Lost your empathy after 3rd year?

[NNguyenMD]

---

Members do not see this ad.

I'm a fourth year, and recently finished my Clinical Skill Exam my school holds for us as a graduation requirement (Not Step CS).

Anyway, one of the recurring themes that I received from each of my evaluators (faculty observers included) was my lack of empathy.

Initially this surprised me, as in the begining of my third year my evaluators would always note how good I was with patients and that I developed good relationships with them.

I really do think that I've changed, and I think there are a lot of reasons why. First is that by the end of third year, I became much more confident on the floors and felt my clinical knowledge had grown immensely. I think that I've become so focused on nailing the right Dx, or figuring out the right Txt that I often forget about theres a patient who is suffering, and needs to know that someone cares.

My chief-resident on surgery was someone who I admired a lot as well, he was very intelligent, confident, cool, collected and decisive. I think I tried emulating some of his traits, but in the process forgot about my patients as well. I'm not going to become a surgeon either, and so there is no reason for me to be in a hurry to get into the OR.

I don't know, does anyone else feel similarly? Like they've lost some of their ability to feel empathetic for someone else?

 

[minnime]

Hey,

Funny you should mention loss of empathy. I've only really started third year and feel the same way. Some days I just can't stand patients and their crying.I am trying to figure out how I became so cold hearted. I went into med school with the goal of helping people...what the hell happened????

I think its because there are so many patients who are non complaient and no matter how much one tried to talk to them, they just don't listen, and also jsut the way hospitals are run.

just my two cents
minnime

 

[Zuwie]

Hey,

Funny you should mention loss of empathy. I've only really started third year and feel the same way. Some days I just can't stand patients and their crying.I am trying to figure out how I became so cold hearted. I went into med school with the goal of helping people...what the hell happened????

I think its because there are so many patients who are non complaient and no matter how much one tried to talk to them, they just don't listen, and also jsut the way hospitals are run.

just my two cents
minnime

Crying is one thing, but I absolutely can't stand patients who look you in the eyes and lie to you with a straight face. Like this lady on a neurology consult who told me "Oh, my heart is fine" and then I look in the previous notes and turns out she got admitted for decompensated CHF and had long-standing CAD and A-fib. Or this guy with COPD exacerbation who practically swore on his mother's grave that he quit using cocaine many years ago, the resident decided to order a urine tox "just in case" and guess what it was positive for?
One of the reasons I chose path is because slides and tissues tend to be truthful.

 

[DarksideAllstar]

One of the reasons I chose path is because slides and tissues tend to be truthful.

Ah, young paduwan, you have much to learn. Yes, much to learn.

 

[Paws]

Count me in here. I think I like patients, but then I find myself sucked into the vortex that is complete insanity, when I find myself spellbound by the nonstop talking of someone. Sometimes, I think: what would happen if I just told them to stop talking? "Hey! shut-UP!" Something like that.

Ok, I have a patient right now who just doesn't get that I need to be in and out of his room in a reasonably efficient manner, and that I cannot stand there and listen to his stream of conciousness ramblings for an hour.

Yeah, I am looking long and hard at how to be a doctor without having to talk to patients. Well, at least today I am. I have to learn how to cut them off and move on. I did cut this guy off and then he was mad at me the rest of the day. 🙄

 

[velo]

Ok, I have a patient right now who just doesn't get that I need to be in and out of his room in a reasonably efficient manner, and that I cannot stand there and listen to his stream of conciousness ramblings for an hour.

I think that's a skill you develop subtly over the years. I've noticed that attendings and upper-level residents always seem to be able to get their message across and get out of the room efficiently, even with the most long-winded of patients, whereas I sometimes feel like I have a sign on my forehead that says "please waste my time with rambling, circuitous, and irrelevant answers to my focused clinical questions..."

 

[Reaganite]

Welcome to 3rd year. LOL. I honestly think making someone go through the 3rd year of medical school is the easiest way to convert them to republicanism!

 

[AmoryBlaine]

Welcome to 3rd year. LOL. I honestly think making someone go through the 3rd year of medical school is the easiest way to convert them to republicanism!

What a weird thing to say...


Honestly though, I'm not sure you're all becoming mutants. Here's my take...

Applying to med school forces people to volunteer extensively and write touchy-feely essays about "helping people" and "answering a call." Fine, all well and good at the surface. However it encourages people to feel like they cannot get into medical school w/o a pie-in-the-sky attitude and without putting forth an image of being a sensitive and reflective soul.

Years 1 and 2 tend to exacerbate this way of thinking. They try to teach you communication skills and sensitivity. M1s leave the hospital after "shadowing" starry-eyed that they got to "talk to a patient," as if the 55 year old obese female with DM2 and CAD is somehow elevated to a special position by her being in the hospital. You have to dsicuss your feelings endlessly with your fellow students. You get lectured by these incredibly inspiring 65 year old family practitioners who still LOVE going to work every day and you are made to feel like that is the only way to be. I'll never forget sitting in our "how to be a doctor" class and hearing a lecturer say "90% of all physician-patient communication barriers are the fault of the physician."

Year 3 teaches you that the previous statement is wrong. Patients are people, and therefore many of them are not cool. People do terrible things to themselves and expect doctors to fix them. They don't want to talk about their motivations, they don't want to talk about their feelings, they want the magic pill. It is hard to empathize with someone who has a huge abscess under one of their rolls of fat and who is drinking a 120oz cup of Coke-heavy while you talk to them. But you do it, and you try to care, and you are a professional. Then once in awhile you see a nice person with a real problem or concern who really wants an answer and is grateful for your services and it's all worthwhile.

 

[8744]

What a weird thing to say...


Honestly though, I'm not sure you're all becoming mutants. Here's my take...

Applying to med school forces people to volunteer extensively and write touchy-feely essays about "helping people" and "answering a call." Fine, all well and good at the surface. However it encourages people to feel like they cannot get into medical school w/o a pie-in-the-sky attitude and without putting forth an image of being a sensitive and reflective soul.

Years 1 and 2 tend to exacerbate this way of thinking. They try to teach you communication skills and sensitivity. M1s leave the hospital after "shadowing" starry-eyed that they got to "talk to a patient," as if the 55 year old obese female with DM2 and CAD is somehow elevated to a special position by her being in the hospital. You have to dsicuss your feelings endlessly with your fellow students. You get lectured by these incredibly inspiring 65 year old family practitioners who still LOVE going to work every day and you are made to feel like that is the only way to be. I'll never forget sitting in our "how to be a doctor" class and hearing a lecturer say "90% of all physician-patient communication barriers are the fault of the physician."

Year 3 teaches you that the previous statement is wrong. Patients are people, and therefore many of them are not cool. People do terrible things to themselves and expect doctors to fix them. They don't want to talk about their motivations, they don't want to talk about their feelings, they want the magic pill. It is hard to empathize with someone who has a huge abscess under one of their rolls of fat and who is drinking a 120oz cup of Coke-heavy while you talk to them. But you do it, and you try to care, and you are a professional. Then once in awhile you see a nice person with a real problem or concern who really wants an answer and is grateful for your services and it's all worthwhile.

Excellent post. Bang on.

 

[Llenroc]

I haven't had problems with patients. I think interviewing disgruntled people is funny.

It's the other doctors that I've had problems with. Many of them are complete duschbags. Of course, I've done OB/GYN and Surgery so far, which are atypical of the rest of medicine. 😴

 

[Zuwie]

Ah, young paduwan, you have much to learn. Yes, much to learn.

yeah, yeah, I know, could be an artifact or a non-diagnostic sample or whatever but still not as hurtful as if the actual patient lies to you.

 

[ortho060802]

All should read HOUSE of GOD by Samuel Shem. It is about a resident looking back at what he has become after his intern year. A classic medical novel.

 

[Rbrav]

I think that's a skill you develop subtly over the years. I've noticed that attendings and upper-level residents always seem to be able to get their message across and get out of the room efficiently, even with the most long-winded of patients, whereas I sometimes feel like I have a sign on my forehead that says "please waste my time with rambling, circuitous, and irrelevant answers to my focused clinical questions..."

I've definitely noticed this. I think it's the air that you give off. A resident or attending walks in, clearly all business, and can get stuff done even if they're nice or if the patient rambles a bit. As a third year, though, we walk in at least a little timid, and you give off a friendly vibe, and you say little sympathetic things like "that must be hard for you" or "you're getting great care" (and you say them with that "i really mean it" tone in your voice, whereas attendings usually just slip it in while talking business), and that gives off the impression that the patient can say anything and eveything to you on friendly terms. This doesn't apply all the time, of course, but I've noticed it a lot.

 

[Hoo\/er]

I'm a fourth year, and recently finished my Clinical Skill Exam my school holds for us as a graduation requirement (Not Step CS).

Anyway, one of the recurring themes that I received from each of my evaluators (faculty observers included) was my lack of empathy.

Initially this surprised me, as in the begining of my third year my evaluators would always note how good I was with patients and that I developed good relationships with them.

I really do think that I've changed, and I think there are a lot of reasons why. First is that by the end of third year, I became much more confident on the floors and felt my clinical knowledge had grown immensely. I think that I've become so focused on nailing the right Dx, or figuring out the right Txt that I often forget about theres a patient who is suffering, and needs to know that someone cares.

My chief-resident on surgery was someone who I admired a lot as well, he was very intelligent, confident, cool, collected and decisive. I think I tried emulating some of his traits, but in the process forgot about my patients as well. I'm not going to become a surgeon either, and so there is no reason for me to be in a hurry to get into the OR.

I don't know, does anyone else feel similarly? Like they've lost some of their ability to feel empathetic for someone else?

I lost all my empathy during junior year. This is coming from a medschool hater though, so I might be a bit biased. But seriously, I did lose all empathy that I had in my body during 3rd year.

You know, evaluations are a subjective piece of $hit anyway. You'll get one thing from attending A and something completely different from attending B. Don't let it bother you. Your evals are simply opinions.

Opinions are like dinguses - everybody's got one.

Let it run off like water off a ducks back and move on. Phuck em.

 

[8744]

I lost all my empathy during junior year. This is coming from a medschool hater though, so I might be a bit biased. But seriously, I did lose all empathy that I had in my body during 3rd year.

You know, evaluations are a subjective piece of $hit anyway. You'll get one thing from attending A and something completely different from attending B. Don't let it bother you. Your evals are simply opinions.

Opinions are like dinguses - everybody's got one.

Let it run off like water off a ducks back and move on. Phuck em.

Even though I enjoyed medical school for the most part, I totally respect the "med school hater." There's a lot to hate. Don't get me started.

 

[burlypie]

I actually feel like I've developed a little more empathy for patients after I see how badly some residents, in particular (caveat: some are wonderful, worthy of emulation) treat them. Calling every woman with pain "crazy". Thinking people are neurotic becuase they're ACTUALLY CONCERNED ABOUT THEIR HEALTH AND ARE SCARED THEY MIGHT DIE/GO BLIND/FILL IN THE BLANK DEPENDING ON DISEASE. Not looking at patients while they're talking. not explaining what they're doing -- you can see the "what the heck is he doing now?" looks on their faces as the doctor goes about his business...

So yes, after seeing way too many confused, frustrated patients I've actually developed more empathy. fortunately, for every time I think, "OK, I've never acting THAT way" there's another physician I think does a great job and I try to take lessons from.

OP: I know what you mean by finding a role model who is cool, collected, decisive, etc...be that way. It's very reassuring for patients, I think. But I find that simply smiling and keeping a little eye contact and a gentler vocal tone can do wonders for the patient/observer's impression of your empathy.

 

[VFTW]

I've definitely noticed this. I think it's the air that you give off. A resident or attending walks in, clearly all business, and can get stuff done even if they're nice or if the patient rambles a bit.

YES! When do we learn how to do that...?

 

[DebDynamite]

YES! When do we learn how to do that...?

I've started practicing this in my psych rotation. "I'm sorry I have to redirect you but I'm curious...."

"We'll be spending about X number of minutes together today and I may need to occasionally redirect you in order to gather all the information I need... "

 

[sphincter tone]

I think a lot of it is a protective mechanism.

What they don't tell you during 1st and 2nd year is that regardless or how hard you work or how much you care some of your patients will die.

...you will see see child/ spousal/ sexual abuse patients and you may have to stare at the aggressor as they vehemently deny any wrong doing and spout off a (terribly unconvincing) cover story.

...you will have drunk/ high/ violent patients spit/ swear/ pee at you.

...you will have patients file complaints about you because when they paged you at 4 am to inform you that they broke a finger nail, you didn't seem to treat the problem with a sense of urgency.

...you will see a family of four devestated by a drunk teenage driver who escaped the wreck with minor contusions while 2 of the victims died, one is brain damaged and one is an amputee.

...and of course, it's a lot easier to stick someone with an IV or crack someone's chest is you're not empathizing with them at that moment

We have to deal with some pretty terrible situations and IMHO if you don't develop a proffestional detachment, you're either going to burn out, sink into a depression, or climb a bell tower.

This is absolutely not to say that you should be cold and mechanical, but that you should try to find a balance and be approachable and friendly to your patients but without getting too emotionally involved.

Just my 2 cents

 

[thewebthsp]

Interrupting patients is a necessary evil, since the primary job at first view is to gather a history and physical...

I feel the opposite tho, I greatly empathize with the vast majority of patients, and I really feel good educating them about their disease and what we're doing to help. On the other hand, I really hate being evaluated and the paranoia that comes with that. I also learned how little work you need to study for exams, and how real life demands much much more -- which is my own thing I need to improve on. Also wish I could do more procedures, etc... and know more.

 

[tomatoattack]

😱 i didnt read everything that was written above, so this may already been said. I think most of the patients are kindof gross. 27 yo 400 pounder who hasn't showered in a week seems to be our typical patient. This is not a pleasant person to work with or even to be in the same room as. Patients tend to smell disgusting. This makes it very hard to empathize with them, as it can often be hard to communicate even very basic things with them, because youve got a million things to do and they have no knowledge base. They seem to actually have a negative knowledge base, where they have made up nonsense about what is actually going on.
Me: "What is that big scar on your abdomen."
Patient: "Thats from where I had my lungs removed."
Me: "You had your lungs removed?"
Patient: "Yep God still allows me to breathe."

How do you even respond to some of the nonsense they tell you? 😡

 

[Igor]

I don't know about ya'll but I have a very difficult time forming any sort of bond/empathy with a fake (um - standardized, that's it) patient.

Even if a patient makes bad decision that make him sick (coccaine abuse causing MI, for example), looking at them in the ER while they are suffering makes me want to try to make them feel better.

Fake patients don't look sick, they don't act sick and the whole thing lacks the urgency or interactions of a real encounter.

Give me a real sick person (even one who hasn't bathed in a while) over a perfectly groomed person with a script deciding how good a doctor based on whether or not I asked about family history in someone who is supposed to be short of breath.

OK - I've vented now.

 

[ironman280]

Growing pains that everyone experiences, but don't lose that sense of humor. There are alot of miserable physicians out there. Embrace the comedy, recognize the privilege of caring for people and you will have a fulfilling career. I propose that empathy is as, or more important for you than it is for your patients. They won't remember your name 10 minutes after they leave your care. You on the other hand have a never-ending plethora of responsibilities. Take care you yourself (Physician heal thyself). Empathy is a great tool for this. The fascination, the trajedy, the inspiration of each individual is amazing - though really frustrating at times. See it, and see yourself fulfilled at the end of a life well lived. Lose it, and you are destined for unhappiness, and probably a career as crappy doctor. In summary, lighten up and enjoy this calling you've dedicated your life to.

 

[YouDontKnowJack]

what is empathy.........

does it mean affixing a permanent smile on your face? will that suffice?...

 

[8744]

Growing pains that everyone experiences, but don't lose that sense of humor. There are alot of miserable physicians out there. Embrace the comedy, recognize the privilege of caring for people and you will have a fulfilling career. I propose that empathy is as, or more important for you than it is for your patients. They won't remember your name 10 minutes after they leave your care. You on the other hand have a never-ending plethora of responsibilities. Take care you yourself (Physician heal thyself). Empathy is a great tool for this. The fascination, the trajedy, the inspiration of each individual is amazing - though really frustrating at times. See it, and see yourself fulfilled at the end of a life well lived. Lose it, and you are destined for unhappiness, and probably a career as crappy doctor. In summary, lighten up and enjoy this calling you've dedicated your life to.

As much as I hate to admit it, it is a privilege. In what other profession can you introduce yourself to someone and five minutes later have a finger up their ass? Or have another adult show you, without hesitation or embarassment, the bloody pile of stool in their bedside commode?

Gosh. It warms my heart.

 

[AmoryBlaine]

As much as I hate to admit it, it is a privilege. In what other profession can you introduce yourself to someone and five minutes later have a finger up their ass? Or have another adult show you, without hesitation or embarassment, the bloody pile of stool in their bedside commode?

Gosh. It warms my heart.

It takes you 5 minutes to get to the DRE? Damn Panda, you must be slowing down in your dotage.

 

[ocean11]

As much as I hate to admit it, it is a privilege. In what other profession can you introduce yourself to someone and five minutes later have a finger up their ass? Or have another adult show you, without hesitation or embarassment, the bloody pile of stool in their bedside commode?

I respectfully disagree, what does it mean a 'privilege'?!? I think we're doing THEM a favour saving lifes or helping aleviate some awful disease. Why is it that med students or doctors need to be so thankthful or greatful to their patients, shouldn't it be the other way around? We're busting our B#$$s here with low paying residency and crazy hours to help others. No I don't consider it a privilege, but I do enjoy doing it! and like interacting with others.

 

[8744]

I respectfully disagree, what does it mean a 'privilege'?!? I think we're doing THEM a favour saving lifes or helping aleviate some awful disease. Why is it that med students or doctors need to be so thankthful or greatful to their patients, shouldn't it be the other way around? We're busting our B#$$s here with low paying residency and crazy hours to help others. No I don't consider it a privilege, but I do enjoy doing it! and like interacting with others.

Again, I hate to get all weepy and empathetic because, as you know, I'm just not like that but the level of trust that total strangers have in you simply because you have become their doctor is both strange and humbling. I may be a hoary old misanthropist and a cynical dog but I never extend these feelings to my patients.

Taking care of patients isn't hard work, it's all the bureaucratic chicken**** that goes along with it that is such a chore.

 

[8744]

It takes you 5 minutes to get to the DRE? Damn Panda, you must be slowing down in your dotage.

Oh man. I had to Guiac a 600-pounder last night. It wasn't pretty and if I had any residual notion that medicine was a glamorous profession this finally drove a stake through it's heart.

 

[oompaloompa]

Whenever I come across a patient that I think is actively trying to make the process more difficult, I take a deep breath and remember this gem attributed to Napoleon Bonaparte:

"Never ascribe to malice that which adequately explained by stupidity."

Remember back in Behavioral class when they told us that 60% of the population never reaches the formal stage of critical thinking. At that time I didn't believe it, I mean, give humanity some credit! That was in the days before I experienced LBJ county hospital.

By the way, I still don't believe it, but now I think they must have grossely overestimated the number of functional people.

 

[fang]

Ironman, excellent post. Although as a 4th year I've definitely become more business-like in my interactions, it's not that I care less about pt's emotions... but I do have a competing priority (to get info so I can help take care of them). It's good to keep in mind how important empathy really is.

That said, I wish I could get back the countless hours of my life 1st and 2nd year spent talking about the "physician-patient interaction", "continuity care", and similar topics. It's too general to be of any real use, and reflects one opinion about what would make a good doctor. I think they should just record a bunch of our practice interviews, then let a cross-section of experienced preceptors and real patients critique them.