Appendix 53a - Empathy

by Michael Greger, MD and United Progressive Alumni

[ Medical School Resources | Appendices | Discussion ]

"Sympathy involves compassion but not passion..."[606]

Henry Spiro, in his heart and soulful article "What is Empathy," asks whether empathy can be taught. How can we make ourselves more empathetic? "A better question might be," he writes, "Can we recover the empathy we once had?"[607] From a letter to the British Medical Journal, "Perhaps the problem is not so much 'teaching' caring as ensuring that it is nurtured rather than squeezed out by the very process of medical education."[608]

"A lot of good feminine qualities do get stomped out," agrees Dr. Mary Lake Polan, an assistant professor of obstetrics and gynecology at Yale.

I think the factor that most people don't consider is fatigue. Until you've worked three nights in a row, or had a night to sleep in which you were awakened every hour by a phone call, you can't understand. That's when your empathy goes. It's not so much that they're trying to deliberately stomp it out of you. That's just the end result.[609]

Residency quenches the embers of empathy. Isolation, long hours of service, chronic lack of sleep, sadness at prolonged human tragedies, and depression at futile and often incomprehensible therapeutic maneuvers turn even the most empathetic of our children into tired terminators. No wonder we have little empathy for the defeated, the humble, the dying, those who have not made it to the top of the heap, and even for the sick. Our energy gets us into medical school and after that little time remains for contemplation.

Time to Spare

From LeBaron's Gentle Vengeance: An Account of the First Year at Harvard Medical School, "There's little doubt that we're being trained not to regard any time as personal preserve."[610] One student writes, "For me, medical school was a terrifying experience... there is no time for anyone or anything...." In a study of 31 stressors of third year medical students, the number one was, "Lack of time for self."[611]

The dean of the Johns Hopkins School of Medicine, David Rogers, "recommends that medical educators cut teaching hours in the first two years by 40 percent and reserve that time for students to do whatever they want [as precious decompressing, self-discovery hours]."[612] "The one [suggestion] I would emphasize most," he writes, "is a less all-consuming institution of training: schools and residencies which allow time and distance for independent moral thought."

From an article in Theoretical Medicine, "Not to become skilled in ethical reflection and not to be able to examine one's own life in the context of the care of others would leave a physician strangely crippled in the moral and spiritual dimensions of his/her life."[613]

Not to worry, though, you can be empathetic anyway - see Appendix 53b.



[606] Spiro, "What is Empathy and Can it Be Taught." Annals of Internal Medicine 116(1992):843-846.

[607] Ibid.

[608] Silverman, JD, DJ Draper and SM Kurtz. Letter. British Medical Journal 310(1995):527.

[609] Osborne, D. "My Wife, the Doctor." Mother Jones 1983(January):21-25, 42-44.

[610] LeBaron, C. Gentle Vengeance: An Account of the First Year at Harvard Medical School New York: Penguin, 1982:79.

[611] Linn, BS and R Zeppa. "Dimensions of Stress in Junior Medical Students." Psychiatry Reports 549(1984):964-966.

[612] Light, DW. "Toward A New Sociology of Medical Education." Journal of Health and Social Behavior 29(1988):307-322.

[613] Knight, JA. "Moral Growth in Medical Students." Theoretical Medicine 16(1995):265-280.



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