I can feel it slipping away already. The long hours are taking their toll on my attitude, draining my patience. The anxiety consumes me as I wait for my knowledge to be tested with endless questions while I try my best to stay out of the way. The patient visits run together and interactions become briefer, although the schedule is fuller. No longer do patient experiences seem important. Less attention is paid to personal stories. The lack of emotion becomes routine.
Evidence that empathy is lessened when students begin their clinical education during the third year of medical school. Empathy in the healthcare setting is defined as “a cognitive attribute, which involves an understanding of the inner experiences and perspectives of the patient as a separate individual, combined with a capability to communicate this understanding to the patient.” (1,2)
Diseker and Michielutte reported a decrease in empathy in medical students prior to and after clinical experiences. Whitemore and colleagues reported that hedonistic personality patterns may contribute to this phenomenon(3). Bellini et al. used the Interpersonal Reactivity Index (IRI) to measure empathy of sixty residents at six points during their internal medicine residency training. It was discovered that empathy only continued to decline(3,4). Lastly, Hojat et al. found a reduction in third year medical student empathy level when measured using a validated questionnaire, the Jefferson Scale of Physician Empathy (JSPE) (1,3).
Other studies have reached different findings. For instance, Zeldow and Daugherty (using the IRI scale) reported no change in empathy levels during medical school(3). Markham found that a behavior science course during medical school made no impact on students’ perspectives of patients(5).
I am consciously reminding myself of my attitude when I started my journey into medical school. I remember writing my own version of the Hippocratic oath and I recall an emphasis on empathy. Just recently, I opened the file to review on my computer. What a wonderful reminder of my commitment to medicine and patient care!
As a physician, I do solemnly promise:
To treat my patients with absolute respect, honesty, and transparency at all times;
To assist any person in need regardless of age, race, financial standing, or sexual preference;
To exercise patience, sympathy and empathy while listening to patient complaints with undivided attention and without interruption;
To remember the professors and mentors who provided me with guidance and the necessary knowledge to pursue this career;
To continuously supplement my education as I mature;
To support individuals of later generations who follow my example;
To keep patient information confidential and secure under any circumstance;
To refuse any temptation to commit fraud or to wrongfully gain unearned compensation;
To treat not simply the disease, but the entire person;
To provide reassurance and to establish a trusting rapport with my patients, and their friends and families;
To never act superior and to treat both my colleagues and my patients as equals;
To seek help if I am unsure of the proper treatment in order to ensure the highest quality of patient care;
To personally apologize and admit my wrongdoing if I am ever to commit any mistakes;
To allow me to accept dishonor, disgrace, and poor reputation if I am ever to deviate from this pledge;
To experience satisfaction and gratitude while living up to these promises.
I believe that providing targeted empathy training for students and interns would prove beneficial for both patients and physicians. In a time of rushed history taking and physical exams, I think that the establishment of an empathetic relationship proves undoubtedly valuable. More medical schools are incorporating reflective writing, or “narrative medicine,” into the curriculum (1,6). Personally, taking a moment twice every month to reflect on my experiences and contribute to this blog has helped to re-center my focus on maintaining superior patient care. It is my goal to inspire other students, residents, and physicians to find a moment for reflection so that their empathy may endure.
1. Singh S. Empathy: Lost or Found in Medical Education? MedGenMed. 2005; 7(3): 74.
2. Hojat M, Gonnella JS, Nasca TJ, Mangione S, Vergare M, Magee M. Physician empathy: definition, components, measurement, and relationship to gender and specialty. Am J Psychiatry.2002;159:1563–1569.
3. Hojat M, Mangione S, Nasca TJ, et al. An empirical study of decline in empathy in medial schools. Med Educ. 2004;38:934–941.
4. Bellini LM, Shea JA. Mood change and empathy decline persist during three years of internal medicine training. Accad Med. 2005;80:164–167.
5. Markham B. Can a behavioral science course change medical students’ attitudes? J Psychiatr Educ. 1979;3:44–54
6. Singh S. The stone circle. CMAJ. 2005;172:522.
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