Loss of empathy during medical school training

I came across an interesting article last week while searching the literature regarding another topic. It was the title which caught my eye: “Is there hardening of the heart during medical school?” The authors determined that there is loss of vicarious empathy during undergraduate medical school training, with differences related to sex and specialty choice.

Loss of empathy during medical training is something that many of us have witnessed. I remember the idealism shared by myself and other medical students during our first few months of medical school. Although people decide to become physicians for a variety of reasons, for most of us, the desire to help others was the foundation for our decision.

Our idealism, however, slowly faded during clinical clerkships, residency and our first few years of practice. I have been saddened to discover that some of the previously generous, kind and empathetic students I had known during school have subsequently gone on to become well-trained, knowledgeable but also very cynical physicians.

What happened? This is difficult to answer.

Medical school and residency are rigorous and challenging. Many students decrease expression of empathy as a protective coping mechanism. For some, medical school training borders on student abuse. (I remember vividly the accidental needle stick into my hand by a surgeon while I was a third-year medical student. He yelled, bullied and threatened me into not telling anyone. It was not until months later when I realized what it could mean and requested to be tested.) Other factors in the loss of empathy include fatigue, cultural differences and lack of continuity of care. These are not excuses; they are reasons why loss of empathy happens.

Empathy is defined as the ability to “put oneself in another’s shoes.” It is one of the most essential aspects of a successful physician-patient relationship. There have been observational studies suggesting that more empathetic physicians are more effective in regards to outcomes such as getting patients to HbA1c and LDL goals. Physicians who are more empathetic are less likely to be involved in medical malpractice claims and have higher patient satisfaction ratings. For those of us in clinical practice, none of this is a surprise.

How can we prevent loss of empathy during medical school and beyond?

That is another difficult question to answer. Making changes to how we educate our students might help. However, although there may be short-term improvements in expression of empathy in students who receive formal training in professionalism and communication, studies have failed to show changes maintained over the long-term.

Rather than focusing on medical school and residency, I think promoting professionalism and empathy must be an ongoing, career-long process. The culture of medicine itself needs to change. Technical competence and diagnostic acumen should no longer be considered sufficient to be an effective physician; good bedside manner and communication skills are required, too.

Many of us, including myself, made a conscious decision long ago to maintain our empathy through our training and beyond. How do we do it? We remember why it was that we decided to become physicians in the first place. We never, ever forget how much of a privilege it is to be part of a profession where we have the opportunity to help people every day. Our patients could have gone elsewhere, but they chose to come see us. It is very humbling.

Professionalism is something we do, not only talk about. Empathy is a characteristic which cannot be faked; one has it or one does not. However, the expression of empathy is a skill. Like any other skill, the expression of empathy can be improved with dedication and practice. Finally, we try to be positive role models for the next generation. We strive to be the kind of physicians whom we would like caring for our family and ourselves.

For more information:

Newton BW. Academic Medicine. 2008;83:244-249.