My school is trying to make me an empathic physician

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?

William Rusnak is a medical student, financial investor, and writer, NueMD.  He can be reached on Twitter @RusnakMD and on Google+.

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  • RuralEMdoc

    I always thought it was funny that schools tried to “teach” empathy. There is an entire standardized exam all medical students have to pass (at $1200 plus traveling cost) just to prove they can communicate compassionately with a fake patient. The whole thing is a huge racket and a giant waste of time.

    It is true that some physicians have horrible bedside manner. It is true that some physicians are huge nerds who have trouble with normal social interactions. If we want more personable doctors who can effectively communicate with a diverse patient base, then we need to stop admitting students based on test scores and GPA. That means we will have to let a friendly student in with a 3.2 instead of a geeky introvert with a 3.9, and we all know that isn’t going to happen anytime soon.

    • William Rusnak

      I certainly wish I had that waste of a day and $1200 returned to me ;) Don’t quote me on the statistic, but I believe the pass rate of that exam is somewhere in the high 90′s. Fairly pointless to be required to take it. That seems to me to be quite the money-maker…

  • SteveCaley

    Well, as Miss Manners points out, there is a difference between manners and etiquette. Etiquette is a list of the formalities of how to behave in some particular situation. People who don’t have much empathy should follow etiquette; learn how to go through the traditions of courtesy during a patient visit. Manners is a thing of intrinsic character. People with Manners always do the right thing, although they might be doing so in a way that varies from standard etiquette.

    Introducing yourself. Saying the patient’s name. Making eye contact. Acting serious while at bedside. These are all behaviors that should be expected as a professional from every doctor.

    If you have good manners and are a caring doctor, you are going to do all that stuff anyhow.

    Medical schools can’t teach empathy. They can teach bedside etiquette. That should be expected of everyone. And those who already have good manners and plenty of empathy, well, they’ll do the right stuff no matter what.

    • DoubtfulGuest

      Yes, and there’s another category of people who have natural empathy but lacked good models for that expression while growing up. These folks can learn by watching others, how to make the outside better match the inside.

    • William Rusnak

      Agree with that. At least fake being a nice person. It’s professional to introduce, call one by his/her name, and make eye contact. You don’t have to care about a person to do those things. In other industries, if you act like many of us in medicine do, people stop buying from you. Thanks for commenting.

  • Ava Marie Wensko George

    I agree with Dave. My experience is that empathy is best taught to students in theory first, then in action. There are some outliers who are just beyond the pale, but you can’t approach all patients like they are potential outliers. You will get better at spotting the seekers and other nontraditional patients. Part of the empathetic learning process is focusing on the patient no matter how they present.

  • Doug Capra

    To some extent, empathy can be taught. But the key to an empathetic health care system is its culture. This may vary from hospital to hospital, clinic to clinic. It may even vary from hospital floor to hospital floor or from department to department. I don’t care what you teach medical students — once they get outside the academy they are subject to the hidden curriculum and that’s what they learn. Health care systems either strive to create healthy cultures or they don’t. Much depends upon how the system treats its employees. Are the doctors and nurses and cna’s and techs and housekeepers treated with respect and empathy? These days, with strategic planning so much in the forefront — it’s important to remember the maxim — “Culture has strategy for lunch.” Teach empathy all you want in medical school — but unless it’s embedded within hospital and clinic cultures — it really won’t make much difference.

  • http://www.kevinmd.com kevinmd

    It’s fixed, thanks for pointing it out.

    K

  • William Rusnak

    I’m a writer for NueMD’s blog. My twitter is @RusnakMD. Thanks for reading.

  • ninguem

    Empathetic?

    I know some doctors that are just pathetic.

  • Thomas D Guastavino

    Empathy is defined as the “ability to understand anothers feelings and perspectives and to use that understanding to guide our actions” Therefore, being empathetic simply means that you are able to sense the hopes, fears and motivations of others. It is not then same as sympathy. In the wrong hands empathy can be very dangerous. Empathy combined with arrogance is a particularly dangerous combination. Con artists can be empathic. So are some politicians. It is difficult, but an absolute necessity, for us to recognize whether or not someone who seems empathic has some ulterior motive.