Like any other industry, in health care, the books and schooling don’t always match the “real world.” Patients everywhere have the same complaints about physicians and their bedside manner. “I feel like she’s talking at me, not to me.” “He said I had cancer like it was just another sentence.” “He walked in, looked at my meds, and walked right out of the room without saying a word.”
Those training tomorrow’s physicians are aware of this and are attempting to correct it by teaching empathy in the curriculum. Unfortunately, teaching someone to “be a kind person” is difficult. More impactful is that humans generally learn from modeling others. That is precisely why schools can only have so much of an influence.
During our pre-clinical years at my medical school, we spent a good amount of time in a “physician and patient” course learning how to become empathic providers. It is honestly a great attempt. However, the real learning happens when the hours are longer and we’re immersed in the clinical environment. At that point we start modeling the leadership around us. The residents and the attending physicians then became our teachers. The empathic training becomes a lot more variable and that is when students begin to pick up bad habits and attitudes. Here are just a few examples of the books versus reality.
1. Introduce yourself to the patient upon walking into the room. There have been countless moments where I’d trail behind a resident physician into a patient’s room, only to have them start talking to the patient without introducing me. Many times they would fail to even introduce themselves. Thus, when a failed introduction occurs, one must continue to look stupid and silent beside the speaker, waiting for the right moment to say something. The situation is truly awkward for both the un-introduced person and the patient. In any case, one could argue that it is my job to speak up if the resident had forgotten and often times that is what I did. On the other hand, would you like to interrupt a serious conversation about a person’s medical treatment, which they have been stressing over for hours, to say, “Hi, I’m Bill, a medical student?” Chances are they would feel annoyed by that.
2. We are treating patients, not diseases. This sounds great until you’re rounding on a service with more than five patients, which is what happens on nearly every service in a teaching hospital. Quickly patients turn into “the gallbladder,” “the CABG,” “524,” “the 9:00am,” or “the psych guy.” Blame it on the classification nature of the human brain or blame it on the fact that physicians, nurses, and other personnel just might see one too many patients in a day. Either way, just like in other busy places of work, the patients become cases and appointments. The challenge becomes maintaining a sense of humanity while processing people like a machine.
3. Patients are scared and emotional. We should be respectful of that. “That lady is bat-shit crazy.” Yes, I’ve heard that more times than I prefer. The truth is that sometimes patients really are unreasonable and dealing with them can be almost unbearable. The danger lies in providers taking patient insults and attitudes personally. Even in my early stages, I know that if it were me or any other provider standing in front of a particular patient, it is likely that this patient would act in the very same unreasonable manner. Knowing that, what sense does it make to take any of it personally? However, lack of sleep and a ton of unsigned documents might make that Zen perspective unobtainable.
The glum conclusion is that after being scammed by a few drug-seekers, involved in an unreasonable law suit, or emotionally drained by a very unstable patient, I too am in danger of falling victim to going through the motions and becoming a cold, distant physician. So the question is this: Is empathy something medical school can teach or is this more of a systemic problem?