Loss of Empathy throughout Medical School

Even before starting medical school I had heard of the “third year burnout”. A phenomenon that occurs nationally during the third year of medical school—students began to lose sight of the importance of their work, become cynical and generally unfulfilled by their studies. This burnout is thought to contribute to a growing lack of empathy towards the patient as the students progresses throughout medical school. I looked a 2005 study by Dr. Hojat that attempts to quantify this growing lack of empathy in medical school using the Jefferson Scale of Physician Empathy. Between the first and third year students were find to have a decline in empathy that was clinically significant for 5 items on this scale.

“It is as important to ask patients about what is happening in their lives as it is to ask about their physical complaints”

“Physicians should try to think like their patients in order to render better care”

“Emotion has no place in the treatment of medical illness”

“Patient illness can be cured by medical treatment; physicians’ affectional ties with their patients cannot have a significant place in this endeavor”

“For more effective treatment, physicians must be attentive to their patient’s personal experiences”

The study goes onto suggests that teaching of empathy should be further incorporated into the medical school curriculum. Another suggestion that future medical school admissions should include some form of testing for empathy. During medical school I have observed many interactions between patients and many different medical students as well as physicians. I was surprised to learn that both students and physicians that behind closed doors showed very little empathy were able to express what seemed like genuine concern for their patients. The patients always seemed very pleased with these encounters. This observation left me wondering if perhaps what’s more important than being empathetic is just acting like you are. I wonder if it is even possible to teach empathy, since I always felt this is something one either inherently feels or doesn’t. I would also think it is difficult to actually screen for empathy as it is easy to see what “the right” answer in questionnaires that measure empathy. Another thought also came to mind when reading this article: perhaps the difference in responses after completion of clinical clerkships in students is not due to a lack of empathy but is secondary to the sad reality of the demanding pace of medicine. For example, while in the ideal world it is important to understand what is going in the personal lives of your patients, a busy clinic day does not allow for it and the patient’s physical complaints trumph their personal lives. What if by not asking too much detail about their personal lives you were ensuring that the clinic schedule runs on time and were in fact being empathetic towards your next patient, who will be seen on time. If this is the case, maybe we should again reconsider the impact patient load and work load is having on perceived empathy.

  1. Hojat, Mohammadreza, Salvatore Mangione, Thomas J. Nasca, Susan Rattner, James B. Erdmann, Joseph S. Gonnella, and Mike Magee. “An empirical study of decline in empathy in medical school.” Medical Education9 (2004): 934-41. Web.

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