear the doctor hat all the time.

But my argument was, at best, incomplete.  I couldn’t quite articulate my intention without sounding like I don’t care about patients other than their disease.  The truth is, if you ask me whether I would have done exactly what the young resident did?  The answer would be yes without hesitation.  The reason why I want to go into psychiatry is because I believe in the power of perspective: how changing the way we think about a disease or situation changes everything about it.

A poignant example of what I mean is this 3-minute TED Talk by Stacey Kramer on the best gift she has ever received, and how perspective played a big role.

I believe that the ER doc was being a phenomenal doctor by trying to treat his patient’s poor relationship with his sister, because his relationship with his family and how much he lets his family support him affects everything from how willing he is to get treatment, to how adherent he will be, to what attitude he will face his cancer with, all of which have tremendous effects on how well the treatment will work.  In that light, isn’t the ER doc doing exactly what his job is as a doctor?  Well, kind of.  So isn’t that shooting myself in the foot?

Well, it took me a long time to clarify my frustration with the entire process, but finally, I think I realized that the issue for me is the difference between wanting to do something and being mandated to.  My frustration isn’t with what the ER doc did, or even with med school’s noble intent of producing doctors who care about patients holistically.  My disagreement lies with the method med school uses to try to teach empathy.  I finally understand that the reason I don’t think a doctor should be expected to do what the ER doc did is because a mandate like that would not produce effective doctors that actually care about the patient – only doctors that pretend to care for the sake of doing their job, which is arguably worse than a doctor who doesn’t try to fake it.  My issue with these types of classes in medical school is that (as a dear friend expressed to me) I don’t think we can teach empathy.  Ultimately, I have no problems with what the doctor in ER did, and I would have done the same thing if it meant being able to heal a patient holistically, but my biggest concern, now that I’ve had time to reflect upon it, is that these courses seem to strive to teach an intangible quality, and I fear that all we can accomplish is teach how to act empathetic and caring without the true substance or intent behind it.

Fortunately, I don’t think my classmates lack empathy (thanks, in part, to the change in the way med school interviews are done), so for the most part, I think these courses will help us refine and clarify our empathetic powers.  I guess my fear with watching and discussing these clips is that it will promote one ideal for what being a “good” doctor is like, and it will encourage us to act in certain ways just to impress or to “do the right thing” even though in our hearts we disagree with the action.  I think the key is to understand the ER doctor’s intention of healing the patient as an entire human being.  Once that is understood, I think the exact course of action that a doctor takes to heal a patient is an extremely individual choice.

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8 responses

27 12 2010
Lisa Frey

I totally agree with you that you can’t teach empathy ;) (It’s sort of like law school and ethics hahaha – you can teach as many rules as you want, but ill intentioned person will just massage or dodge them). I think/hope the course is just poorly named and they really mean coping techniques for how to balance your desire to help everyone with your overwhelming responsibilities.

27 12 2010
Eric Ma

June, very thoughtful post there. I’m heartened to hear that there’s at least one doctor out there :-). Empathy certainly can’t be taught, but here’s a counterpoint, if not because I disagree with some of your thoughts, then at least for some discussion.

For some, learning things like empathy, love etc. starts from an experiential standpoint. For others, it starts intellectually, and for yet others, it begins emotionally. While empathy may not be “teachable” in a classical learning sense (a full course load, replete with concepts and examples), for some individuals, an intellectual framework of “empathy” including some keywords other people use is a good starting point for further clarifying what empathy really is. In that sense, I see value in a “class” or a “course” on empathy. Perhaps a class or a course is overdoing it, perhaps regular and mandatory sessions, but nonetheless informally-run, like what you’ve got is more appropriate.

What do you think?

27 12 2010
Judy

The Stacey Kramer TED Talk was an interesting example of what I had just read in Barbara Ehrenreich’s Bright-Sided. In the first chapter, Ehrenreich describes how when she was diagnosed with breast cancer, she noticed that all support groups advocated positive thinking and many cancer patients and survivors referred to cancer as “a gift.” When she expressed her anger toward her condition, she found very few who shared her sentiments. She felt the positive thinking and all the pink ribbons and teddy bears felt almost cult-like and removed from reality. As I was reading the chapter, I thought to myself, these people who call cancer a gift would never give it to their loved ones, so how can they call it a gift? So it was interesting to see Kramer speak of her tumor as a gift with watery eyes (not sure which emotion that is) and admitting that she’d never wish this gift upon others.

28 12 2010
June

Thanks to all of you for the thought-provoking posts!

Eric, I completely agree with what you’re saying. I think there is a lot of value to having these types of classes, and I think that’s certainly one of McGill’s goals with these sessions. I certainly use these courses to clarify what empathy is in a field-specific context. I just think that we don’t always frame these sessions in that way, so I fear that for some, the message can be misleading, misunderstood, or misconstrued.

28 12 2010
Jason p

June, I agree that it is questionable whether empathy is a skill that can be learned or an innate one to be honed. I am inclined to think that at the age of medical students if they are not innately empathetic it is too late for most. So your concern that “learning” to act with seeming empathy may produce doctors who are at best insincere (except those who are naturally empathetic). My question is so what? Do you think that business people are sincerely friendly with all clients or are turing on their charm for business sake? Do you think that a patient would benefit more from a doctor who acts professionally or uses language that makes him seem empathetic? Or from a doctor who wants to be honest with his poor people skills and carelessness? I think most patients would benefit from the former. However you make a good point that each doctor patient interaction should take an individual course.

29 12 2010
June

Hey Jason!  Thanks for the comment!

I think empathy is generally a desirable quality to have in a doctor, or else McGill would not have changed our interview process to better screen for this quality.  (I don’t think you disagree with that.) As a result, I think we have quite an empathetic class.  My whole point is that I think we need to frame our classes so we don’t give the impression that empathy only looks one certain way, because that would waste our empathetic powers.

I think your question is what do we do with students that have been accepted who lack empathy.  Well, I think empathy is actually an innate quality that most humans possess, so linking to Eric’s comment above, I think those who seem to lack empathy may simply not have had a chance to discover their own powers.  For these colleagues, I think our courses can be especially effective; I simply think we need to be more clear that the purpose of these courses is to have discussions and experiences that promote the understanding of our own empathy rather than to promote how to look empathetic, which is sometimes the message that I am getting from the classes.

While businessmen undoubtedly turn on the charm, the most successful ones tend to be the ones that truly value and care about their clients.   Furthermore, I think my issue with comparing empathy in medicine to sincerity in business is that we make them sound like just skills to hone for the sake of success, except that in med, faking empathy affects patients’ lives, so I think empathy is an important prerequisite for doctors, and it can be developed if the courses are framed in the proper way.

2 01 2011
Eastwood

I don’t have much to add to this thoughtful discussion, apart from the following posts: “Empathy is such a simple skill” and “The Talk“.

29 03 2011
Is empathy teachable? « The Pro-Psychotics

[...] The following is an essay I wrote for Physicianship class, on the subject of whether empathy is a teachable quality.  In a lot of ways, the essay is a continuation of my exploration of a subject I have been thinking about for a while… [...]

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