I think a decrease in empathy is a normal protective response to the experiences of medical personnel. My daughter works in intensive care and her patients die because they are at the ends of the their lives. It is desirable to be self-protective when empathy would leave you unable to function well. Further, many medical personnel must do things to patients that inflict pain (to achieve the greater good of better health). They must tell patients bad news on a daily basis. Empathy would make that very difficult. Additionally, many medical students are trained in hospitals that serve large numbers of indigent patients who do not comply with treatment plans (many because they cannot). Students come to see the deterioration of these patients as a result of non-compliance which undermines their best efforts. Cynicism is the natural consequence of excess idealism. Hopefully, a balance will be achieved later in their careers, but maximizing empathy does not strike me as a reasonable goal when students are not taught alternative ways of dealing with their own emotional responses to what they must do each day.

Perry, at 8:50 am EST on February 29, 2008

Wonder if any of this correlates to malpractice suits?

Max, at 11:25 am EST on February 29, 2008

I, along with many others, had hoped that an influx of women physicians would help change the practice of medicine, rejoining the care of patients with professional judgment. However, this study seems to confirm the conversations that I’ve had with some medical ethicists—that female physicians tend to mirror the attitudes and concerns of their male counterparts, much more than those of their patients. I understand well that there are grounds for cynicism, with patient noncompliance, and that one must distance themselves to some extent in order to inflict pain in the service of healing, but Paul Ramsey’s seminal work “Patient as Person” really ought to be recalled. The ability to empathetically imagine what a patient might be going through, to care enough to think of them as a person with a disease, rather than just a disease that needs to be eradicated, a surgery that must be performed, etc., seems absolutely vital. Physicians are healers who assist the patient’s body to restore itself to health, and they often lose sight of that in their quest for personal glory (they would much rather perform an organ transplantation than counsel patients on how to avoid the need for one. Preventative medicine is notoriously unsexy despite its many advantages).

michelle, at 3:30 pm EST on February 29, 2008

me, too

I find the pattern for doctors understandable and unavoidable — I felt more empathy for students before I began teaching them, myself.

Michael Tinkler, at 8:25 am EST on March 1, 2008

No statistical evidence, but

I’m going to suggest something here that is simply not going to go over well with those of you who are doctors (or studying to be): the basic problem is the medical establishment itself. Thanks to the success of the AMA in the first decade of the 20th century in establishing control over their profession with the aid of the state, the education has been homogenized around the mythology created during that period. It is that doctors are very special people put on Earth to perform things that are only intelligible to other members of the Brotherhood; the public cannot be entrusted with the special knowledge because they are simply not capable of understanding or using it in the right way.

My mother and ex-wife were/are RNs. Many of my high school classmates are doctors. My sister is a few credits shy of MD-ship. I have been around doctors, would-be doctors, and ex-doctors my whole life. Yes, they are usually very smart. Even unusually smart. But their natural abilities have been blown out of proportion to hyper-arrogance by a profession in whose interest it is to keep the public ignorant. Every doctor assumes they are as brilliant as House, and think their “eccentricities” are justifiable. When my sister was moving her stuff out of Med School, I went with her to visit her advisor one last time. They began to discuss some arcane rule of the professional society she was joining and had a disagreement. She suggested that he look it up in the new rulebook, at which point — rather than apologizing — he vindicated himself with this sermon: “I assumed that you were wrong, and that is always a good assumption to make.” You can bet that he takes this attitude bedside, too.

Eric H, at 1:00 pm EST on March 1, 2008

empathic vis empathetic

Since when did empathic lose to empathetic?

It’s similar to people using orientated instead of oriented. ....

a

A Khosla, at 5:05 pm EST on March 3, 2008

Unempathic Healthcare Providers are Dangerous

Empathy for patients is the hallmark of a psychologically mature health care provider. The lack of empathy is a professional deficit and not a “psychological protective mechanism” as one commenter has stated. If you do not have the maturity or psychological capacity to deal with your patients’ difficult emotions in a supportive way than you need to learn how or you need to get out of medicine (for the benefit of everyone). Justifying a lack of empathy as a “protective device” is quite simply, a rationalization of mega proportions. I agree that health care providers need to be cautious about pyschological identification with their patients (i.e, actually feeling their patients’ emotions)but a cold, aloof, unempathic health care provider is a dangerous health care provider! Also, I find it interesting that one commenter would state that patient non-adherence with treatment plans leads to cynicism and a decrease in empathy. While on one level this is undoubtedly true, the link between cynicism and a continued lack of empathy is more a reflection of poor professional development on behalf of the health care provider than anything else. For example, it is widely known that a lack of empathy on the provider’s behalf leads to patient non-adeherence. Patient noncompliance is much more than just an individual patient characteristic. Becoming cynical is a common occurence either in medical school or residency. And coming to terms with one’s cynicism is an important step in developing a professional, mature identity as a physician. Just because many patients won’t change their self-defeating behaviors despite your best efforts does not mean that one has to check their idealism at the hospital gates. To me, getting stuck in a protacted period of cynicism says much more about a person’s pscychological imimaturity than anything else. In sum, health care providers that lack empathy are toxic health care providers. They are toxic to their patients, the healthcare systems that they work for and ultimately, they are toxic to themselves.

Paul Nicholas, MD, MPH Director of Medical Student Education in Psychiatry Medical College of WisconsinEmail: pnichola@mcw.edu

Paul Nicholas, MD, MPH, Director of Medical Student Education at Medical College of Wisconsin, at 4:20 pm EDT on July 22, 2008