Students lose empathy for patients during medical school

Researchers found that female medical students showed more compassion than male students.

By — Posted March 24, 2008

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It only takes a year to start draining empathy from future physicians, according to a study of medical students in the March issue of Academic Medicine. But empathy is a key quality medical schools should promote, experts said, because it makes for better physicians.

"We know as a medical community that really good communication skills with patients help the patients to comply with the instructions of the physician," said lead study author Bruce W. Newton, PhD. "It puts them more at ease with the physician, a bond of trust is established, and if something unfortunately goes wrong, if you have this bond and communications skills, you are much less likely to be sued."

Communication experts said the study underscores other research on the value of empathy in the physician-patient relationship. They said the erosion of compassion that begins in medical school is the start of a career-long battle for physicians as pressure to become increasingly efficient squeezes out time for building relationships with patients.

The study followed 419 medical students at the University of Arkansas for Medical Sciences, Little Rock, from 1997 to 2004. Students from four graduating classes were tracked from freshman to senior year.

Researchers measured vicarious empathy, defined as a person's vicarious emotional response to perceived emotional experiences of others. Students reported their agreement or disagreement on a nine-point scale in response to statements such as "I cannot feel much sorrow for those who are responsible for their own misery."

Student empathy scores dropped after the first year of medical school. The decline was likely due to a year of stress and anxiety linked to the students' competitiveness and desire to overachieve on exams, said Dr. Newton, associate dean of undergraduate medical education at the Arkansas medical school. Scores decreased again after the third year in school, when students finished their first year of clinical rotations.

"We thought their having contact with patients and physician mentors would help, but it didn't," Dr. Newton said. He attributed the additional drop to the intensity of hospital practice. Instead of being reinvigorated by working with patients, students probably found hospital patients to be very sick and complex to treat, he said. Teaching physicians likely were rushed, and students may not have received as much bedside teaching or mentoring as they expected.

Women had higher empathy scores than men, the study said. Students going into internal medicine, family medicine, pediatrics, obstetrics and gynecology, and psychiatry showed greater empathy than those entering specialties such as surgery, pathology and radiology.

Schools strive for compassion

Nationwide, medical students face problems trying to stay empathetic. But schools are attempting to make medical education a more humane process, said Richard Frankel, PhD, professor of medicine and geriatrics at Indiana University School of Medicine in Indianapolis and research scientist with the Regenstrief Institute.

"The public tells us they want physicians who are good diagnosticians and also caring people," Dr. Frankel said. "We start with students who are very caring but have no diagnostic skills and end up with physicians with great diagnostics skill but who don't care."

IU's medical school is studying how to transform its informal curriculum to foster attentiveness to human interactions in medical training and practice. Nineteen medical schools have sent representatives to learn about the effort, called the "Relationship-Centered Care Initiative." Officials from nine other schools will attend a conference on the project this spring.

Mohammadreza Hojat, PhD, professor of psychiatry and human behavior at Jefferson Medical College, Thomas Jefferson University in Philadelphia, has studied physician empathy and helped develop the "Jefferson Scale of Physician Empathy," which measures cognitive, role-playing empathy.

His research showed a decline in medical student empathy, higher empathy ratings among female physicians and general differences in empathy by specialty. But he has no data on whether physician empathy changes during a doctor's career.

Jerome Groopman, MD, author of How Doctors Think and chief of experimental medicine at Beth Israel Deaconess Medical Center in Boston, said it is clear physicians become worn down by time pressures, work load and the diminishing sense of autonomy in the health care system.

"Everything about health care reform is about efficiency, and empathy is not a question of efficiency," he said. "It takes time. Doctors want to provide it, but the system prevents it."

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Compassion drain

[download pdf]

Researchers at the University of Arkansas for Medical Sciences in Little Rock tracked medical students' vicarious empathy and found it declined over time. The first drop was noted after the freshman year. Scores went down again following the junior year of medical school, after students began clinical rotations. Empathy scores are for students in the 2001 to 2004 graduating classes, with a score of 50 considered average.

Mean scores at start of year:

Women Men Both
Freshman 62 38 46
Sophomore 57 32 40
Junior 57 31 40
Senior 50 26 34

Source: "Is There Hardening of the Heart During Medical School?" Academic Medicine, March

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