When dealing with patients and families coping with life threatening illness, one of a physician’s greatest interventions may be that of empathy. Defined simply, empathy is the responsiveness to the emotional state of another person—we try to understand another’s experience. It is a process that requires effort and intention. Sympathy is an awareness of another person’s situation and is an almost “autonomic” type response. Sympathy is important and is part of what humanizes a caregiver but Empathy is integral to a successful doctor-patient relationship.
Many studies of medical students have indicated that empathy is lacking. A study published in Academic Medicine in 2009 indicated that empathy in fact actually declines during the 3rd (Clinical) year. In this study, 456 students were followed and completed the Jefferson Scale of Physician Empathy (a reliable, validated survey) at different times during their medical school careers. During the first two years, scores remained consistent—however a significant decline was noted in the third year and persisted until graduation. There were no gender or eventual specialty related differences—it occurred across the board. What a paradox—after 2 years of dissection and sitting in lectures, empathy declines when the short white coats are adorned and students become face to face with patients for the first time.
In my opinion, empathy should be the basis of all patient care and the cornerstone of the doctor-patient relationship. We must find a way to cultivate empathy in medical education. Medical school admission officers must select applicants that have potential to truly care for the sick. Medical school deans and other leaders must demand and emphasize inclusion of doctor patient relationship training in the standard curriculum. We must prepare our students for practice in a world full of challenges and change. Our patients face increasing stresses outside of illness including job loss, financial ruin, drug and alcohol addiction and family crisis. These patients put their trust in their physician. We as providers must provide not only a proper diagnosis but emotional support and genuine human kindness as well.
I can think of many barriers to empathy in medicine and medical education—all good excuses. I believe that some of the most compelling are the current lack of empathetic role models, negative experiences on the wards, time pressures and academic grade pressures, and an over-reliance on technology and testing. (Remember 80% of the diagnosis is made with a good H &P). Students are driven to be the “best of the best”—that’s who we typically select to fill our medical school classes. More emphasis needs to be placed on the way we interact with patients, families and each other. We, as mentors, must model empathy in patient care every day. It’s just good medicine.
So, next time you go into a room on rounds, take a moment and sit by the bedside. Talk to the patient and family and truly ask and understand the answer to the question “How are you feeling today?”