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

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I think some people are kind of missing the point here. (Especially some of the high stepI/AOA/etc. types, which I will come back to at the end)

I think the observation from the blog about the mechanism of loss of empathy is very real, but maybe they didn't say it concisely enough.

Basically, medical school and intern year places you into interactions with people in situations that would have normally invoked an extremely natural and strong emotional empathic response in "real" life, BUT in the context of medical school/internship many feel so stressed out about the expectations of their superiors because of the complete power they have over our future, that we end up focusing entirely on ourselves in these situations. Over time this kind of destroys empathy.

So I think there are two main groups of people who can most escape this situation.

1)Those who know they are planning on doing a non-competitive specialty like peds/psych/FM so they don't really have to care what their superiors think and they are smart enough to recognize that they don't need to worry so much.
2) Those who going into MS3 already have a super stacked CV (relative to whats expected for their specialty) with high board scores, AOA or awesome research, etc. so inside they know that they are going to get what they want.
 
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BestDoctorEver said:
But derm seems to be the most friendly specialty in term of lifestyle... By the way, I saw in the AAMC 'Careers in Medicine' site that derm physicians make 446k/year working an average of 45hrs/wk... Are these numbers real? If so, I think the 241 average step1 fro derm is still relatively low...:p
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Yeah. But you'd still have to be a dermatologist.
 
Armadillos said:
So I think there are two main groups of people who can most escape this situation.

1)Those who know they are planning on doing a non-competitive specialty like peds/psych/FM so they don't really have to care what their superiors think and they are smart enough to recognize that they don't need to worry so much.
2) Those who going into MS3 already have a super stacked CV (relative to whats expected for their specialty) with high board scores, AOA or awesome research, etc. so inside they know that they are going to get what they want.
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Those two groups make up the majority of med students. The third most common group is those who have mediocre applications, but believe they are better than they are or believe that they can easily move into the "super stacked" category. If your interpretation was correct, then only a small percentage of med students would be expected to lose empathy throughout their education.

PS. Those people going into peds/psych/FM probably care way more about what people think about them than people going into competitive specialties. Who do you think is more susceptible to being broken by a mean attending? The med student interested in peds or the med student interested in ortho? Personality type alone dictates that.
 
BestDoctorEver said:
But derm seems to be the most friendly specialty in term of lifestyle... By the way, I saw in the AAMC 'Careers in Medicine' site that derm physicians make 446k/year working an average of 45hrs/wk... Are these numbers real? If so, I think the 241 average step1 fro derm is still relatively low...:p
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I would be highly suspect of those numbers.
 
TooMuchResearch said:
I look at skin during almost every patient encounter. "Normal color and temperature. No rash or diaphoresis." Can I have $446k please?
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These kind of comments are not very wise. A pharmacist friend asked me what I was interested in and I told him anesthesiology. His response: Anesthesiology? That's easy right?
Not sure how his zero hours of experience in the operating room allowed him to make that kind of judgment
 
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MOHS_01 said:
I would be highly suspect of those numbers.
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What is the average salary then? When I look at their source, it seems like it was taken from the MGMA, which many consider to be a a good source when it comes to physicians' salary... Is derm that competitive just because of lifestyle?
 
I have never understood why even among physicians there is a negative attitude toward derm and psych... why is that?
 
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Psai said:
These kind of comments are not very wise. A pharmacist friend asked me what I was interested in and I told him anesthesiology. His response: Anesthesiology? That's easy right?
Not sure how his zero hours of experience in the operating room allowed him to make that kind of judgment
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Sarcasm. Perhaps you've heard of it?
 
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BestDoctorEver said:
What is the average salary then? When I look at their source, it seems like it was taken from the MGMA, which many consider to be a a good source when it comes to physicians' salary... Is derm that competitive just because of lifestyle?
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Averages are wholly worthless as is the very notion of salary for the majority of medicine. We are paid in a piecemeal fashion; it all comes back to revenues vs costs incurred. If you had a heavily pediatric or medical derm practice, somewhere in the 200's would be your reward for 40 patients a day 4.5 days a week. If you happen into a busy position that provides you a healthy number of simple procedures or an established cosmetic practice, you would see averages in the 300-400 range. If you inherit a mature, procedure heavy dermatology practice, you might see a 400-500 average. If you inherit a busy, procedure or pathology only practice (doesn't happen unless your daddy gives it to you), you can do better than that. Averages are only useful in that they tell you what is possible; it does not provide you with anything resembling what you can realistically expect as they are not salaries in the traditional sense at all.

... oh, a note on MGMA: the bulk of their data comes from large and well established organizations who participate for the sole purpose of benchmarking for new recruits without having to pay the annual fee for such information. As such, there is a significant inherent statistical bias in their data. FWIW, I believe the best data for a medical student to go on is not MGMA -- it would be recruiters' data based upon placements. This tells you what organizations are willing to lay out to bring someone with a perceived needed skill set aboard. It can vary widely, but that is much more realistic of what one can "expect" as opposed to "what is possible".
 
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jdh71 said:
Exactly. You pull on double that!

(And you still won't take me on your yacht!!)
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That's right. Total dick move on my part, sure... but I have yet to identify the bish I would kick off to make room for you. Heh
 
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Arkangeloid said:
You rang?
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705946757773647277.gif
 
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Armadillos said:
I think some people are kind of missing the point here. (Especially some of the high stepI/AOA/etc. types, which I will come back to at the end)

I think the observation from the blog about the mechanism of loss of empathy is very real, but maybe they didn't say it concisely enough.

Basically, medical school and intern year places you into interactions with people in situations that would have normally invoked an extremely natural and strong emotional empathic response in "real" life, BUT in the context of medical school/internship many feel so stressed out about the expectations of their superiors because of the complete power they have over our future, that we end up focusing entirely on ourselves in these situations. Over time this kind of destroys empathy.

So I think there are two main groups of people who can most escape this situation.

1)Those who know they are planning on doing a non-competitive specialty like peds/psych/FM so they don't really have to care what their superiors think and they are smart enough to recognize that they don't need to worry so much.
2) Those who going into MS3 already have a super stacked CV (relative to whats expected for their specialty) with high board scores, AOA or awesome research, etc. so inside they know that they are going to get what they want.
Click to expand...
You really think those 2 groups aren't stressed?
 
alpinism said:
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.
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This should have ended the thread right here. This article wasn't some kind of crazy revelation (although DermViser might have thought so). It was all this right here.

My loss of empathy is for all the medical/law/whatever students who spew this crap as if we should all feel sorry for their first world problems after I just read about another batch of innocent humans getting slaughtered in Iraq. Spending two years cooped up in an apartment studying?? The horrors.
 
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calvnandhobbs68 said:
This should have ended the thread right here. This article wasn't some kind of crazy revelation (although DermViser might have thought so). It was all this right here.

My loss of empathy is for all the medical/law/whatever students who spew this crap as if we should all feel sorry for their first world problems after I just read about another batch of innocent humans getting slaughtered in Iraq. Spending two years cooped up in an apartment studying?? The horrors.
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I wonder if you would've said this the year before you started med school.





See what I did there? Anyway, by your logic all the patients you see should shut their whiny mouths and think about the innocents being slaughtered in Iraq instead.
 
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seminoma said:
I wonder if you would've said this the year before you started med school.

See what I did there? Anyway, by your logic all the patients you see should shut their whiny mouths and think about the innocents being slaughtered in Iraq instead.
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I absolutely would have said this the year before I started medical school. I have no idea "what you did there".

It never hurts to have a little perspective on life. I find that personally it makes me do a double take and not complain about many things I might have otherwise. Higher education suffers in general from the all too well known "special snowflake syndrome" among many people who never stop to realize that the world doesn't owe them anything. In fact, I think this article is a perfect example of that syndrome. Her medical education is all about "me, me, me". What did I want, how I thought things should have been done, how do I think thought my life should be? Instead of using her mother's illness as an opportunity to truly reflect and appreciate the skills she is developing to bring to the table to help others in similar situations, she focuses on it as some kind of inspiration to a magical fairy land where she should get to be where she wants to be just because she wants to be there.

The article cries of the "middle class America my life is so hard" tone (and make no mistake, "oil field worker dad" is likely solidly middle class or possibly higher...look up those salaries). Had to work at a coffee shop to pay for the MCAT? Alone in the small apartment that my loans afforded me? "Pain is part of life, pain is nothing." Right, cause studying in your apartment sipping coffee in your office chair and getting pimped on rounds is kind of the same as doing hard labor down in the coal mines, amirite everybody?

Cry me a river. Seriously, DermViser is all about knocking down the "millennial" attitude but can't recognize it when it's right under his nose.
 
TooMuchResearch said:
I look at skin during almost every patient encounter. "Normal color and temperature. No rash or diaphoresis." Can I have $446k please?
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I love getting consults from medicine or heme/onc or whoever, and I look at the last progress note and the skin exam (if it's even mentioned) always says "warm and perfused" or some variation. Sometimes I'll even get "no rash", which is especially amusing when the consult is for . . . a rash.
 
GuyWhoDoesStuff said:
Jealousy, mostly.
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Why would they be jealous towards Psych, then? It's not nearly as competitive as Derm.

I think physicians hate their Psych colleagues because the diagnostic criteria are not as neat and categorical as they are in other specialties. Most physicians come from hard science backgrounds, and these people also hate Psych because they perceive it as a "soft" field.

If you look at the people coming from Sinai's HuMed program, they enter Psych over twice as often as regular medical students. Clearly, former humanities students do not share the objections to Psych that many of their colleagues do.
 
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TooMuchResearch said:
I look at skin during almost every patient encounter. "Normal color and temperature. No rash or diaphoresis." Can I have $446k please?
Click to expand...
If that's all you can delineate from looking at a skin disease, then yes, it's not for you.
 
calvnandhobbs68 said:
This should have ended the thread right here. This article wasn't some kind of crazy revelation (although DermViser might have thought so). It was all this right here.

My loss of empathy is for all the medical/law/whatever students who spew this crap as if we should all feel sorry for their first world problems after I just read about another batch of innocent humans getting slaughtered in Iraq. Spending two years cooped up in an apartment studying?? The horrors.
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I never said this was a kind of crazy revelation. If you think the loss of empathy comes from 2 years of studying, then you have truly not read the literature about this well known phenomenon. Great job jumping to conclusions though.
 
Arkangeloid said:
Why would they be jealous towards Psych, then? It's not nearly as competitive as Derm.

I think physicians hate their Psych colleagues because the diagnostic criteria are not as neat and categorical as they are in other specialties. Most physicians come from hard science backgrounds, and these people also hate Psych because they perceive it as a "soft" field.

If you look at the people coming from Sinai's HuMed program, they enter Psych over twice as often as regular medical students. Clearly, former humanities students do not share the objections to Psych that many of their colleagues do.
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Many other fields (wrongly) believe that Psych isn't "real medicine" (whatever that means). There's a reason at the end of 4 years no body gives a **** what other people think in terms of their specialty selection. It's your life, not theirs.

If medical school and specialty selection is based on your self-esteem and what others think of you, you will NEVER be happy.
 
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DermViser said:
I never said this was a kind of crazy revelation. If you think the loss of empathy comes from 2 years of studying, then you have truly not read the literature about this well known phenomenon. Great job jumping to conclusions though.
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Do you have a good review article? I've read a dozen or so of articles on the matter a few months ago, but I don't remember drawing any consistent conclusions about what's responsible for the observed decreases in empathy
 
While we're on the subject of derm, I really enjoy watching derm procedure youtube videos. It's strangely addicting, I enjoy it because you can directly see the effect of whatever you've done and it's also cool because they generally take a little bit of time so you can actually see what's going on and basically how the problem is solved. Really "positive" connection in my opinion(positive as in 2 pieces fitting together well, not happy). Plus it's hands on with the patient and sometimes you're using cool tools( which are micro power tools in my opinion- and power tools are good).
 
Cytarabine said:
Do you have a good review article? I've read a dozen or so of articles on the matter a few months ago, but I don't remember drawing any consistent conclusions about what's responsible for the observed decreases in empathy
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I'll have to look and see again. Don't have the PDF articles on me, but based on what I've read it looked like the largest empathy drop was across/after the MS-3 year, MS-1/MS-2 not as much. I'm assuming these were schools in which actually clinical exposure was mainly in the MS-3 year, while the first 2 years are mainly classroom learning.

Obviously pinpointing the exact reason why there was an empathy drop is different for each individual student.
 
DermViser said:
I'll have to look and see again. Don't have the PDF articles on me, but based on what I've read it looked like the largest empathy drop was across/after the MS-3 year, MS-1/MS-2 not as much. I'm assuming these were schools in which actually clinical exposure was mainly in the MS-3 year, while the first 2 years are mainly classroom learning.

Obviously pinpointing the exact reason why there was an empathy drop is different for each individual student.
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Thanks. I know there's at least one longitudinal study showing steady empathy over the 1st 2 years and a drop over 3rd, but consistent findings in multiple papers are nice for observational studies
 
PL198 said:
While we're on the subject of derm, I really enjoy watching derm procedure youtube videos. It's strangely addicting, I enjoy it because you can directly see the effect of whatever you've done and it's also cool because they generally take a little bit of time so you can actually see what's going on and basically how the problem is solved. Really "positive" connection in my opinion(positive as in 2 pieces fitting together well, not happy). Plus it's hands on with the patient and sometimes you're using cool tools( which are micro power tools in my opinion- and power tools are good).
Click to expand...
A skin punch biopsy is a power tool? I guess. LOL. Your reasons are actually good reasons to pursue the field. I think being able to "see" the results of treatments and/or procedures you've done is very gratifying. Many of the ones who really like doing procedures all the time go on to do Mohs.

[URL='http://www.acuderm.com/category_s/7.htm'][/URL]
 
Cytarabine said:
Thanks. I know there's at least one longitudinal study showing steady empathy over the 1st 2 years and a drop over 3rd, but consistent findings in multiple papers are nice for observational studies
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Depends when the snapshots were taken. All the papers aren't consistent. Some did it at the beginning of MS-1 and end of MS-4, some did it every year, etc. This isn't just an "immaturity" issue. If that was the case, nontraditionals would be immune from this, but they are not.
 
DermViser said:
A skin punch biopsy is a power tool? I guess. LOL. Your reasons are actually good reasons to pursue the field. I think being able to "see" the results of treatments and/or procedures you've done is very gratifying. Many of the ones who really like doing procedures all the time go on to do Mohs.

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meant hand tool, had a mental fart. When you guys do procedures using a scalpel(shaves,etc), is that a special blade? I feel like it would be so risky to use a standard one
 
The second episode of Scrubs talked about this topic. JD had a patient he thought he had convinced to stop smoking, only to catch the patient later in the episode smoking in a staircase. After getting burned that many times, empathy falls away. Compassion fatigue is real.
 
PL198 said:
meant hand tool, had a mental fart. When you guys do procedures using a scalpel(shaves,etc), is that a special blade? I feel like it would be so risky to use a standard one
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I usually use a dermablade for shave biopsies:
dermablade.jpg




Except on the face, when I use a 15 blade:
10918_37.jpg
 
GuyWhoDoesStuff said:
I usually use a dermablade for shave biopsies:
dermablade.jpg




Except on the face, when I use a 15 blade:
10918_37.jpg
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that would be so freaky using the scalpel on a patient, if they sneeze or something, oh lord
 
GuyWhoDoesStuff said:
I usually use a dermablade for shave biopsies:
dermablade.jpg




Except on the face, when I use a 15 blade:
10918_37.jpg
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Oh yes, of course. I thought the latter is what he meant by standard blade. I realize now that he probably meant this by standard blade:
 
PL198 said:
that would be so freaky using the scalpel on a patient, if they sneeze or something, oh lord
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Unless they sneeze so hard that they jump directly off the chair/table, there really isn't much chance for error, at least not if you're holding the scalpel blade correctly. Most patients though who know they are about to sneeze tell you beforehand so you can pause, let them sneeze, and then you can continue.
 
PL198 said:
holy crap after that video that would be sweet to do. it's like carpentry with human tissue.
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It's really cool to watch. I think the more "fun" part is throwing in stitches with the needle driver at the end to close it up. There are some people who are really quite talented in that area esp. with huge excisions: http://www.dermnetnz.org/procedures/excision.html
 
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