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Goodbye Dr. Welby…Hello Dr. House

Created 08.03.11 by Helena Bachmann
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You’d think that compassionate doctors are a given but, unfortunately, that is not always the case. TV’s anti-social and arrogant Dr. House may only be a fictional character, but research shows that decline in physician empathy happens in the real world as well, and it starts to take root during medical school.

Numerous studies have reiterated these findings over the years, including one conducted in 2006 by the Mayo Clinic. That particular research found that among the 10 most common items on patients’ “wish-lists” was their physicians’ ability to be caring and compassionate.

In fact, the level of empathy can actually impact – both positively and negatively – the patients’ health. In March of this year, Academic Medicine, thejournal of the Association of American Medical Colleges (AAMC), reported a study involving 891 diabetics and 29 family physicians treating them. The doctors were asked to rate their empathy as “high,” “moderate,” or “low.”  Patients whose physicians had a high empathy score were much more likely to better control their diabetes than their counterparts with low-empathy doctors.

What Studies Show

In the past years, several studies have documented this troubling trend.

The most recent research, published in the August 2011 issue of Academic Medicine, found that“empathy declines significantly during the course of medical school and residency.”

An earlier study that appeared in the same publication in 2008 showed a similar trend:  Student empathy scores dropped after the first year of medical school, further decreasing during the third year.

An article in the March 31, 2011 issue of New England Journal of Medicine confirms the existence of documented evidence showing “the high level of compassion with which students enter medical school and the sharp decline that occurs during the ensuing four years.”

The article notes that most of this decline occurs in the third year, just as students shift from an academic environment to a hands-on patient care in a pressure-filled hospital setting. “It is ironic that precisely when students can finally begin the work they believe they came to medical school to do — taking care of patients — they begin to lose empathy,” it says.

Multiple Reasons

While the study published in the August 2011 Academic Medicine does not give specific reasons for this phenomenon, the researchers of the 2008 study – which followed 419 medical students at the University of Arkansas for Medical Sciences from 1997 to 2004 – offered several possible explanations.

Stress and anxiety caused by the students’ competitiveness and desire to overachieve on exams could contribute to the empathy drain, researchers said. Later on, while doing clinical rotations, residents mentored by rushed and overworked hospital physicians may not have received as much guidance on proper “bedside manner” as they needed.

And, the study points out, other health professionals are not immune to this phenomenon either. In a comparison of 130 U.S. dental students, self-assessed compassion toward patients declined considerably during clinical training.

Rx for Compassion

The erosion of empathy among medical students is, justifiably so, an important issue to educators.

“We are aware of this important literature on the loss of empathy and altruism among medical students and post-graduate medical trainees as they go through school and training,” Henry M. Sondheimer, M.D., AAMC’s Senior Director of Student Affairs and Student Programs tells SDN.  “This is an area of great concern for the student affairs deans I work with.”

In order to train future doctors to be more compassionate and sensitive in their relationships with patients, many of the 135 U.S medical schools the AAMC represents “have introduced or are in the process of introducing extensive wellness programs for their students, which they hope will counter this disturbing trend,” Dr. Sondheimer says.

The newest such program, called SELECT (an acronym for Scholarly Excellence. Leadership Experiences. Collaborative Training) has just started at University of South Florida College of Medicine (USF COM), with the arrival, on July 25, of the inaugural class of 19 students. Those numbers will increase to 48 students next year, and 56 in 2013 and thereafter.

“Students will be immersed in leadership training and grounded in empathy and other core principles of patient-centered care,” Alicia D.H. Monroe, MD, USF COM’ Vice Dean of Educational Affairs tells SDN. She adds that students in this program will take regular “core MD” classes in addition to their SELECT-specific curriculum.

She explains that this new track, developed in collaboration with the Lehigh Valley Health Network (LVHN) in Allentown PA, will provide “outstanding education in the biomedical and clinical sciences, unique training in leadership development, intense coaching, and the scholarly tools students need to become empathetic, passionate leaders who will be catalysts for change.”

Students can apply to the traditional MD Program, the SELECT MD program, or both. However, those wishing to participate in the SELECT program are expected to show evidence of compassion and a caring attitude before they are admitted. As Dr. Monroe explains it, “Faculty trained in the interview technique evaluate the prospective students’ responses – studying not just the events they described, but how they reacted to those events – to look for key characteristics of emotional intelligence, such as collaboration, adaptability, or emotional self-control.”

After completing their first two years on USF COM’s Tampa FL campus, SELECT students will undergo two years of clinical training at LVHN. “Faculty based in both Florida and Pennsylvania will actively collaborate to teach, coach and mentor SELECT program students throughout the four- year curriculum,” Dr. Monroe adds.

A Creative Approach

Some medical schools are taking innovative approaches to instilling principles of sensitive patient care in a new generation of doctors.

Instead of focusing merely on the scientific subjects required for a MD (or DO) degree, many schools are increasingly emphasizing courses in the arts and humanities, which allow med students to develop the ability to observe and express their own feelings in a context not usually available in the medical setting.

The following two examples – culled from various reports – demonstrate some of the more creative ways in which medical colleges across the United States attempt to foster empathy among their students:

  • Brown University’s medical school has a reflective-writing program that assesses their students’ ability to express feelings about difficult experiences, such as witnessing their first death.
  • Students at Weill Cornell Medical College can sharpen their observational skills – certainly a key quality for a physician – by visiting the Metropolitan Museum of Art and hearing a commentary by an art historian. Or, they can choose to join the Music and Medicine Initiative, a program Weill Cornell runs together with The Juilliard School of Music.

 

 

Positive Results

 

Research suggests that programs like these are effective in fostering compassionate patient care.

The March 2011 issue of Academic Medicine reported an experiment that involved 209 Robert Wood Johnson Medical School students in the classes of 2009 and 2010. They followed a mandatory “Humanism and Professionalism” course, which included blogging about their clerkship experiences, talking about important events they had witnessed, and discussing articles, books, and films.

The “before-and-after” findings showed that third-year students who participated in this program did not show a significant decline in empathy. “A curriculum that includes safe, protected time for third-year students to discuss their reactions to patient care situations during clerkships may have contributed to the preservation of empathy,” the report summed up, adding that “programs designed to validate humanism in medicine may reverse the decline in empathy.”

That is the goal empathy-based programs at various medical schools are trying to achieve.

“We fully expect to see physicians who exude compassion and confidence, who have a clear sense of vision, mission and purpose, and who can demonstrate flexibility and adaptability in responding to both crisis situations and clinical dilemmas,” SELECT’s Dr. Monroe points out.  This new generation of physicians “will be able to balance the values, hopes and dreams of patients with the best scientific and clinical evidence, while demonstrating the highest degree of professional integrity.”

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  1. Narmerguy says:

    Fabulous writeup. Good food for thought for those striving for healthcare fields.

  2. Kaustikos says:

    Cure the disease, don’t just take care of the symptoms. What should be done? Look at your criteria for admissions and see what you’re doing wrong. I won’t say you’re not accepting great students. No, aside from a few of the neurotic psychopaths you allow, I’ll stand by the fact that schools definitely choose students that, for the most part, become competent physicians. However, you’re attempting to produce competent physicians that are supposed to reserve a moment/portion of their time for emotions and empathy. Unfortunately, I don’t see that happening with what makes the cut for matriculants; 4.0 GPA and 30+ MCAT. These are the people who’ve been trained to work hard and overcome whatever challenges come their way AND THEN MOVE TO THE NEXT OBSTACLE. That’s how they’re trained/been trained since the beginning of time. They have this competitive spirit and high intelligence fit for being the one in charge to diagnose and treat diseases. What they don’t ever learn from the time that they step foot in college is to care/empathize/work with people. They volunteer, sure, and spin a good story to sell you guys. They even make a great essay that shows how caring and compassionate they have already been while in undergrad. But the fact is that the minor percentage of people who aren’t lying/truly give a damn about people are the ones that fight the uphill battle. They sacrifice their ability to excel academically (or do the best) by allowing emotions to get tangled into their pursuits. These are the ones you say you want, but realistically won’t make the cut. Not because they’re not smart enough, but because they aren’t what you accept. And now you’re going to solve the problem with creative writing classes…

  3. Jack says:

    I agree with Kaustikos. I’d like to point out that the system is really messed up too. Even if young, emotionally engaged students make it into medical school, they face a caustic and punishing environment that devalues humanistic traits. They are told that investing their emotions into patients is a waste of time and that kind acts are a sign of foolish naivety.

    I remember a time that I went out of my way to respond to an elderly patient who was crying out for a nurse (and had been for about half an hour). She told me that she was very cold. When I brought her a blanket, a nurse began snickering and told me that she was demented (like that matters when you’re chilled) and I was wasting my time.

    Now that event by itself didn’t shatter my ego. If you add up many others, however, their culmulative weight drag you down. It’s this abrasive socialization that grinds down their empathy. Given this, I am not suprised that empathy falls during the clinical years. It takes a very resilient person to weather the subtle criticism of their peers, colleagues and superiors and emerge with their principles intact.

    Maybe these new programs will help aspiring physicians build up their defenses and provide a shelter from a malignant system.

  4. trinity says:

    I also agree with Kaustikos. Where is the balance?

    It also doesn’t help if you are going into primary care and you know that you are going to be shuttling patients in and out of your office in 15 minutes or less in order to keep up with appointments. Why even bother to get to know the patient, right?

  5. Fourth-Year says:

    I agree with Jack. I’ve had similar experiences, including being told that I had to “learn not to care so much, if you want to be a good doctor.” Luckily, I had other role models and mentors who have showed me how to be caring AND effective, not one or the other.

    But the hidden curriculum is strong, and given the fluffy reputation of “physicianship” or “doctor/patient” lectures, it’s not surprising that medical students become increasingly cynical in the clinical environment. I’m not even sure that more lectures or extracurriculars are really the answer, especially for clinical students who barely have enough time to eat lunch or go to the bathroom.

    As a side note, it would be great if these SDN articles could link to the studies referenced, or have a bibliography at the end.

  6. mikejm11 says:

    First of all this was done on ONE medical school, which is 419 students. Anyone taking this information seriously should be medicated.

  7. Steve says:

    Have to agree with the previous posters.

    Ideally, your doctor not only heals you but makes you feel like family. Ideally, I can walk into the gas station and buy a lottery ticket and win the jackpot. See how that works? Ideals are not always realistic, and that is so incredibly true for medical students and doctors alike.

    Medicine is a massively different field than it was years ago. Whenever I hear people talk about how bad their doctor visit was because he/she was cold and uninvolved, I cringe. I just want to turn to that person and ask them if they are still alive, because if they are than they should be thanking the doctor, not berating them because they didn’t smile and chat them up in the exam room. Still, to have people like those mentioned in this article who think supplementing writing classes into a medical student’s life to increase their empathy will work, absolutely disgust me. That is so far from what is needed, it is unreal.

    Lower your standards from 4.0 GPA and 35+ MCATs with 1,000+ volunteer hours and an extensive EC background and maybe you’ll get students who do genuinely care. The typical student who gets accepted into medical school is an anal, hard-working, incredibly driven, and emotionless human being because that’s what it takes to get into medical school. Your friends, your family, your relationships and your life don’t matter if your dreams are for medical school. Your entire life IS school and you’ve accepted that. Third year of medical school isn’t any different for these students and I guarantee you that this isn’t “when it happens”. It happened years ago when their counselor told them they needed to become obsessed with school if they want any shot at medical school.

    Still, I personally would rather have an emotionless, highly-driven, hard-working, anal doctor taking care of me over an incompetent, overly emotional, and far too self conscious little girl who botches the diagnosis and makes my life worse because he/she was too worried about making me happy.

    But hey, that’s just me.

  8. Joe says:

    Physician empathy is going down… obesity is going up. Coincidence?

  9. Statistics Rock! says:

    In a recent study by Some Peoples it was found that chocolate consumption was decreasing as physician empathy levels drop. They show an alarming trend that must somehow absolutely link chocolate consumption to physician empathy. Give me a nice grant and I’ll run a study on an arbitrarily chosen sample that poorly reflects the population of interest to PROVE that chocolate is the reason physicians are less empathetic towards their patients.

    You know, disregarding about a billion other variables that could have a significant impact on physician psychology, like changes in: work environment, financial incentives, political climate, social position/role, patient behavior, climbing medical school debt, etc. Further, lets pretend everything in the world happens by straight forward cause and effect… you know, its not like variables impact each other in complex ways or anything.

    This article is…unbelievable.

  10. BogusBecause says:

    I remember when I lost the majority of my empathy… it was during my 3rd/4th year of medical school; and I learned that I was paying good money in tax dollars for the ‘privilege’ of treating drug-seekers, malingerers, and those who are looking to sue you for whatever frivolous reason they can think up.

    I read the above posts from (no doubt), pre-meds and 1st/2nd years… those with minimal to no patient contact and with zero medicolegal experience.

    Pffft. Buckle up, kids.

  11. BogusBecause says:

    You can “care” all you want. None of that “caring” is going to save you from the tax-man, the malpractice attorney, or the drug-seeker.

    Maybe if society treated us like we spent eleven+ years studying (and several hundred thousand dollars) to manage their ills… rather than assailing us with statements like – ‘but I KNOW my body!’ and ‘I know what’s best for me’, then we wouldn’t be so aggravated and so indifferent. After all, if they take away my license to practice… then I’m no good to anyone, now am I ?

  12. Mr. Bean says:

    “the high level of compassion with which students enter medical school and the sharp decline that occurs during the ensuing four years.”

    Its called people lying to get in, when their real motivation is MONEY!!! Wake up Adcomms!!! My former roommate who graduated last year from med school always talked about how she hated medicine because the primary reason she came into medicine was because she thought it was a prestigious field. Unfortunately, she didn’t feel that it was prestigious enough to spend 8 years+ of her life in training since she hated patients, especially having to take care of the sick. I would love to meet folks who voted for her admission. LOL

  13. Bird says:

    Why does SDN post these trash articles? Is there no filter?

  14. Pablo says:

    I don’t really buy this. I had the good fortune of going to a great med school that took over a hundred of these 4.0, 35+, 1000 volunteer hour folks and they were some of the most compassionate and passionate people I know. Yes you get jaded once you hit the wards but I never saw it effect who they were as people or how they treated their patients. And outside of the hospital they were always doing volunteer work (cause they loved it not for the cv) started non profits and worked abroad. Sure, there were heartless automatons but as a whole I think these were some of the finest people and doctors I’ll ever meet.

    I also don’t agree with the reflective writing. When we did this in school I found that it was pointless especially when you had to share what you wrote. Small groups were better but not by much. To be honest the best way I found was having classmates over for anger and decompressing. It kept us human and kept up our support structure…but then I guess you would have to have good people to start with.

  15. kg062007 says:

    This article reminds me of the girls who say they want a bad boy , yet he is caring, considerate and likes to cuddle. This kid of guy simply does not exist. Neither does the 4.0 35+ MCAT student who wants to sit besid an elderly womans bedside and hold her hand. Realistic expectation are key.

  16. MB says:

    I believe the lack of empathy from physicians stems from a number of things. The years of hard work that it takes to become a physician is beyond grueling to say the least. Most if not all of medical students enter medical school with a sense of altruism that dwindles as time goes on. Throughout undergrad and medical school so much time is dedicated to study and other people besides oneself that the ability to focus your emotions on other people can diminish. Even those that do not loose the ability to empathize when he or she has completed their education, it is drowned in the volume of patients that they have to see in such a short amount of time and the legal BS that clouds heath care. That being said, my experience is that there are a tremendous amount of phenomenal people in medicine today. If anyone is not happy with how empathetic their physician is, choose a new one. There are plenty out there that are very good.

  17. JJ says:

    I was a med hopeful for many years (still am a little bit) and have been working in a major multi-center urban hospital for about 2 years as a health professional (while maybe trying one more time for MD).
    I get to see the cycle of residents every single day at my work.
    I will tell you this much that I have honestly learned in first hand experience working with them – a few come from very well-to-do homes and do it purely/blantantly for the prestige and two letters; some have egos like I’ve never seen before and I would not be friends with them outside work at any cost – they are manipulative, back-stabbing, blantanly complain about their supervisors. I don’t know if it is the younger culture (I’m slightly older), but the respect is not there. I honestly will say that from what I see on a daily basis, only a small few of the residents stand out as caring and compassionate people.

    Attitude/character is easy to see. It is picked up in the chatter of the lunch room/elevators. I know that most of these kids love the prospect of $$$ and are driven by it…I mean some of them are 23 and already decking themselves out in expensive suits/watches…and they still couldn’t tell you the protocol for acute MI.

    I fear for the days when I’m old and need help and these kids are running the show.

    I truly think it is a generational thing…I’ve had friends in other career fields tell me they see the same attitudes with their young interns.

  18. JJ says:

    I agree with kg062007!!!

    You hear enough quips from these young residents joking at smelly patient rooms, weird patients etc….I don’t see any of the current residents I work with sitting in a patient room holding their hand and “listening” to them.

    sorry, these kids do not exist

  19. ehcmd says:

    Steve…you must be extremely healthy and never had to utilize the services of a doctor or a nurse. I was a sickly child, and as such I strive to be a competant, empathatic, physician that I preferred seeing as a child.

  20. Johnson says:

    Thanks everyone for stereotyping me as apathetic; but then I guess I have no feelings.

  21. Cerberus says:

    JJ, I don’t know what it was like before, but I can tell you a resident at my program who is spending their time
    “sitting in a patient room holding their hand and “listening” to them.” is going to be falling behind doing the primary thing we are tasked with, keeping patients alive and treating their illnesses.

  22. Rudy says:

    Steve, Amen brother. you said it so perfect.

  23. Mike says:

    Honestly I think much of the coldness that people feed off of when they are at the doctor’s office is derived from the physicians resentment. Resentment from spending years in medical school learning about impetigo contagiosa rather than coding and billing. Resentment from Joe Sixpack sitting behind his desk making 10 bucks an hour sending you a letter from the insurance company about how you should treat your patients in order to get payment from them. We expect physicians to be under constant scrutiny and have a god-like sense of morality, yet we consistently undermine them. It’s time to stop the perversion of medicine and bring back the autonomy to physicians and either subsidize their education or pay them more. It doesn’t pay to practice good medicine anymore; it pays to see more patients. Once physicians are paid based on outcomes rather than volume, then we’ll be heading in the right direction.

  24. Austin says:

    Medical school is rough, debt is high, prestige is gone, insurance is nightmarish, doctors are maligned and the system (like all systems) is pretty much broken. It could still be a lot worse. (One problem, I think, with a lot of recent MD admits is that they’ve never worked a 100 hour work week or built something with their bare hands. They’re competitive and cut-throat, but deep down they are soft.)

  25. ayushman80 says:

    Totally agree with bogusbecause!!!! Couldn’t have said it any better. The two schools mentioned up there who have you “reflect on your feelings” do have a unique idea. But the idea is implemented in years 1 and 2 when you have very little patient contact or contact with patients who are very sanitized and ideal for learning. 3rd and 4th years are where the “real” patient contact begins and you see the morbidly obese who want a pill to cure their obesity, the 100+ packyear smokers w/ COPD who don’t want to stop, the IVD users in public housing who use disability to fuel their habit and yet again don’t want to stop, etc…. That is just scratching the surface. Very hard to be compassionate towards these types of patients. I doubt that these studies ever differentiated how patients w/ cancer are treated vs the above type of patients. I am willing to bet that kids with ALL are treated with exceptional compassion. Its very easy to lump everyone together and say that patient care is declining overall; this way of looking at things is very misleading.

  26. Danny says:

    I’ve only met a few compassionate doctors. Most of them seem like they just want to write me a prescription and send me on my merry way. They forget to write work excuse notes, and some of them have a very dismissive attitude about both my visits and my complaints. I understand that these people spend a lot of time studying medicine, but I haven’t, so it’s only natural that some things will concern me until a doctor tells me there’s nothing to be worried about. Sneers and jeers aren’t the right way for a doctor to do that, because it makes me feel like the doctor is an arrogant idiot who hasn’t even considered my symptoms and could be missing something. Aptitude suffers without the right attitude.

    Granted, if I were in their shoes, I don’t know if I’d be any more empathetic. I’m in a diagnostic/engineering type job, and when laymen try to tell me what’s “really” going on, it gets very frustrating. I typically have to ignore most of what my clients tell me, because it’s pure, ignorant BS 95% of the time. I can only imagine what it’s like for doctors, with the added pressure of dealing with druggies, lawsuits, and hypochondriacs…

    Really tough issue.

  27. BG says:

    High grades and test scores seem to be reliable in determining how well most will handle the pressure in medical school, and great academic performance is an absolute requirement to succeed in medical education. There are plenty of people that could succeed in medical school, and there is absolutely no shortage of people that could be admitted, and could be successful, but what metric do adcoms have to judge a student’s empathy other than a short bit of polished personal statement and a twenty minute interview? I think that by recognizing that the medical field is changing, and trying to change with it instead of ranting aimlessly (which, from above, doesn’t seem to be working for most of you) is at least worth some consideration. For those who are already students, is it really going to hurt to allow people to discuss their feelings with one another in a low pressure environment? We discuss what we feel anonymously on the forums everyday and that has helped me before. At worst, these plans wont work and life will go on. Then again, we as students might learn something from people who manage their problems more effectively before we are burned out instead of blindly marching in with a book knowledge of “how its supposed to go and often doesn’t” and learning the hard way with plenty of frustrations. I say give it a shot and we’ll see how it goes.

    B

  28. Sammy says:

    I know JJ brought up an excellent point… that maybe it is a generational thing.

    My mom is a RN. She was a supervisor at a nursing home and is now at an assisted living home. She has noticed a similar trend. Many younger nurses are lacking compassion and have terrible attitudes. She can’t even tell someone that they’re doing something incorrectly without rolling their eyes and thinking that my mom is out to get them. They also have a higher incidences of neglect.

    The BScN program at my undergrad didn’t require any screening to get in. There are higher incidents of cheating in the nursing classes, which the administration is trying to cover up. I’ve witnessed drama between students and professors in the hallway! We’re entering the entitlement age.

    Yeah… there is a big difference between med school and nursing, but the trends are still frightening. In both professions, there is the drive to go into it for the $$$.

  29. mommymdtobe says:

    While I agree that physicians need to be compassionate, physicians are there to treat a physical ailment. You would not go to a therapist for treatment of a stroke or colon cancer, right?

  30. Homeboy says:

    Ditto with the general sentiment on these “trash” articles. Like someone mentioned, people DESERVING of compassion receive it, like the kids with ALL, most cancer patients, et al those with diseases NOT caused by self infliction. And those that don’t but should unfortunately receive the byproduct of our healthcare system, which is not “medicine” in the historical sense, but a prescribed protocol or rules & regulations goverened by bureaucrats & policy-makers too far removed to have any appreciable understanding of what actually comprises REAL medicine.

    You’re damn right physicians lose their compassion at increasingly earlier stage. Why wouldn’t they given the quagmire of managed care they are entering? Simply blows my mind that educators think simply adding “compassion classes” and documenting that med students are officially “trained” in compassion is going to solve the problem.

    People don’t want to be a martyr for a failed and disingenuous system that amounts to no more than indentured service.

  31. amandamd says:

    I lost all my empathy during my 3rd/4th/ and now intern year. The disrespect and lack of gratitude accompanied with the upcoming Obamacare. If given the opportunity, I would never of applied to medical school. So yes, I have lost all empathy.

  32. whocares says:

    “Traditional” medicine is not “evidence-based” medicine which treats people as “number needed to treat” adjusted for cost benefit ratio. Maybe I am wrong – I didn’t live in the past decades and centuries – but I imagine medicine used to be about trying to relieve suffering, not blaming patients for their ills, being creative, rather than protocol driven, IRB stiffled, etc. Now we have technology, mountains of paperwork and immortalization at the expense of dignity and common sense. Is there a common root between hospitality and hospital? I don’t see that – not with the “dispo” being the last item of each plan, but really the first one on the mind. When I entered med school, I had high GPA and high MCAT score, but yet I was idealistic and compassionate. I did not turn into an automaton, but yes I became discouraged and jaded. I guess that’s called reality check.

  33. whocares says:

    The generatoinal thing is interesting. The only people in my department I know who don’t complain (much) and don’t use the many obstacles as excuses are over 60. And these are also the people who are most optimistic about the future. Counterintuitive, isn’t it? When I asked the most senior physician in our division “what makes a good doctor”, his answer at first dismayed me by its nebulous, intangible nature, but now I think he was right (as always) – he said “doing what’s right for the patient”. Trivial, but true… and so freaking hard to do unless you believe in it.

  34. Falseprophet says:

    Do unto others…?

  35. Anonymous says:

    Why would would the University of South FLORIDA, a state school that takes mostly Florida residents, send their medical students to Lehigh Valley in Eastern PENNSYLVANIA? This makes no sense whatsoever. Can empathy not be taught in Florida?

  36. Buck F. says:

    Caring doesn’t pay the bills.

  37. Jane says:

    Buck F., thank you for the best comment!

    We live in an environment that selects for fighters, not bleeding-hearts. What results did you expect?

  38. Joe Strauss says:

    You all must be Caucasian.

  39. Sydne says:

    Lol, right Strauss ? I love you

  40. Dan says:

    If it were up to the patient, he/she would choose the more compassionate and competent doctor. However, due to many factors, healthcare policy being one of them, patients have been losing that ability to choose over time. So doctors don’t have to establish a good relationship to stay in business.

    IMO this is just a symptom of the problem that patients can’t afford to pay out of pocket and have to resort to getting insurance subsidized by their workplace or the state.

  41. ZackG says:

    There is another aspect to all of this. Most medical school students are fairly recent college graduates. College students tend to be very idealistic and optimistic because they haven’t seen much of the world. May be they did a study abroad in Kenya for one semester or worked for a Summer in an inner-city clinic but that is not what I’m referring to.

    Most college students haven’t dealt with making important decisions and living with long term consequences yet. Many have not had to pay all of their own bills before. A lot of college students feel the world would be a better place if things were run they way they see fit. They have not had to deal with the realities of responsibility and see why changing the world is not easy (and in somecases not always the best idea anyway.)

    As people mature, they begin to realize that their is nuance to life and not all problems can be easily fixed. This realization can hurt a person’s flowery vision of the world and make them pessimistic. This happens to many people regardless of their background or philosophy. It’s not necessarily bad, it just means the real world is complicated.

    Back to medicine. Some students come in to medicine with an idealized vision of how to care for people and the degree of impact they can have on society. As students begin to mature and experience more of life (in and out of medical school) they begin to see that fixing our healthcare system and treating patients isn’t as easy as just caring a lot. There are many factors that contribute to chronic disease, lack of cures for major diseases, inefficiencies in our system and so on. Also, they become painfully aware that money (like it or not) is almost always a factor in any important decision. As they realize that they cannot do as much as they had once thought to fix these problems they lose their motivation. I know a lot of my class mates who after they started rotating became convinced that doctors can’t do anything to fix people’s individual health problems.

    My point is simply this: the problem isn’t that medical students lose their compassion because of medical training but that they start off with naive assumptions (like most college students) and as reality sets in they lose their motivation. Pre-medical students would do well to spend a good deal of time out of school getting to know the realities of the world around them and if they maintain their compassion and idealism they will more likely maintain it in medical training. It’s important to start off with realistic expectations.

  42. Matt says:

    “My point is simply this: the problem isn’t that medical students lose their compassion because of medical training but that they start off with naive assumptions (like most college students) and as reality sets in they lose their motivation. Pre-medical students would do well to spend a good deal of time out of school getting to know the realities of the world around them and if they maintain their compassion and idealism they will more likely maintain it in medical training. It’s important to start off with realistic expectations.”

    This is very true. As a medical student 5 weeks in, I can tell you that most pre-meds have absolutely no idea what they are getting themselves into. It doesn’t matter if you had a 30+ MCAT and/or 4.0 GPA, you are NOT prepared for the amount of information about to flow your way when you enter the classroom. The only small piece of your yourself that will keep you alive is that Type-A personality that the admissions committee was looking for during your interview. Sure, they want to make sure you know what compassion is, but they also do not want you to lose your grip, go crazy, and flunk out.

    Compassion and humility comes with the training. In fact, I would say that humility comes very quickly. Imagine being a student that has never made less than an A, and now you have to struggle just to get a B (or in some cases even a C). The loss of humility, I think that comes later (maybe in residency). A lot of residents I know say that once you get to that point, you are so fed up with the system that you almost give up.

  43. paige says:

    I think this is a great write up! I’m pre-med right now and i definitely feel the competition. But I don’t have a competitive bone in my body. I would rather work together with people than against them. Besides they say you learn best by teaching Others. I definitely agree that doctors and health care professions are not being taught how to work in a busy environment and be empathetic. That’s one of the reasons I want to be a doctor. I had a bad experience during a 5 day stay i had in the hospital. The people working there were awful. I never felt more scared or lonely I’m my life than whati felt during that stay ever since then ive wanted to change that about health care

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