Teaching doctors empathy

One of the headline articles at The Atlantic today is How to Teach Doctors Empathy.  I’ve written about this before back when Pauline Chen at the New York Times WellBlog raised the issue, and I still contend that empathy cannot be taught but you can certainly teach someone how to fake it.

I’ll admit I glanced through the article, but it was one of the comments that really caught my attention.  It’s posted below – and my angered commentary shall follow.  Philgrimm seems to be an expert on medical students/residents/physicians.

I enjoy reading essays about how to “fix” our defective medical system.  If empathy is a vital skill then the general population is out of luck.

First, for a young adult to get into medical school and then into a residency, that person has to compete with other highly motivated and academically talented individuals, each trying to secure a goal dangling above their heads. These are not average people, these people are excellent at life and they are so much better than an average person it is a wonder that they are willing to be near a defective Homo sapiens.

These otherwise excellent students are repeatedly judged and found lacking about academic details related to both normal physiology and disease, yet not one in a thousand of these young doctors has ever experienced a real disease. Empathy requires understanding and when you as a person has never endured a life altering disease or injury that affects your being and changes the course of your life, there is no way you can have empathy.

These students have never encountered failure, they think they will life forever and will not get sick. Medical students know nothing about the human condition. They know facts, but they don’t know where they all fit. That is exactly why a physicians “natural” reaction is to respond to an expressed feeling with a fact. They only “know” facts, at this point in their lives, any feelings that they may have are irrelevant to the situation. They have nothing to offer when confronted with the unknown and their feelings about having any given disease is almost in a different universe than the feelings generated in a person with that illness.

You can fake empathy and that is eagerly accepted by patients. After a period of time, time spent in actual practice of medicine and in the actual practice of life; empathy creeps in around the edges but real empathy only comes when the physician suffers his/her own brush with mortality and morbidity and has had time to truly learn the profession of medicine.

One final thought: too much empathy is bad for the physician’s family life. You can not be all things to all people.

Personally, I consider myself to have been an above-average student – there were many other students in my high school, college, and medical school who were far smarter, more studious, and possessed greater talent than I could ever have dreamed of.  Ironically, a lot of them went into fields other than medicine.  And yes, a certain amount of intelligence is necessary to succeed in medicine, but while my medical school classmates were smart, many of us were not the top of our high school class or anywhere close to the smartest.

To be fair, philgrimm is right about some medical students out there, but I’m not so sure that he’s familiar with the changing demographics of the average medical student population. On average, medical school classes are getting older as more and more “non-traditional” students are turning to medicine after pursuing other careers.  These students have certainly lived, struggled, and overcome.  Other “non-traditional” students failed to gain admission to medical school straight out of college for one reason or another.  These students have certainly felt the sting of failure.  My colleagues in medical school and residency have certainly suffered their fair share of adversity – the loss of loved ones, personal health problems, tumultuous pregnancies, difficulties in their personal lives, learning disabilities, and financial instability.  We’ve all certainly felt the pain of failure when we lose a patient.

The idea that we as physicians believe ourselves to be “not average people” and “excellent in life” is the misguided view of an outsider who has not seen the profession up close.  Physicians are flawed just like everyone else – if not more so.  We have our own problems, baggage and demons.  We are human; despite the public’s unrealistic view that we must always be perfect, we make mistakes.  It is for these reasons that we are able to not only be near “defective Homo sapiens” but why we can relate and why we have dedicated our lives to taking care of them.  For they remind us of ourselves.


About justgngr

the ramblings of a medical professional by day, judgmental ginger by night
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