I never understood the loss of empathy during medical training. Until now.

[DermViser]

Very interesting article as always: http://www.kevinmd.com/blog/2014/09/never-understood-loss-empathy-medical-training-now.html

I thought it was funny that he went to a medical school that tries to standardize and quantify everything which in turn led to his decreasing empathy and when he went to his school psychologists the felt he was anxious/depressed and it was an internal failure rather than a system failure.

I wonder how much of the empathy lost is school-generated vs. actually not liking medicine. Thoughts?

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[totu22]

That is really deep.

 

[fancymylotus]

ouch

 

[DermViser]

That is really deep.

I thought so too. I know study after study in the literature has confirmed a loss of empathy in medical students across 4 years, but I think his detailed story kind of puts a human perspective as to why exactly this is. I've wondered if it's something medical schools themselves are actively doing which promote this loss of empathy, whether it's the so-called "hidden curriculum" at work, or whether it's just something inherent to medical school that will be there regardless of what schools do.

There are medical schools that have tried to change things - whether it's P/F grading in the first 2 years, wellness initiatives, etc. I don't know how helpful these things are in the long run. For example, the NYU grad intern at Columbia that committed suicide was in AOA: http://www.times-herald.com/obits/20140822obit-o-rourke, so having great academics doesn't necessarily mean you're immune from not being happy.

More importantly, what qualities should one have before entering medical school to not have that loss of empathy, depersonalization, etc.? Or what interventions should there be to where medical students can not have or at least mitigate it? Counseling? Discussions with other medical students with faculty facilitators?

Is there a decrease in empathy in dental school, for example, @fancymylotus?

 

[fancymylotus]

Yes.

And I think a lot of it does come from unmet expectations, administration, etc. But trying to maintain good coping mechanisms and not decompensating when SHTF is really tough sometimes. And I do understand the "none of my family or friends get it, why should I bother keeping in touch with them, they need to stop telling me to study harder and its just going to be okay" mentality. I pushed a lot of people away during school, and although my coping mechanisms tend to be things like shopping, I know there was rampant drug and alcohol use amongst my class and other classes.

 

[circulus vitios]

More importantly, what qualities should one have before entering medical school to not have that loss of empathy, depersonalization, etc.? Or what interventions should there be to where medical students can not have or at least mitigate it? Counseling? Discussions with other medical students with faculty facilitators?

Is there a decrease in empathy in dental school, for example, @fancymylotus?

Cold and calloused.

 

[DermViser]

Yes.

And I think a lot of it does come from unmet expectations, administration, etc. But trying to maintain good coping mechanisms and not decompensating when SHTF is really tough sometimes. And I do understand the "none of my family or friends get it, why should I bother keeping in touch with them, they need to stop telling me to study harder and its just going to be okay" mentality. I pushed a lot of people away during school, and although my coping mechanisms tend to be things like shopping, I know there was rampant drug and alcohol use amongst my class and other classes.

Wow. I would not have thought dental school would have such a decrease in empathy. Not bc it's "easier" bc it's not, but bc at least in general dentistry, you get a good night's sleep, not on call (that I know of), etc. Specialization in dentistry is more a cherry on top thing, with different procedures but same type of outpatient practice (besides OMFS).

Cold and calloused.

You think coming in already cold and calloused will make things easier to deal with in medical school? I would think that's the perfect recipe for disaster. Or maybe you're more referring to having more realistic expectations?

 

[Kahreek]

my favorite time in medschool is also earlier in the morning or after lunch waiting for people, that and elevator rides.

 

[fancymylotus]

@DermViser I was also sort of referring to things the way my med school and resident friends describe them. And the stories I've heard from K, too.

 

[Mad Jack]

I came into this completely dead inside, I doubt I'll leave it much worse.

But this sounds like a culture issue, completely.

 

[DermViser]

@DermViser I was also sort of referring to things the way my med school and resident friends describe them. And the stories I've heard from K, too.

Yes, I know. I was just surprised that dental school had the same type of empathy drop, which is surprising bc after dental school, residency is optional, you have your own business in private practice, and hours are relatively on an outpatient basis. Yes. I don't know how K is still going for Surgery after all that, TBH.

 

[DermViser]

I came into this completely dead inside, I doubt I'll leave it much worse.

But this sounds like a culture issue, completely.

Of the person or of the medical school?

 

[fancymylotus]

He's doing what he loves. So it's worth it.

 

[Mad Jack]

Of the person or of the medical school?

Medical training in general, not just the individual school.

 

[DermViser]

He's doing what he loves. So it's worth it.

I guess. You REALLY REALLY have to love Surgery with everything else secondary in order to get thru it (at least during residency), I believe.

 

[fancymylotus]

I guess. You REALLY REALLY have to love Surgery with everything else secondary in order to get thru it (at least during residency), I believe.

Yeah, but if you decide to do something that makes you unhappy, it doesnt matter how great things are at home, you'll never be a happy person..

 

[DermViser]

Yeah, but if you decide to do something that makes you unhappy, it doesnt matter how great things are at home, you'll never be a happy person..

Yes, but I think happiness is a lot of parts together. It isn't just a specialty. Everyone likes Surgery as you're working with your hands, actually doing something, etc. but there's a difference between liking it and loving it to the detriment of other things. In Surgery residency, you REALLY have to love it. I mean REALLY, but you don't just get to cut and you're done.

I don't know, maybe @Winged Scapula will be able to articulate what I'm saying better, as she actually made it to the top of the mountain or @DarknightX.

 

[fancymylotus]

I guess. What do I know. I'm just a dentist.

 

[DermViser]

I guess. What do I know. I'm just a dentist.

 

[fancymylotus]

Lol. My favorite emoticon. Sorry. My stress and frustration levels are through the roof atm. And I can't exactly medicate or drink myself out of it

 

[Kahreek]

Lol. My favorite emoticon. Sorry. My stress and frustration levels are through the roof atm. And I can't exactly medicate or drink myself out of it

drink chamomile tea

 

[DermViser]

drink chamomile tea

 

[circulus vitios]

Wow. I would not have thought dental school would have such a decrease in empathy. Not bc it's "easier" bc it's not, but bc at least in general dentistry, you get a good night's sleep, not on call (that I know of), etc. Specialization in dentistry is more a cherry on top thing, with different procedures but same type of outpatient practice (besides OMFS).


You think coming in already cold and calloused will make things easier to deal with in medical school? I would think that's the perfect recipe for disaster. Or maybe you're more referring to having more realistic expectations?

I guess more of the latter. Being cold and calloused will definitely help, though.

 

[operaman]

Gonna have to call some BS on the article.

Person says they decided on med school after taking care of their sick mom, presumably as an adolescent/young adult.

Describes Step 1 as stressful because with a bad score he/she wouldn't get the specialty she's been dreaming about since she was 3 years old.

How can you be dreaming of a specialty choice as a small child and not decide to become a doc until high school/college? Seems like wanting to be a doctor would come first and the specifics later. Maybe even simultaneously. Not before.

Now, I know it was used more as a figure of speech, but I think it gets to one important piece of a very complex issue: you can't buy into the @#% people are selling. Not everything is a crisis and you can't hold a wake after every bad grade. If you know who you are and what you want out of the field, then who cares what anyone else thinks?

Assuming the author of the piece was telling the truth and not just regurgitating a part of his/her personal statement, there are countless fields where you can help sick and dying patients and not all of them require perfect grades/boards. Frankly, I'm not buying the author's story one bit. I've got $100 says the KevinMD publication is now on her ERAS that in 10 days will be sent off to every dermatology program in the country along with another personal statement about how her mom's illness led to her passion for skin disease.

 

[touchpause13]

I think med school makes people crazy. Idk if it's the amount of material or the competition, but I guess I wasn't expecting to be affected so much. Like things that haven't been issues for years just come back like it was yesterday. Freakin nuts. I think @Goro has commented on this before, med school really is a pressure cooker

 

[Kahreek]

I think med school makes people crazy. Idk if it's the amount of material or the competition, but I guess I wasn't expecting to be affected so much. Like things that haven't been issues for years just come back like it was yesterday. Freakin nuts. I think @Goro has commented on this before, med school really is a pressure cooker

so early in the game, already taking the toll on you. Chill out girl. Take out some pressure on me.

 

[DermViser]

Gonna have to call some BS on the article.

Person says they decided on med school after taking care of their sick mom, presumably as an adolescent/young adult.

Describes Step 1 as stressful because with a bad score he/she wouldn't get the specialty she's been dreaming about since she was 3 years old.

How can you be dreaming of a specialty choice as a small child and not decide to become a doc until high school/college? Seems like wanting to be a doctor would come first and the specifics later. Maybe even simultaneously. Not before.

Now, I know it was used more as a figure of speech, but I think it gets to one important piece of a very complex issue: you can't buy into the @#% people are selling. Not everything is a crisis and you can't hold a wake after every bad grade. If you know who you are and what you want out of the field, then who cares what anyone else thinks?

Assuming the author of the piece was telling the truth and not just regurgitating a part of his/her personal statement, there are countless fields where you can help sick and dying patients and not all of them require perfect grades/boards. Frankly, I'm not buying the author's story one bit. I've got $100 says the KevinMD publication is now on her ERAS that in 10 days will be sent off to every dermatology program in the country along with another personal statement about how her mom's illness led to her passion for skin disease.

Great and unnecessary crack on Dermatology. I'm sure you're proud of the effort it took to come up with that. I'm sure the SDN Peanut Gallery is giving you high fives.

You really think people don't imagine what specialty they will be practicing when they come into medical school? Really? So if someone went into medical school due to a family member with cancer, you can't see that person as wanting to do Heme/Onc or Surgical Oncology as a field starting from MS-1?

 

[DermViser]

I think med school makes people crazy. Idk if it's the amount of material or the competition, but I guess I wasn't expecting to be affected so much. Like things that haven't been issues for years just come back like it was yesterday. Freakin nuts. I think @Goro has commented on this before, med school really is a pressure cooker

I think a lot of it depends on the person, managed expectations, and your student body culture. A psychiatrist could build a whole practice on medical students and residents alone.

 

[alpinism]

Honestly that was cringe worthy.

She sounds like an extremely sheltered and naive girl who thought of medicine as some sort of cinderella fairy tale happy ending. Almost as if med school was supposed to conform to her life and expectations not the other way around. You have to work long hours in med school?!? Studying isn't always fun and interesting?!? I can't spend every weekend with family and friends?!? Residents will correct my mistakes and criticize my work?!? I can't spend an hour connecting with every patient and learning their life story?!?

I think what happens to medical students is not a loss of empathy but rather a loss of immaturity. I'd argue that more often than not this immaturity is being confused with empathy in M1s.

Its easy to have "empathy" when your whole worldview is filled with unrealistic expectations of med school, residency, and practice.

Then you come to find out that you're not the smartest person in the room anymore, you have to work hard to pass classes. You have to sacrifice time with family and friends. You have to give up some of the things you loved doing before med school. You have to spend long hours in the hospital including weekends and holidays doing a mostly thankless job. You have to accept the fact that you don't solve most of your patients' problems. But most of all, you have to learn the hard way that you don't make a difference in most people's lives.

Welcome to the real world.

 

[DermViser]

Honestly that was cringe worthy.

She sounds like an extremely sheltered and naive girl who thought of medicine as some sort of cinderella fairy tale happy ending. Almost as if med school was supposed to conform to her life and expectations not the other way around. You have to work long hours in med school?!? Studying isn't always fun and interesting?!? I can't spend every weekend with family and friends?!? Residents will correct my mistakes and criticize my work?!? I can't spend an hour connecting with every patient and learning their life story?!?

I think what happens to medical students is not a loss of empathy but rather a loss of immaturity. I'd argue that more often than not this immaturity is being confused with empathy in M1s.

Its easy to have "empathy" when your whole worldview is filled with unrealistic expectations of med school, residency, and practice.

Then you come to find out that you're not the smartest person in the room anymore, you have to work hard to pass classes. You have to sacrifice time with family and friends. You have to give up some of the things you loved doing before med school. You have to spend long hours in the hospital including weekends and holidays doing a mostly thankless job. You have to accept the fact that you don't solve most of your patients' problems. But most of all, you have to learn the hard way that you don't make a difference in most people's lives.

Welcome to the real world.

So then how would one go about getting "realistic" expectations?

 

[Birdstrike]

Wow. I would not have thought dental school would have such a decrease in empathy.

Dude, you need to spend a few 10 hour days stuck in rotten mouth-holes smelling of necrotizing anaerobes, then you'll be begging to have a shred of your empathy back, brutha.

Gotcho back, Fancy.

 

[operaman]

Great and unnecessary crack on Dermatology. I'm sure you're proud of the effort it took to come up with that. I'm sure the SDN Peanut Gallery is giving you high fives.

You really think people don't imagine what specialty they will be practicing when they come into medical school? Really? So if someone went into medical school due to a family member with cancer, you can't see that person as wanting to do Heme/Onc or Surgical Oncology as a field starting from MS-1?

Yeah, sorry about the derm crack, but rhetorically no other specialty had the same zip and absolute disconnect from the situation.

Of course people can come to med school knowing what specialty they want -- I sure did. The disconnect is that heme/onc and surg onc are fields that don't require perfect grades and boards. Sure, we all want to be the best we can be, but one can do either of those fields with fairly average numbers.

My point was that I don't believe this loss of empathy thing is a culture issue so much as an individual one. I see too many disconnects in the article to really take it that seriously. All the people in my class who seemed like empathetic people early on are still acting that way, maybe even more so. The people I'm close enough with to have such conversations have all said how much they've enjoyed med school so far and feel their passion for medicine and patients only intensified. The people who are cold, callous a--holes were like that since the first day of M1.

To those feeling like the system is f-ed up and they're losing their own empathy: you've got to treat this whole shebang like the game it is. It's kinda like the military. The drill instructor yelling at you doesn't REALLY think you're a no good piece of maggot s--t, that's just his job and you can't take it personally. You gotta take a lot of the med school stuff in similar stride. You have a bad day on rounds and feel like an idiot? Just let it roll off because that's just part of the game; now go read and don't make the same mistake twice. Have cold callous residents who treat you like s--t? Just focus on your work, smile, and take care of your patients. Don't let the game define you.

 

[DermViser]

Dude, you need to spend a few 10 hour days stuck in rotten mouth-holes smelling of necrotizing anaerobes, then you'll be begging to have a shred of your empathy back, brutha.

Gotcho back, Fancy.

Dentists wear face masks, genius. Also, it's fully on an outpatient basis.

 

[DermViser]

Yeah, sorry about the derm crack, but rhetorically no other specialty had the same zip and absolute disconnect from the situation.

Of course people can come to med school knowing what specialty they want -- I sure did. The disconnect is that heme/onc and surg onc are fields that don't require perfect grades and boards. Sure, we all want to be the best we can be, but one can do either of those fields with fairly average numbers.

My point was that I don't believe this loss of empathy thing is a culture issue so much as an individual one. I see too many disconnects in the article to really take it that seriously. All the people in my class who seemed like empathetic people early on are still acting that way, maybe even more so. The people I'm close enough with to have such conversations have all said how much they've enjoyed med school so far and feel their passion for medicine and patients only intensified. The people who are cold, callous a--holes were like that since the first day of M1.

To those feeling like the system is f-ed up and they're losing their own empathy: you've got to treat this whole shebang like the game it is. It's kinda like the military. The drill instructor yelling at you doesn't REALLY think you're a no good piece of maggot s--t, that's just his job and you can't take it personally. You gotta take a lot of the med school stuff in similar stride. You have a bad day on rounds and feel like an idiot? Just let it roll off because that's just part of the game; now go read and don't make the same mistake twice. Have cold callous residents who treat you like s--t? Just focus on your work, smile, and take care of your patients. Don't let the game define you.

Actually there are - PM&R, Rads, Path, Allergy, etc.

No one is going to directly admit that they hate medical school to you as it is taboo. A lot of medical school is holding your cards close to your chest.

 

[fancymylotus]

Dentists wear face masks, genius. Also, it's fully on an outpatient basis.

I'm in the OR a few times a month. Which for most of you is NBD I know. But for "just a dentist" it is. We're not 100% outpatient. I have to cover call and stuff too.

 

[fancymylotus]

Also hi @Birdstrike

 

[circulus vitios]

So then how would one go about getting "realistic" expectations?

It's easy. Drop the touchy-feely expectations and concentrate on the financial ones, within reason.

 

[DermViser]

I'm in the OR a few times a month. Which for most of you is NBD I know. But for "just a dentist" it is. We're not 100% outpatient. I have to cover call and stuff too.

Who said you were "just a dentist"? General Dentistry/Orthodontics/Periodontics, etc. is usually in a private practice and is a fully outpatient specialty. With no call or OR responsibilities unless you choose to for more income.

 

[DermViser]

It's easy. Drop the touchy-feely expectations and concentrate on the financial ones, within reason.

So your solution for people to have realistic expectations is for people to enter medicine with their only goals being the financial ones?

 

[fancymylotus]

Who said you were "just a dentist"? General Dentistry/Orthodontics/Periodontics, etc. is usually in a private practice and is a fully outpatient specialty. With no call or OR responsibilities unless you choose to for more income.

I did. Coz I'm a sometimes self deprecating grouch. How else do you think I survive in allo without getting a WoH??!

 

[circulus vitios]

So your solution for people to have realistic expectations is for people to enter medicine with their only goals being the financial ones?

Remove the stunted humanistic aspects of medicine and what is it?

A job.

 

[fancymylotus]

Remove the stunted humanistic aspects of medicine and what is it?

A job.

This times a million.

 

[DermViser]

Remove the stunted humanistic aspects of medicine and what is it?

A job.

That's one thing if you're practicing as an attending. Depending on the specialty, it's a job with a lot more responsibility, call, # of hours worked, people dying on you left and right, etc. Your solution is for med students and premeds to just look at the paycheck?

 

[DermViser]

I did. Coz I'm a sometimes self deprecating grouch. How else do you think I survive in allo without getting a WoH??!

What's a WoH?

 

[touchpause13]

I don't think they do WoHs over here @fancymylotus

 

[fancymylotus]

I don't think they do WoHs over here @fancymylotus

Lol. I was fully expecting a dentist hate movement.

 

[Apoplexy__]

You have to accept the fact that you don't solve most of your patients' problems. But most of all, you have to learn the hard way that you don't make a difference in most people's lives.

Welcome to the real world.

Poignant.

People bash the curriculum of med school, but besides the "hidden curriculum", I can't think of what could meaningfully be changed of the soul-crushing process to preserve passion and spirit in medicine. The knowledge has to be gained somehow. Everyone always talks about the long hours of isolated studying, endless feelings of inadequacy through subjective and objective assessment, etc. but is there really any other way?

 

[circulus vitios]

That's one thing if you're practicing as an attending. Depending on the specialty, it's a job with a lot more responsibility, call, # of hours worked, people dying on you left and right, etc. Your solution is for med students and premeds to just look at the paycheck?

I'm aiming for non/barely competitive specialties that prioritize lifestyle. I'd sooner self-immolate than subject myself to the **** show that is surgery or inpatient IM.

 

[DermViser]

I'm aiming for non/barely competitive specialties that prioritize lifestyle. I'd sooner self-immolate than subject myself to the **** show that is surgery or inpatient IM.

Yes, but my point is you're recommending that premeds and incoming med students concentrate only on the financial paycheck as a motivator. You think that's a good idea?

 

[Mad Jack]

Poignant.

People bash the curriculum of med school, but besides the "hidden curriculum", I can't think of what could meaningfully be changed of the soul-crushing process to preserve passion and spirit in medicine. The knowledge has to be gained somehow. Everyone always talks about the long hours of isolated studying, endless feelings of inadequacy through subjective and objective assessment, etc. but is there really any other way?

We could do what most of the rest of the world does and make residency and medical school a significantly longer but less grueling process. In many countries, medical school is 6 years and you are a junior doctor for 5-7 years, but you start right out of high school, so you end up finishing right around the same time as an American grad. Not going through the stress of the premedical process, having a prolonged curriculum, cutting out a lot of the BS we don't actually need in clinical practice, and making residency take longer in terms of years, but with significantly reduced weekly hours- I think these things could add up to making things a lot more bearable. They'll never happen, obviously, but I think a lot of the suck does come from packing so much learning into such a short period of time. That and the way the process basically selects for people that are willing to jump through hoops well and breaks anyone who does otherwise.