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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