What medical school fails to teach


This May, I will graduate from medical school. I will also be part of the first group of medical students to graduate from its new Literature and Medicine track. To me and the other participants, this has been one of the most important components of our medical education. In many ways, it has kept us grounded, serving as a constant reminder that there are experiences different from our own.

We know that in order to be a competent and caring clinician, physicians must do more than master facts: they must also become expert communicators. The crux of the clinical encounter — why are you here today — may seem simple, but it is deceptively complicated. Patients do not tell you a diagnosis; they tell you a story.

Learning to unpack these stories — understanding why your patient is actually here today — is one of the most important steps in becoming a physician. Yet the medical education system fails to adequately cultivate this skill. As medical students, we spend years memorizing physiology, pharmacology, and pathology, among other subjects. The body, we learn, can be reduced to a series of tiny processes, and this approach is often extended to all facets of medicine. Alongside biochemistry, we are taught a step-by-step process of how to talk to another person. Human interaction is reduced to a series of prescribed talking points designed to most effectively elicit necessary information.

After all, we get to medical school by being exceptionally skilled at following directions. These lessons in human interaction would be laughable were they not necessary for so many of us. The difference between obtaining data and understanding the story shared by the person in front of us is vast, and beyond the scope of even the most refined communication course. To do so requires empathy. But becoming empathic is no simple task.

Gaining that skill is particularly difficult in today’s climate of social unrest, in which society defaults to suspicion and mistrust. At the same time, bias, both implicit and explicit, remains prevalent among clinicians, and it continues to adversely affect patient-physician interactions. A 2015 review of 15 studies examining the extent of health care professionals’ implicit racial and ethnic biases demonstrated that health care professionals displayed “low to moderate levels of implicit racial/ethnic bias.” Although this is comparable to the general population, the study also revealed important relationships between these biases and health care disparities. Provider bias was associated with poorer patient-provider interactions, discrepancies in treatment recommendations, and worse psychosocial health outcomes such as decreased satisfaction with life and higher rates of depression.

The question, of course, is how to overcome these issues. A 2011 study found that perspective-taking strategies, which facilitated “active contemplation of other’s psychological perspectives,” resulted in improved interracial and interpersonal behaviors, both in terms of participants’ inherent tendencies and actual behaviors. In other words, these exercises increased participant empathy. Although the idea of empathy has become a touchstone of modern medical education, it remains a fundamentally limited concept. After all, it is difficult to empathize with those things you have never experienced or imagined; the only world we know is our own.

But empathy, like any skill, can be practiced. Each time we listen to someone’s story, we broaden our understanding of countless possible worlds, giving ourselves a wider range of experiences upon which we can draw to better understand the next person. This understanding requires practice and repetition: Each new story makes you better at hearing the next. But there are only so many worlds to which we are given access.

This is where reading fiction comes in. Books open our eyes to new worlds; they elevate our understanding of what it means to be human, to be someone else. Fiction, with its vast and far-reaching scope, broadens our horizons and forces us to consider novel possibilities. Reading the first-person narrative gives us insights into the interior thoughts and feelings of others that we can get no other way.

I advocate for endeavors like our Literature and Medicine Track because they function as a continuous reminder of the person at the heart of the patient-physician interaction. Teaching science is an art in medical school, but teaching empathy has historically been left by the wayside. Folding literature into the curriculum nurtures the idea that every single person who sits in the examination room bears the weight of their own story. Reading fiction makes us better students of those patients’ stories.

Caroline Humphreys is a medical student. 

Image credit: Shutterstock.com


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