When do medical students lose their empathy?

It’s common knowledge among third year medical students that statistically a lot of us are mentally damaged in some way. Knowing these stats makes us feel better about our ongoing feelings of low self esteem, high anxiety and sometimes outright panic. In the car on the way to rotations, regular starters of conversation are statements like, “Did you know 35% of med students are depressed at any given time?”, to which everyone nods seriously because we’re all thinking exactly the same thing: “Well, at least I’m not the only one.”

I have accepted, like much of my cohort, that medical school — particularly the clinical years — is a breeding ground for feelings of insecurity and self-doubt. Barrier exams at the end of long years, on the spot assessment by consultants, and episodes of bullying and abuse which take place every day on the ward make for a less than ideal way of living. The image that you put out to the world, “I am training to be a doctor. My parents are proud of me. I am a success,” is absolutely no reflection of what is going on inside your soul.

Much of your spare time (when not at the hospital or studying) is spent trawling Internet forums and finding solace in anonymous posts by other students (too afraid to put their name to their work for fear of repercussion) who speak honestly about their daily feelings of at times crippling anxiety and dark melancholia.

As medical school is very much a sink or swim experience, particularly once exposed to the hierarchy of the hospital system, you do, as a student, to some degree learn to rationalize your fears and struggles, and simply soldier on.  If not, you simply won’t survive. So much of your identity is tied up in being a medical student that to quit becomes in essence, a non-option. You would rather deal with ongoing mental pain than the feelings of failure and shame if it were to all suddenly end. So you deal with this, understand it, and continue forwards.

The moment I truly realized how much the system had affected me was taking the history of a young woman in her twenties (my age), who had presented with a nebulous constellation of symptoms and ultimately was diagnosed with an aggressive cancer that had a survival rate of less than 20%. She had three children, a husband, and until that moment, in the emergency department, had no idea that her life was about to change completely. I completed the history, felt a momentary stab of pity, and immediately searched for my consultant to tick the box and mark my form so I could get through the daily checklist of requirements I needed to fulfill to successfully complete the rotation. I did not stop to think about this patient and the news she was receiving and how that would affect her and the people who loved her until I was driving home. As I sat at the traffic lights and reflected upon her terrible diagnosis and equally distressing prognosis, the question that swam into my mind was this: “What kind of person have I become? And what kind of doctor will I then end up being?”

I used to pride myself on my endless empathy, on my ability to engage with people and their problems, and to offer them kind words which came from a place in my heart that truly felt for them. It was part of the reason I entered medical school and much of the attraction of becoming a doctor — it allowed me a scope and place where in a professional context I was allowed to really care.

By the end of third year I find that I am a person who is more concerned about which boxes of which form I can get ticked, rather than allowing myself to engage with a patient facing the worst news of her life.

Doctors are always very rushed. We are stressed, and there is always something else to sign and somewhere else to be. Perhaps the reasons why we stop engaging is simply because our minds have a hard time comprehending the desperate reality of some of the awful truths that we are faced with daily in the emergency department or on the wards.

I’m not sure the exact moment was when I started to lose my empathy. Perhaps after one too many exams, or harsh words by a more senior doctor. A question I couldn’t answer, or a sterile field I accidentally ruined. Whenever it was, I’m now actively searching for it because I want it back.

Fear of exams, of angry surgeons, of night shifts, and of looking stupid is one thing. But fear to engage with a patient, to feel their pain and offer them your comfort — that is something else entirely. For all the medical procedures and lab tests and suture ties I cannot perform as a student, comfort is something that takes no study at all and can be given freely, with almost guaranteed good results.

In fact, the act of healing through comfort and empathy is very possibly the one area in which all students can excel, if we allow ourselves the time to perfect it. Which will make us much better doctors, and far nicer human beings.

Sonia Henry is a medical student.

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  • alex

    Did you consider nursing or social work? Those are careers that allow more time to connect/empathize with patients, less exams, less debt, and definitely less mental stress.

    Actually empathy is far from the key trait I think is sought in a doctor. Knowledge, work ethic (ability to keep working and keep “checking things off”), and ability to follow rules and hierarchy seem much more important.

    • buzzkillerjsmith

      Social Work!? You might as well beat yourself vigorously and repeatedly about the cranium with a bal-peen hammer. That’s so bad of a job that even a family practice doc like me wouldn’t trade for it.

      Being a PA or NP for a subspecialist is not too bad of a job they tell me. But once you’re in med school you’re not going to do that.

      • alex

        True. Come to think of it, I know many people who work for non-profit organizations and LOVE it. They get to ‘empathize with’ and help people (not necessarily people with health troubles either). Pay is ok, and can be well beyond ok if you are as intelligent/hard-working like most pre-meds.

        Again, my argument in these comments that many naive pre-meds and even med students over-think the empathy and doctor-patient bonding stuff.

  • Dr K

    This is a great piece. I am one year out of medical school and it was a really hard four years. You do feel like you lose your ability to empathise and at the end of the day everyone likes a nice doctor. Patients and colleagues alike.

  • NewMexicoRam

    I was in med school and residency from ’82 to ’89.
    The 80′s are just a blur to me.
    I feel I missed out on the best “growing up” years of my life.
    And I’m not sure if life has gotten any better.
    I’m not sure what I would have done differently.

    • buzzkillerjsmith

      You need a new job, man. You’ll wonder why you waited so long. Take it from this guy who’s been there.

  • Noni

    I remember misery during residency, but medical school was ok. I wonder, if you are this miserable in medical school why continue?

  • disqus_tuKfH0P0aW

    The saying which goes along the lines of ‘doctors heal sometimes, but comfort always’ springs to mind and indeed medical training is a very trying experience, but with support of our colleagues and genuine patient care we are reminded of why we began in the first place, and strive to continue. Articles like this are so important because they remind us of what being a doctor is all about, and that empathy towards our peers and patients results in better outcomes for all.

  • alex

    You are absolutely correct, my point was different. Of course docs need to truly care about their patients, address their patients concerns, lead them through a difficult time, etc. And yes the best docs are the ones the patient can connect with and feels the doc truly cares about them.

    But my point was that the docs role is limited to some extent. Is a doc really the person the patient needs to spend time with and discuss the “news she was receiving and how that would affect her and the people who loved her”? The doc needs to “engage with a patient, to feel their pain and offer them your comfort”?

    • Suzi Q 38

      Yes, if you want to be a good doctor.
      Like any profession, there are the jaded ones who think the contrary. It is probably very difficult, but I think that doctors should strive to help their patients and empathize with them.
      After all, they are physically ill and emotionally “spent.”

  • buzzkillerjsmith

    The time pressure won’t get any better when you get out, but instead of residents and attendings you’ll be under the thumb of turnip-brained ex-frat rats from the state college who went to business school to be able to order around the likes of you (and me).
    And if you know what’s good for you you won’t go into primary care either.

    • Suzi Q 38

      What if she has her own practice with like minded physicians?

  • Suzi Q 38

    “Usually those moments are certain conversations with patients.”

    Thank you for this sentiment.
    Yes, there are those in the medical field that make fun of us patients. I am well aware of that. I am sure that my doctor thought that I was making all of my symptoms up, and he probably called my the “hysterical one,” or something similar, as he had recently removed my uterus and ovaries.
    I had troubling nerve symptoms, and he just didn’t believe me for a year and a half. It turned out to be severe spinal stenosis in my c-spine. He wasn’t laughing at me after that. He looked sheepish, worn-out, and contrite. I wanted to tell him” “Thanks for passing me off as a hypochondriac. I guess you can see that I walk with a limp now.”
    In spite of all that happened to me, and how I was treated by him, I understood. It would be hard to see a patient after you totally screwed up. I was going to punish him by continuing to see him for yearly check ups, but have decided that that would be somewhat cruel on my part.
    After all, too many colleagues know what happened, as I needed too many specialists to fix his mess.

    I decided to try to understand that he was stupid, it was not his area of expertise, and he made an error in judging me to be a hypochondriac when I was far from it.

    I left him in a somewhat positive way, fairly cordial, but sad.

    I knew it would be the last time I would see him, as I was doing the patient-doctor “break-up” that has to occur at times and is unfortunately unavoidable.

    I quietly went to another teaching hospital and asked for a
    gyn/oncologist who was good at “listening to h/her patients.” My gyn also made the request on my behalf.

    The new gyn/surgeon came in the room, and asked me “What happened?” She said she was surprised because she knew the other doctor. Small world, LOL.
    I gave her the very short “Reader’s Digest version, and she said she understood and would accept me as her patient.
    I was careful not to bad-mouth the other doctor, suffice to say that he made errors and did not get me treatment which resulted in C-spine surgery and permanent nerve damage and limited mobility.
    I told her that I would only ask that she listen to what I have to say as I am quite intelligent, thank you.

  • sshima123

    At the end of the day, if you don’t love what you do, then what are you doing with your life? Don’t listen to those jaded sour grapes. They’re quite a drag.

  • Noni

    I understand the dark feelings of despair during medical training. I really do. I guess I was fortunate mine did not come until residency.

    But you are only a medical student. After this you’ve got internship, residency, potentially a fellowship, and then the hazing and long hours of starting in a new practice. American medicine is a soul crushing, overly bureaucratic mess of a system. Most docs I know are completely burnt out, and many speak of getting out just as soon as they are financially able. I see the system getting worse before my very eyes. I am making the types of career changes now that I did not envision making until I was nearing retirement. I am extremely fortunate to have paid off my loans. I work with a colleague right out of residency who has 350K in student loans that he will spend the rest of his life paying off.

    I guess I’m trying to tell you that there may not be a big pay off to all the drudgery that you are going through right now.

    Life is so short. I know how unimaginable it could be to lose your identity as a medical student. It’s what you’ve spent your life working for! But man, you have such a long way to go. There are worse things than jumping off a sinking ship. I wish you the best.

  • Rginsberg2

    There is nothing more important in life than the gentle, compassionate (empathic) connection with others. It is healing, often beyond the curing of an illness. It is our common humanity. Sonia Henry is insightful, as this essay shows. She will be a very good doctor!! Additionally, she will be able to teach others her insights on the practice of excellent medicine. — It isn’t quite fair to judge one’s lack of achievements at a time of intense pressure, stress, sleep deprivation…! Compassionate self-care is also important. We need to understand how to love ourselves so that we enough to give away.

  • http://www.zdoggmd.com ZDoggMD

    I once heard it said, from a particularly insightful Baylor physician, that medical school deconstructs human beings…but doesn’t do us the courtesy of putting them back together again.

    Perhaps we should be searching out the bright spots; in which situations do students NOT lose the ability to empathize? We should latch on to those successes and implement changes that help.

    Or, like everything else, we’ll be forced in medicine to outsource empathy to a robot. http://www.zdoggmd.com/tedmed/