CurrentMedStudPosted June 18, 2011 at 4:40 pm | PermalinkI just finished my clinical year at a top 5 medical school. The emotional blunting that occurs is tangible, and I have no doubt that this is a real phenomenon. At the beginning of the year it was not uncommon for classmates to start weeping at the death of a patient, now such an event is often met with a solemn shrug. I think, perhaps, that this emotional change is a necessary response to the near-constant barrage of depressing situations one sees in a trauma bay or ICU. Those classmates and residents who have retained their pre-med school “emotional understanding” are less effective in life-and-death scenarios because their personal emotional responses prevent the kind of dispassionate logical thinking that is necessary for good patient care in emergent circumstances.
As for the comments about teaching, most medical schools now have classes to teach empathetic patient interviewing and techniques to turn your interaction with a patient into a partnership. These classes produce students that spout off insincere platitudes like, “that must be so difficult for you” or “i can’t imagine what you’re going through,” instead of encouraging real emotional bonds that will promote patient satisfaction. The humiliation style of teaching (we call it pimping) that you decry has produced the best physicians the world has ever known. Being asked a question that you don’t know the answer to in front of 100 of your peers is terrifying at first, but it provides the best motivation to learn the staggering amount of facts and patterns that are necessary for adequate patient care. A person whose psyche cannot endure temporary embarrassment in front of classmates will never be able to be a good in patient doctor where death, pain, and disfigurement are everyday occurrences.
Empathy and kindness will win you rewards in patient interactions, but those benefits (e.g., increased patient “enablement”) have the greatest impact in the primary care setting. Empathy will not make the radiologist see more clearly, nor will it make the surgeon’s scalpel sharper. As the medical schools produce fewer and fewer primary care physicians (only 5% of my class will go into primary care), it makes sense that we are trained to operate in the high stress inpatient environment. If we are becoming more emotionally removed, it’s because we need to in order to survive a 30 hour shift in the pediatrics ICU where we have to fill out death certificates for three kids or when we have to tell the pregnant woman that her 7-month old fetus will not survive outside her body. I am not setting up a dichotomy, there are great inpatient doctors who have empathy oozing from every pore in their epidermis, but these are without the doubt the exception. For somebody decrying the lack of empathy in doctors, you don’t seem to have a whole lot for those providers who have to deal with sickness and dying on a daily basis.
Just as medical doctors and surgeons were once trained separately, I imagine that specialist and primary care docs will be trained separately in the future. This is already starting to happen in the form of physician assistant and nurse practitioner programs, in which non-MDs are providing fantastic primary care. Those going to primary care can have their emotional naivete sheltered from the harsher realities of illness, and they can enjoy greater patient satisfaction. Those who want to take care of seriously ill patients can develop the emotional coping mechanisms necessary to survive in the hospital.
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