1. The SDN iPhone App is back and free through November! Get it today and please post a review on the App Store!
    Dismiss Notice
  2. Dismiss Notice

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

Discussion in 'Medical Students - MD' started by DermViser, Sep 5, 2014.

  1. DermViser

    5+ Year Member

    Joined:
    Apr 4, 2009
    Messages:
    17,561
    Likes Received:
    12,879
    Status:
    Resident [Any Field]
    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?
     
    DoctorWhoo likes this.
  2. Note: SDN Members do not see this ad.

  3. totu22

    Joined:
    Aug 25, 2014
    Messages:
    36
    Likes Received:
    54
    Status:
    Pre-Medical
    That is really deep.
     
  4. fancymylotus

    fancymylotus A Whole New World
    Dentist 10+ Year Member

    Joined:
    Jul 21, 2004
    Messages:
    36,024
    Likes Received:
    17,572
  5. DermViser

    5+ Year Member

    Joined:
    Apr 4, 2009
    Messages:
    17,561
    Likes Received:
    12,879
    Status:
    Resident [Any Field]
    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?
     
    Megalomis and ruedjgtc like this.
  6. fancymylotus

    fancymylotus A Whole New World
    Dentist 10+ Year Member

    Joined:
    Jul 21, 2004
    Messages:
    36,024
    Likes Received:
    17,572
    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.
     
  7. circulus vitios

    7+ Year Member

    Joined:
    Jul 18, 2008
    Messages:
    6,257
    Likes Received:
    1,632
    Cold and calloused.
     
    seminoma and fancymylotus like this.
  8. DermViser

    5+ Year Member

    Joined:
    Apr 4, 2009
    Messages:
    17,561
    Likes Received:
    12,879
    Status:
    Resident [Any Field]
    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?
     
  9. Kahreek

    2+ Year Member

    Joined:
    Jun 1, 2013
    Messages:
    1,719
    Likes Received:
    847
    Status:
    Pre-Health (Field Undecided)
    my favorite time in medschool is also earlier in the morning or after lunch waiting for people, that and elevator rides.
     
    Nasrudin likes this.
  10. fancymylotus

    fancymylotus A Whole New World
    Dentist 10+ Year Member

    Joined:
    Jul 21, 2004
    Messages:
    36,024
    Likes Received:
    17,572
    @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.
     
  11. Mad Jack

    Mad Jack Critically Caring
    Physician Classifieds Approved 5+ Year Member

    Joined:
    Jul 27, 2013
    Messages:
    34,509
    Likes Received:
    62,876
    I came into this completely dead inside, I doubt I'll leave it much worse.

    But this sounds like a culture issue, completely.
     
    Nasrudin likes this.
  12. DermViser

    5+ Year Member

    Joined:
    Apr 4, 2009
    Messages:
    17,561
    Likes Received:
    12,879
    Status:
    Resident [Any Field]
    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.
     
  13. DermViser

    5+ Year Member

    Joined:
    Apr 4, 2009
    Messages:
    17,561
    Likes Received:
    12,879
    Status:
    Resident [Any Field]
    Of the person or of the medical school?
     
  14. fancymylotus

    fancymylotus A Whole New World
    Dentist 10+ Year Member

    Joined:
    Jul 21, 2004
    Messages:
    36,024
    Likes Received:
    17,572
    He's doing what he loves. So it's worth it.
     
  15. Mad Jack

    Mad Jack Critically Caring
    Physician Classifieds Approved 5+ Year Member

    Joined:
    Jul 27, 2013
    Messages:
    34,509
    Likes Received:
    62,876
    Medical training in general, not just the individual school.
     
    DermViser likes this.
  16. DermViser

    5+ Year Member

    Joined:
    Apr 4, 2009
    Messages:
    17,561
    Likes Received:
    12,879
    Status:
    Resident [Any Field]
    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.
     
    Megalomis likes this.
  17. fancymylotus

    fancymylotus A Whole New World
    Dentist 10+ Year Member

    Joined:
    Jul 21, 2004
    Messages:
    36,024
    Likes Received:
    17,572
    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..
     
  18. DermViser

    5+ Year Member

    Joined:
    Apr 4, 2009
    Messages:
    17,561
    Likes Received:
    12,879
    Status:
    Resident [Any Field]
    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.
     
    #17 DermViser, Sep 5, 2014
    Last edited: Sep 5, 2014
  19. fancymylotus

    fancymylotus A Whole New World
    Dentist 10+ Year Member

    Joined:
    Jul 21, 2004
    Messages:
    36,024
    Likes Received:
    17,572
    I guess. What do I know. I'm just a dentist.
     
    touchpause13 likes this.
  20. DermViser

    5+ Year Member

    Joined:
    Apr 4, 2009
    Messages:
    17,561
    Likes Received:
    12,879
    Status:
    Resident [Any Field]
    :rage:
     
  21. fancymylotus

    fancymylotus A Whole New World
    Dentist 10+ Year Member

    Joined:
    Jul 21, 2004
    Messages:
    36,024
    Likes Received:
    17,572

    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 :rage:
     
    DermViser likes this.
  22. Kahreek

    2+ Year Member

    Joined:
    Jun 1, 2013
    Messages:
    1,719
    Likes Received:
    847
    Status:
    Pre-Health (Field Undecided)
    drink chamomile tea
     
  23. DermViser

    5+ Year Member

    Joined:
    Apr 4, 2009
    Messages:
    17,561
    Likes Received:
    12,879
    Status:
    Resident [Any Field]
    +pissed+
     
    OsteoQuack likes this.
  24. circulus vitios

    7+ Year Member

    Joined:
    Jul 18, 2008
    Messages:
    6,257
    Likes Received:
    1,632
    I guess more of the latter. Being cold and calloused will definitely help, though.
     
  25. operaman

    Physician 7+ Year Member

    Joined:
    Jun 7, 2010
    Messages:
    1,722
    Likes Received:
    3,717
    Status:
    Resident [Any Field]
    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.
     
    calvnandhobbs68 and ilMaestro like this.
  26. touchpause13

    touchpause13 nolite te bastardes carborundorum
    5+ Year Member

    Joined:
    Jun 25, 2012
    Messages:
    14,434
    Likes Received:
    14,005
    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
     
    OsteoQuack and Megalomis like this.
  27. Kahreek

    2+ Year Member

    Joined:
    Jun 1, 2013
    Messages:
    1,719
    Likes Received:
    847
    Status:
    Pre-Health (Field Undecided)
    so early in the game, already taking the toll on you. Chill out girl. Take out some pressure on me.
     
    seminoma likes this.
  28. DermViser

    5+ Year Member

    Joined:
    Apr 4, 2009
    Messages:
    17,561
    Likes Received:
    12,879
    Status:
    Resident [Any Field]
    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?
     
    fab4fan likes this.
  29. DermViser

    5+ Year Member

    Joined:
    Apr 4, 2009
    Messages:
    17,561
    Likes Received:
    12,879
    Status:
    Resident [Any Field]
    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.
     
    Megalomis likes this.
  30. alpinism

    alpinism Give Em' the Jet Fuel
    7+ Year Member

    Joined:
    Nov 6, 2011
    Messages:
    2,999
    Likes Received:
    2,621
    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.
     
  31. DermViser

    5+ Year Member

    Joined:
    Apr 4, 2009
    Messages:
    17,561
    Likes Received:
    12,879
    Status:
    Resident [Any Field]
    So then how would one go about getting "realistic" expectations?
     
  32. Birdstrike

    7+ Year Member

    Joined:
    Dec 19, 2010
    Messages:
    4,660
    Likes Received:
    3,333
    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.
     
    fancymylotus likes this.
  33. operaman

    Physician 7+ Year Member

    Joined:
    Jun 7, 2010
    Messages:
    1,722
    Likes Received:
    3,717
    Status:
    Resident [Any Field]
    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.
     
    Successful BM likes this.
  34. DermViser

    5+ Year Member

    Joined:
    Apr 4, 2009
    Messages:
    17,561
    Likes Received:
    12,879
    Status:
    Resident [Any Field]
    Dentists wear face masks, genius. Also, it's fully on an outpatient basis.
     
  35. DermViser

    5+ Year Member

    Joined:
    Apr 4, 2009
    Messages:
    17,561
    Likes Received:
    12,879
    Status:
    Resident [Any Field]
    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.
     
  36. fancymylotus

    fancymylotus A Whole New World
    Dentist 10+ Year Member

    Joined:
    Jul 21, 2004
    Messages:
    36,024
    Likes Received:
    17,572

    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.
     
  37. fancymylotus

    fancymylotus A Whole New World
    Dentist 10+ Year Member

    Joined:
    Jul 21, 2004
    Messages:
    36,024
    Likes Received:
    17,572
  38. circulus vitios

    7+ Year Member

    Joined:
    Jul 18, 2008
    Messages:
    6,257
    Likes Received:
    1,632
    It's easy. Drop the touchy-feely expectations and concentrate on the financial ones, within reason.
     
  39. DermViser

    5+ Year Member

    Joined:
    Apr 4, 2009
    Messages:
    17,561
    Likes Received:
    12,879
    Status:
    Resident [Any Field]
    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.
     
  40. DermViser

    5+ Year Member

    Joined:
    Apr 4, 2009
    Messages:
    17,561
    Likes Received:
    12,879
    Status:
    Resident [Any Field]
    So your solution for people to have realistic expectations is for people to enter medicine with their only goals being the financial ones?
     
  41. fancymylotus

    fancymylotus A Whole New World
    Dentist 10+ Year Member

    Joined:
    Jul 21, 2004
    Messages:
    36,024
    Likes Received:
    17,572
    I did. Coz I'm a sometimes self deprecating grouch. How else do you think I survive in allo without getting a WoH??!
     
  42. circulus vitios

    7+ Year Member

    Joined:
    Jul 18, 2008
    Messages:
    6,257
    Likes Received:
    1,632
    Remove the stunted humanistic aspects of medicine and what is it?

    A job.
     
  43. fancymylotus

    fancymylotus A Whole New World
    Dentist 10+ Year Member

    Joined:
    Jul 21, 2004
    Messages:
    36,024
    Likes Received:
    17,572

    This times a million.
     
    altitudinarian likes this.
  44. DermViser

    5+ Year Member

    Joined:
    Apr 4, 2009
    Messages:
    17,561
    Likes Received:
    12,879
    Status:
    Resident [Any Field]
    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?
     
  45. DermViser

    5+ Year Member

    Joined:
    Apr 4, 2009
    Messages:
    17,561
    Likes Received:
    12,879
    Status:
    Resident [Any Field]
    What's a WoH?
     
  46. touchpause13

    touchpause13 nolite te bastardes carborundorum
    5+ Year Member

    Joined:
    Jun 25, 2012
    Messages:
    14,434
    Likes Received:
    14,005
  47. fancymylotus

    fancymylotus A Whole New World
    Dentist 10+ Year Member

    Joined:
    Jul 21, 2004
    Messages:
    36,024
    Likes Received:
    17,572

    Lol. I was fully expecting a dentist hate movement.
     
  48. Apoplexy__

    Apoplexy__ Blood-and-thunder appearance
    5+ Year Member

    Joined:
    Oct 20, 2012
    Messages:
    1,152
    Likes Received:
    1,445
    Status:
    Resident [Any Field]
    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?
     
  49. circulus vitios

    7+ Year Member

    Joined:
    Jul 18, 2008
    Messages:
    6,257
    Likes Received:
    1,632
    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.
     
    touchpause13 and fancymylotus like this.
  50. DermViser

    5+ Year Member

    Joined:
    Apr 4, 2009
    Messages:
    17,561
    Likes Received:
    12,879
    Status:
    Resident [Any Field]
    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?
     
  51. Mad Jack

    Mad Jack Critically Caring
    Physician Classifieds Approved 5+ Year Member

    Joined:
    Jul 27, 2013
    Messages:
    34,509
    Likes Received:
    62,876
    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.
     

Share This Page