Empathy 101

September 23, 2011

It seems that there are medical schools taking the initiative to help their students become more compassionate.  It’s a worthy goal but I don’t know if it’s possible.  We can teach individuals to act compassionate.  But that, of course, is different from being compassionate.  While there may be literature to support the cause, I don’t think that a curriculum can cultivate empathy.

Is it possible to change a student or doctor’s heart?  Of course, I see it all the time.  But not from role playing or small groups.  It’s human circumstances that drive change.  Personal loss and life experience tempered by introspection and humility change how we see those around us.  It’s only when we recognize our own vulnerability that we can begin to see it in others.  This doesn’t happen in a classroom.

Maybe we need to do a better job choosing students on the front end.  Of course it’s easy to find someone who can make it through medical school.  It’s harder to find someone who can make it through with the capacity and drive to connect with others.  But the academic complex likes its numbers and standard curves.  Abstract human qualities are terribly difficult to plot.

Perhaps we’ll figure out how to reliably measure these things.  Until then we should see empathy as a gift and recognize that there are certain human traits that are very difficult to teach.


{ 7 comments }

Nurse K September 23, 2011 at 1:44 pm

Assuming this is similar to the nursing school version thereof, the point of this type of training is to teach people how to respond to someone who is having troubling issues that is not your friend, family member, or significant other.

I kind of make fun of this when I say lines like ‘it must be hard having all this on your plate’ on my blog and the other lines that we had to recite in these role-playing scenarios. Keep in mind the average student probably has only done things like hug someone, cry, send a card, send flowers, or avoid someone who is experiencing a health crisis (because it’s a friend or family member or maybe a co-worker). People truly have to be trained what to do when it’s a patient vs. a stranger vs. someone you’re personally close with. The other issue that this addresses is keeping yourself a certain distance away from the emotions of the other person without ignoring them, which is the most important skill.

If you call that “teaching empathy”, fine, but it’s really just teaching someone their role and how to avoid burnout when a patient is having issues.

Jacqueline September 23, 2011 at 4:30 pm

I agree with you Bryan that you can’t make people compassionate by training alone.
Still training can help people to improve their communication skills and to become more open minded to the needs of others. Training can help students to become more compassionate once they care for patients.
I have understood that in the near future fierce shortcomings in this area (someone failing to act properly towards patients or colleagues) may have similar repercussions as failing for an exam, at least in the Netherlands.

Imho, Empathy is one of the skills doctors should “master”. Of course we should not exaggerate and try to train “social workers with a stethoscope” [quote prof. Jan Stam, Neurologist]. On the other hand “What good are doctors who have great knowledge but behave badly?” [quote prof Maas Jan Heineman)].

I previously wrote about etiquette-based medicine here
http://laikaspoetnik.wordpress.com/2008/05/11/etiquette-based-medicine/

Jacqueline

Chris Johnson September 23, 2011 at 7:08 pm

Good question. There was a good NEJM perspective piece about it last spring: http://www.nejm.org/doi/full/10.1056/NEJMp1100674

In response to that Maggie Mahar and I did a little mini-symposium at HealthBeat about it. The comments were quite good. Here are the links for those interested:

http://www.healthbeatblog.com/2011/05/medical-school-how-the-hidden-curriculum-snuffs-out-compassion.html
http://www.healthbeatblog.com/2011/05/nurturing-doctors-can-empathy-be-taught.html

My conclusion: empathy is not so much teachable as already widely present in most (even all) students, and it can be nurtured. The key is not to let the medical education process snuff it out.

Carolyn Thomas September 28, 2011 at 11:50 am

Thanks for posting those links, Dr. Chris. I had commented at the time on that ‘HealthBeat’ piece, as I’d just been asked to serve as a reference for a young woman applying to med school. The article included these lines:

“Studies have documented the high level of compassion with which students enter medical school and the sharp decline that occurs during the ensuing 4 years. . . Most of the decline occurs in the third year.”

Until then, I had blamed med schools for accepting socially inept brainiacs! Sad to think that medical education itself may be responsible for “snuffing it out”.

Jim Salwitz September 24, 2011 at 4:18 pm

I very much agree with Chris and the sentiment expressed in the NEJM piece. Humans, and especially medical students, are naturally empathetic (a few corrupted outliers the exception). In its simplest form our job as mentors is to grant permission to express those skills and feelings in the medical environment. By teaching certain techniques and granting a platform for the professional study of “caring”, a significant majority of future doctors will find the way to the hearts of their patients.

Rishi September 25, 2011 at 6:44 pm

One thing I’ve noticed since starting my clinical rotations is that a number of those who consistently aced exams in the basic sciences struggle with the “human interaction” component of being a student-doctor. You touched on the very true notion that empathy is something which must be cultivated through experience rather than text. We are fortunate at BCM to have the opportunity to gain empathy for a multitude of different patient populations, and I feel I’ve made significant strides since January. :-)

Emily Lu September 26, 2011 at 8:10 pm

As others in comments have touched upon, I think you may be right that empathy cannot be fully taught in the classroom but:
- most students admitted to medical school have some modicum of empathy before they are admitted (i.e. through their experiences and personal growth, they are assumed to have passed “empathy 101″ already).
- the experiences that one faces in medicine calls on a person, no matter how empathetic to begin with, to build on and develop their previous skills. Some of that can begin in preclinical years (your students will complain of being “not sufficiently prepared” otherwise) but ultimately, that training occurs not in the classroom but in that other half of medical school and the rest of the training that very much does NOT occur in the classroom.

And the fact is, if what I hear of clinical training can be believed (still in preclinical years myself so I can’t speak too much about it), there is *much* that can be done to improve the student experience and cultivation of empathy in the clinic.

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