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Does Med School Promote or Destroy Compassion?
Kendra Campbell -- According to the dictionary, the definition of compassion is, "a feeling of deep sympathy and sorrow for another who is stricken by misfortune, accompanied by a strong desire to alleviate the suffering." I have always believed that compassion is a necessary prerequisite for a physician, yet I have met some physicians and physicians-to-be who don’t appear to have a well developed sense of compassion.
After a conversation that I had with a fellow medical student the other day, I started thinking about which qualities are inherently necessary for a medical student to possess, and which ones can be learned from instruction. Can common sense actually be taught? Is a knack for science a necessary prerequisite for being a good doctor? Must a doctor actually be compassionate in order to be effective?
I can’t help but think that compassion is most definitely an integral component in effective healthcare. Perhaps I just can’t comprehend a world in which people would be able to heal the sick without being compelled by a need to alleviate suffering. But, we’ve probably all known a few doctors who don’t seem to truly care about their patients. The reality is that they exist, and the truth is that it is sometimes the educational system, as well as a largely disjointed healthcare system, that actually contribute to the apathy of physicians.
I look around at my fellow classmates and I wonder if all of them are inherently compassionate people. Do they even need to be? Should the educational system be designed in such a way that compassion is taught with the same fervor as biochemistry? If medical students are not compassionate to begin with, will the system end up helping them grow into caring doctors, or will it have a deleterious effect on their humanity?
To me, it seems like compassion should either be a prerequisite to medical school, or it should be integrated into the curriculum. I know that admissions committees do everything they can to only accept qualified candidates, and that many of them value compassion as an important quality. But would they be more apt to admit the 4.0 GPA student who doesn’t have any obvious compassionate qualities, or the 2.0 GPA student who truly believes in alleviating the suffering of the sick? It certainly is a tough decision.
Many medical school administrations are taking active steps towards guaranteeing that they are producing proficient, as well as compassionate doctors. But I’m not convinced that they are always successful. It seems harshly ironic that the very system that is dedicated to producing skillful, compassionate doctors, is the cause of many students’ declining empathy towards patients. Perhaps the real question we should be asking is, "can compassion even be taught?"
November 30, 2006 in Kendra Campbell | Permalink
Comments
Kendra,
I think you hit the nail on the head with this blog. I have worked with 8 M.D. Orthopedic surgeons over the past 4 years and about 3 or 4 of them I can say are truly compassionate. I don't believe it is something that can be taught, but rather something that you have inside of you. I'm one of those struggling 2.5-2.7 GPA students still trying to make their way past the monotonous basic sciences and enter medical school, where I believe I could make a great doctor; not only with skill but also compassion. I'm glad I'm not the only one who feels the way you do!
Posted by: Michael | Dec 4, 2006 3:56:19 PM
i think you would be surprised how compassionate some of these 'apathetic' doctors are once you get to really know them. judging a person's compassion from a pedestal is easy enough. practicing compassion while working 80 hrs a week is a different story. as a current intern, i think you will see the line between compassion and apathy blur quickly about 6 months into your intern year...
Posted by: john | Dec 5, 2006 6:43:32 PM
Brilliant, Kendra. I've long held this view and strongly believe that the medical education system is more conducive to the destruction of compassion than it is to cultivating it. It came as no surprise to me when I learned that although depression among med students is more common than in the general population, the 3rd year is when the effect is most pronounced. Some people like to claim that this is because students in the 3rd year are for the first time exposed to suffering patients on a daily basis, but I do not think that is the main cause in most cases. Rather, being worked for so many hours, with no duty hour limit to even begin to protect them, students are often forced to abandon everything else dear to them in the name of "learning".
I find it equally disturbing that so many attendings despise the 80 hour weekly limit for residents. Without that limit, what's to keep residents from being worked 120 hours a week? There may not be evidence that the 80 hour work week has reduced medical errors, but I would guess that is because 80 hours is still way too much. People who have stayed up for 24 hours straight are like the legally intoxicated, but residents are often kept up longer than that.
It is time that medicine, a profession which prides itself in being compassionate and noble, showed compassion toward its poor learners instead of continually trying to push the envelope on physical and mental endurance. It's not good for the doctors, not good for the patients, and not good for the face of the profession.
Posted by: David | Dec 5, 2006 7:01:41 PM
Well, I'm no doctor or med student, and I agree that compassion certainly helps and is, in fact, prerequisite in dealing with especially pediatric or emotionally-sensitive adult patients. However, ultimately it comes down to how much a doctor or any other healthcare professional can do to improve the health of his or her patient most effectively and effciently that really matters, I believe. Personally, I would rather have a very competent yet incompassionate (or, rather, shall we say "unemotional") physician help me get well sooner - so that I can also leave him sooner - than a less competent yet a compassionate (or, rather, shall we say "friendly") one who will bring me more grief with a longer stay at a hospital, a longer or less recovery, but a bigger medical bill in the end.
Posted by: Robert | Dec 5, 2006 7:02:48 PM
I like what you said, Michael. I think that for the most part, we are born with empathy and compassion. Med school, and even more so, internship, is a constant uphill battle to maintain your perspective and ideals in a profession where unfortunately compassion is not the norm. As a person who is compassionate, there are times (in internship, usually when I have been working for 20 hours straight) when I don't act with as much compassion as I would have liked to toward my patients. At the end of the day (the abusively long day of exhaustion and anxiety) I have to reflect on the times I was able to act empathically toward patients and think that maybe I made a difference in their lives. I believe it is very important for people who are inherently compassionate to become healthcare practitioners, in spite of all the obstacles, because the profession lacks this type of role model.
Posted by: Lauren | Dec 5, 2006 7:10:13 PM
I agree with this. I have found that the same is true of nursing school. It appears to almost be a prerequisite to drop one's emotion at the door. A lot of time is taken in the classroom to educate on "caring" and yet so few of the instructors appear to have minimal compassion toward the students; this seems to breed the same behavior from the students, but out of pure survival. There is no room for human-to-human intimacy when the stress level is so elevated. It is very saddening as most medical students, whether it be nursing, physicians, or other disciplines go into the medical field because of a strong desire to make a connection with people and to help.
Posted by: Dolly | Dec 5, 2006 7:33:31 PM
There is actually literature to support the erosion of empathy during the intership year. See abstract below - this is not the only study, a search of "empathy" and "internship" revealed 120 hits.
1: JAMA. 2002 Jun 19;287(23):3143-6.
Comment in:
JAMA. 2002 Oct 16;288(15):1846-7; author reply 1847.
Variation of mood and empathy during internship.
Bellini LM, Baime M, Shea JA.
University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
Bellini@mail.med.upenn.edu
CONTEXT: Internship is a time of great transition, during which mood
disturbances are common. However, variations in mood and empathy levels
throughout the internship year have not been investigated. OBJECTIVE: To examine
mood patterns and changes in empathy among internal medicine residents over the
course of the internship year. DESIGN: Cohort study of interns involving
completion of survey instruments at 4 points: time 1 (June 2000; Profile of Mood
States [POMS] and Interpersonal Reactivity Index [IRI]), times 2 and 3 (November
2000 and February 2001; POMS), and time 4 (June 2001; POMS and IRI). SETTING:
Internal medicine residency program at a university-based medical center.
PARTICIPANTS: Sixty-one interns. MAIN OUTCOME MEASURES: Baseline scores of mood
states and empathy; trends in mood states and empathy over the internship year.
RESULTS: Response rates for time 1 were 98%; for time 2, 72%; for time 3, 79%;
and for time 4, 79%. Results of the POMS revealed that physicians starting their
internship exhibit less tension, depression, anger, fatigue, and confusion and
have more vigor than general adult and college student populations (P<.001 for
all). Results of the IRI showed better baseline scores for perspective taking
(P<.001) and empathic concern (P =.007) and lower scores for personal distress
(P<.001) among interns compared with norms. Five months into internship,
however, POMS scores revealed significant increases in the depression-dejection
(P<.001), anger-hostility (P<.001), and fatigue-inertia (P<.001) scales, as well
as an increase in IRI personal distress level (P<.001). These increases
corresponded with decreases in the POMS vigor-activity scores (P<.001) and IRI
empathic concern measures (P =.005). Changes persisted throughout the internship
period. CONCLUSIONS: We found that, in this sample, enthusiasm at the beginning
of internship soon gave way to depression, anger, and fatigue. Future research
should be aimed at determining whether these changes persist beyond internship.
Posted by: Marc | Dec 5, 2006 7:46:55 PM
i agree one hundred percent. as i am studying for finals of the second year of med school, honestly there are days in which i wish i just didn't wake up. because i hate the person that i have become in this stupid system. as someone pointed out earlier, there is no time for socializing, no time for excersing, and honestly, little time for sleeping. i understand it's important for us to learn what it is we have to learn, but what about REALLY learning it? how is that possible when we are sleeping 4-5 hours a night, and then going to lecture for 8 hours, and then studying for 10? what's wrong with expanding med school to five years, diluting second year into two years? sadly, what drove me to this field was my desire to help alleviate suffering, because i had a knack for understanding people and empathizing with them. all of that has gone to shit as i simply struggle to survive and make it through the day. true, there are people that are born without compassion (honestly, most of my excelling class mates), but the way the system is built does nothing to commend those few compassionate remainders.
Posted by: giulia | Dec 5, 2006 7:55:40 PM
I'm a paramedic, which is leaps and bounds from what you're going through. I think the absence of empathy may come up as self defense mechanism. Some people can't separate empathy from sympathy. So, for them none-at-all is best. I can see where the compassion is beat out of you during school. Hold on to that shred that you may still have. Maybe you can grow it again when school is over, and the painful memory of residency Hell is less. You all have my utmost respect for what you go through to help others.
Posted by: Lynn | Dec 5, 2006 8:15:04 PM
In response to Laura above:
I've heard this particular rationalization many times in several different forums of discussion, and each time I can't help but wonder why people make the automatic assumption that compassion and skill are somehow mutually exclusive, that we must make some choice between the two.
This assumption that a friendly doctor is somehow less competent, or that a "jerk" is always brilliant, is a fallacy. There are many physicians out there who are both brilliant and who will cause you to trust that they truly care about your health.
Take care.
Posted by: Jake | Dec 5, 2006 8:15:41 PM
Compassion is a difficult concept in healthcare, especially in our commodified society. Compassion is a product of experience: while you can teach medical students general guidelines on bedside manner, they will not understand compassion until they are on the receiving end of an act of compassion.
As for the 2.0 GPA student who wants to alleviate suffering, social work is an alternative field that has an equally important societal impact.
Posted by: Sam | Dec 5, 2006 8:16:41 PM
Kendra,
I enjoyed your piece, and think you're addressing a crucial issue. I hope you'll consider writing more about this in the future. I did the following application essay that speaks directly to your question, and I'd value any comments you may have.
Be well,
Jordan Silberman
___
Since beginning to work in pediatric palliative care, I have listened to many discussions about compassion. My recent psychology training, and inquiry into the nature of psychological constructs, prompted me to reflect on assumptions underlying these discussions. I question some of the assumptions that underlie vernacular conceptions of compassion. Conceiving of compassion differently; and addressing the construct in a unique, realistic, and dedicated way; will enhance my ability to work with patients.
My conceptualization of compassion differs from that of colleagues in two ways. Some discuss the capacity for compassion as if it were static, but I suspect that the quality is dynamic. Perhaps the inclination toward compassion is temporarily altered by affective states, stress, fatigue, and other factors.
I have also noticed that some discuss compassion just as musicians discuss perfect pitch--as a genetic gift. The construct may be more nuanced. Most people, I suspect, can cultivate the capacity for compassion regardless of genetic predisposition. An exhaustive nature versus nurture controversy is outside the scope of this work, but it suffices to suggest that many people may be able to enhance their capacity for compassion. These views, of course, are not unique; similar ideas are found in millennia-old traditions like Buddhism and Hinduism.
Thinking of compassion as dynamic and cultivatable yields an important conclusion: I may be able to provide better health care by further cultivating the capacity for compassion. One of my distinguishing characteristics is my willingness to take steps, on a daily basis, to develop this capacity. I have and will continue to cultivate compassion through ancient and deceptively simple techniques that involve dedicating loving-kindness to myself, to loved ones, to those I do not know, and even to those I dislike.
Cultivating the capacity for compassion will be invaluable. It will help me perceive psychological subtleties and thus improve my ability to relieve suffering, will help me establish the rapport necessary for solid patient-provider relationships, will itself be emotionally healing for patients, and will enhance my own positive affect and thus (according to research) problem-solving skills. Accepting the dynamic and cultivatable nature of compassion, and using time-tested techniques to increase my capacity for compassion, will be one the greatest strengths I bring to a medical community.
Posted by: | Dec 5, 2006 8:53:06 PM
Hello Kendra, great blog. I personally think compassion should be the first item to be evaluated in an applicant. Once those that are lacking compassion have been dismissed, then the selection process should continue on! Generally I believe most people that go to medical school have that compassion some place inside of them although they might not always be able to display it to others. I recently finished my second year and most doctors that I have encountered are very compassionate but that was mainly in a hospital setting. Once you go into a private practice setting, everything changes for some reason and that's very sad.
To add to your thoughts, I wonder if it's our society that destroys the compassion in doctors. As doctors, we get trained to give, sacrifice, ignore and concentrate when nothing is going right. It's not all taught in school but you have to learn to do it because that's the only way most people can get through everything in medical school while having a life in the outside world. When working at the hospital, you're faced with people that are hanging by a string and look at you as the only person that can do something about it. When that happens, you give it all you have and push things to the limit as much as you can.
When you step in the outside world everything changes. People have no flexibility, no sense of responsibility, no sense of care, nothing! As a doctor, you miss Christmas or a loved ones birthday only to come home to a building manager that will have you freeze behind the door, because your landlord hasn't turned in the $25 deposit to get your key to the main door! You offer to pay the deposit but she still won't help because "that's just not the way it's done!", you show her your lease and ask her to remind your landlord to request a key and guess what? "It's not her responsibility" and she won't do it. You go to court for a speeding ticket that a cop gave you while you were going ten miles over the speed limit to get to a lecture and at the door they tell you that you're not allowed to have your cell phone/pager/PDA inside the building! You explain to them that you're working NICU and need to have your pager...guess what? Too bad, not the guard's responsibility. You ask him to hold it for you because you'll be late if you go back to the car...NO WAY, he can't do it!
So you see, we're trained and have the outmost desire to bend in every direction possible to help improve the quality of life for people that we don't even know but the rest of the world just doesn't give a **** about anything or anyone.
With all of these sacrifices, in the eye of the community, it's never enough because people have the misconception that being healthy and having excellent health care is a god given right even after they use and abuse their bodies for many years without ever thinking about the future. Generally people have a negative attitude towards doctors when they're not sick mainly because they see a big dollar sign walking around. Nevermind that the dollar sign spent years in school, missed holiday after holiday, birthday after birthday and made many more sacrifices but none of that matters. However no one has a problem with Starbucks making 1.9 billion dollars every 3 months selling Caramel Machiatos at 5 dollars a cup!
In contrast to this, small towns don’t treat each other like this. I was in a small town and the cable guy gave me free cable when he was connecting my internet connection. He risked his job but in his words: “You need to relax after you study for a long time”. That community was also the place where I saw the most compassionate doctors. In a big city, a bad day might start with a cab driver cutting a doctor off on the way to the hospital but it gets passed on because all of those defense mechanisms that we learned about in med school, kick in gear to protect us from our hostile environment.
Posted by: Sam | Dec 5, 2006 8:54:13 PM
Kendra-
It is a very interesting question, but I agree with the panel in that compassion is something that is inherently in a person who truly wants to practice medicine. The facets of medicine consist of science and art. The blending of the two is where some people get caught, feelig pull more to the science or the art. Compassion is having a true love of people in general and wanting them to succeed in all of their endeavors and from a doctor's standpoint, it is promoting health and wellness. I am a 3rd year medical student and with out doubt, compassion cannot be taught from a textbook or medical school because most students would dismiss the class in favor of the anatomy test on Monday....with the intent of having the right answer for an attending physician about the triangle of chloe rather than showing compassion for their patient and family members.
The quest for medical knowledge can be overwhelming at times with everyone wanting some of your time in the name of learning, but truly the art must be practiced in order to maintain your humanity in a profession that may require you to question your level of compassion.
Posted by: bryon | Dec 5, 2006 9:42:12 PM
Here is an experience I had about 30 years ago. I was around 10 years old and had to meet the principal of a private elite military boarding school. I was asked what I wanted to be when I grew up. I replied that I wanted to be a doctor. Then I was asked why I wanted to be a doctor. I replied that I wanted to treat the sick and help poor children and old people. I wanted to help these poor people because they couldnt go to school and couldnt afford the treatment and care. I would tell them how to live in a healthy way and not take any money from them.
The seasoned principal was visibily amused. At that age most children wanted to be army generals,pilots, police, sportsmen actors and media heroes.
Other concerned parents were there with their wards visibily upset or happy. I was however not selected and that was fine with me but my father spoke to the principal afterwards. He felt upset at the decision of this seemingly intelligent and wise man. I had no shortcoming. The principal said that I was an intellectual,too soft, perhaps ahead for my age but not ready to be in a school for future army officers. My dad made his point that anywhere else in the world a trully spirited and dedicated teacher would see the spirit of compassion, altruism, sacrifice and service, and any school would be proud to nurture such values. The nation needed such people and this boy be given a chance to make his mark. He felt that the 'go grab' and greed mentality with bully traits is the kind that was being promoted in the school and that no wonder the world is what it is. We only reap what we sow.
The principal was effected by the talk and was willing to change his decision, but we declined. Not excited at the prospect of being in boarding school anymore. The truth was written all over the place.
I later went to medical school and became a dedicated physiian. It is really sad how the system is today. Compassion and empathy cant be taught as classroom lessons. They come from having high ideals and examples to follow as part of our culture and tradition. We must realize that philanthropy from existing celebrities is not an example of empathy and compassion. Our celebrities today are not true heroes, only just glitter and glamour. The media is no help at all. They can help redefine our values and ideals, only then will we see culture change and notice basic instincts like compassion and empathy. Doctors today are part of the system. How would they hear a different drum. Medical profession is not a service anymore and now the physician is just a salesman with a product. The idealism he had is going, going gone. Next time 'Cultivating Compassion.'
Posted by: Syed Hussain | Dec 5, 2006 10:52:30 PM
I really appreciate the forum and the topic Kendra. As a fourth-year now, I look back on how disillusioned and cynical I became about compassion and its fleeting role in medicine (and society in general for that matter). To be honest, it is possible this may have actually served me to better understand myself. Because I was so disheartened and appalled by what I had experienced, I became unrelenting about my own crusade to hold onto those ideals which I now value highly in myself. In the beginning, it was especially difficult. I would watch the way attendings, residents, and yes, even medical students turned medical compassion into an oxymoron, with conformity generally the rule. But now, through the grace of hindsight, I have developed several theories about the origin and existence of compassion in medicine. Please keep in mind that these are opinions based on my own personal experience, and my intention is neither to alarm nor offend.
First and foremost, I believe it depends on how you were raised, and how secure you are with yourself. Let’s face it, if you never had it, compassion will surely not be something you learn in medical school. And though at first it may sound a bit trite, think about what it means in this context to be secure with yourself. Have you too noticed that younger students tend to transform more rapidly than older or non-traditional students? Those with established or moderate temperament seem less affected by the dwindling compassionate norm. Another factor to consider is a personal history of illness, loss, or suffering and subsequent ability to self-relate. Again, not to knock the junior honor kids, but the fewer years you have lived, the less likely you are to have as much “life” experience; that is just statistics. You ask any truly compassionate physician about their past and you are likely to find a history indicative of adversity, suffering, or personal experience (read Viktor Frankl). Regardless of age or life experience, every medical student has a certain sense of that subjective clerkship grade looming over your head, and therefore is propelled towards conformity and to not stir the pot so to speak. There is a certain irony there about independent thinking and grading. On the opposite end of the experience scale, for the attendings, a profound amount of desensitization occurs. It is human nature that after myriad exposure to something, even suffering, compassion may become blunted or an attitude complacent. This is not an excuse mind you, only an observation. The house staff has their challenges as well. Frequently they are exhausted, befuddled, stressed out, and generally disgruntled which further facilitates their insensible lapse into a haze of derealization and overt apathy. Finally, one must appreciate the effect of socioeconomic and cultural disparity on compassion. I don’t know about you, but I live in Miami, and it can be a pretty hostile community. Both the environment you live in and the environment you work in affect your empathy and understanding towards patients. Where I am, there are countless factors negatively contributing toward a poverty of compassion. There is cultural intolerance to contend with, disparage of the homeless, minorities, or homosexuals, language barriers, and a potent self-seeking attitude to name a few. To end on a positive note, I believe that understanding the problem is imperative to developing a solution. Education is always an answer, and it would be nice to have students focus as much on compassion as Biochemistry as you say. The schools themselves can screen applicants more sensitive to compassion. Clerkship professors can be selected with more attention to demonstrating compassion. Teaching compassion is indeed a sticky situation, but as medical students we primarily learn from example. Putting the focus back on the patient and awakening to the compassion within is a winning situation for everyone.
Posted by: Mark | Dec 5, 2006 11:38:21 PM
One of the tenets which the med school I go to is the fact that they say they teach all of their students and which supposedly, all of the faculty, including the doctors is suppose to have. It's a load of bull. All they do is talk and talk and talk and keep on repeating to us that we should have compassion. It's as if they repeat it so many times we'll believe we do and they will think they teach us to. This sort of brainwashing is not just limited to this. I mean they say something and they do something else which totally contradicts what they said. Plus they treat us like crap. We're the low of the low, the bottom feeders. Negative reinforcement is more like the rule, rather than the exception. I believe that actions speaks louder than words. If they would truly want us to be compassionate, it must start with them. How can we learn compassion from people who don't show us much, if any, compassion?
Posted by: RJ | Dec 6, 2006 2:53:47 AM
I dropped out of the RN program just because of this very fact (and was carrying a b+ average). I felt my compassion was not wanted or needed in the process of becoming an RN. My background is in hospice, which relies heavily on compassion from all it's members. I talked to many other RN program drop-outs who dropped for the same reason as I did. With the nursing shortage, isn't it ironic that out of 120 students, 30 dropped the first quarter - all with B+ averages, due to the program which compromised their compassion. Another 27 dropped out due to being emotionally beat-down by instructors.
RJ rejaharris@yahoo.comk
Posted by: RJ | Dec 6, 2006 7:34:11 AM
I really liked you article, Kendra but I agree with some of the people who have commented that while compassion is needed, it is also important to have the skill of working in the medical field. I have a very compassionate heart by nature and even only in the nursing program, I am beginning to find out that while I need to be compassionate with each patient, I also need to separate myself from the situation. I can not hold on to every patient I get and worry about every single one, because I will go nuts and I would not be able to perform my job as well either. To me, the idea of compassion is essential to the medical field and i believe many doctors do still possess it as well as nurses but we all must remember to leave the work stuff at work and not get too emotionally involved in every single person that we come into contact with at work. Basicallly, we can not make every patient's problem our own and we need to make sure to keep our emotional selves intact with each patient.
Posted by: Angie | Dec 6, 2006 9:37:16 AM
I think that to a degree compassion is innate to the individual, but I feel it is also directly related the level of compassion they have recieved themselves, and the degree of hardship and suffering that they have endured.
On the note of the empathy deficit cultivated in the latter years of medical school, I am inclined to agree with David-- There is an undeniable inverse relationship between the extent that a student is worked and their expression of inward compassion. It doesnt matter what type of training you recieved...if you are consistently working 16-24 hour days, dealing with cumulative sleep deprivation, and simultaneously being subjected to irreverent treatment from attendings and residents, it is going to take its toll on even the most resilient of individuals.
Posted by: Micah | Dec 6, 2006 10:47:29 AM
Well well... seems like alot of different opinions on the subject of compassion and that can only be a good thing... diversity of the mind..... so doesn't there in lie the answer to the question? That compassion is completely contextual, personal, individual, and truly cosmic in its inability to be defined, labeled, or taught? As an older non-traditional medical student, I appriciate Mark's comments. As a former nurse I feel the plight of RJ and Angie. As both I have learned that compassion and it's definition, it's practice, and the times when to put a sock in it are directly a function of experience. I've known literally hundreds of medical students and residents.... and invariably have found those who have lived life, worked, toiled and were held responsible for their very daily bread for years prior to making the "choice" to become physicians, to be light years ahead of their "traditional" counterparts in many ways. (Not to disparage younger students who should not be blamed for simply not existing as long) I put the word "choice" as such since more often the traditional path is what is expected or chosen because of pressure or an idea who's details are as of yet unclear. Walk a mile in yours and someone else's shoes... test your compassion, know when to withold it and know when to hide it as well as you know how to spread it around. You can be successful and dutiful in this way. For those of you worried about your GPA... you're right... it has nothing to do with your potential to be excellent physicians... but it is one of the only objective ways for those who choose to complete a difficult selection process. If it makes you feel any better... I graduated from high school with a 2.7, went to two universities earing my first bachelors degree with another 2.7, and my second bachelors and most of a masters in nursing from a top ten university with a 3.8.... got C's in organic chemistry and then aced the MCAT without studing more than a week..... didn't attend more than 5 classes (except for labs) my entire second year of medical school beat two standard deviations above the mean on Step I and Step II of the boards.... if you love it... you'll make it!!!
In parting... and as my schools devils advocate in training... do you even think that everyone deserves your compassion???? Have a great holiday!
Posted by: Gregory | Dec 6, 2006 2:16:09 PM
Thanks Kendra, it's nice to think one is not alone! I sometimes despair of my peers' attitude towards suffering, especially with regards to mental health. I am not talking about doctors here, but pre-clinical medical students. It is especially striking to me that many of us have suffered from depression at some time, and yet medical students give each other so little support. I thought this lack of compassion towards people suffering from such common conditions as stress/depression/anxiety stemmed from ignorance, but medical students have not got the luxury of that excuse... Too many of us are far to quick to jump to conclusions and be judgemental, rather than respect the individual's reality.
Posted by: Lilly | Dec 6, 2006 3:14:25 PM
I'm afraid I disagree with two positions in your article.
First, I don't think that compassion is equivalent to efficacy as a physician and don't believe it is an absolute prerequisite to health care. Medicine covers such a huge scope of careers that it encompasses nearly every personality type and value system. Some people will be better suited at working with chronic pain patients while others will be better reading a CT or analyzing epidemiologic data, etc. I'm afraid your "compassion prerequisite" policy would screen for only one personality type and would leave the field of medicine worse off. Work ethic, honesty and competency are attributes I value more highly in a physician.
Second, I really dislike the idea of incorporating compassion into a curriculum. "Teaching" values seems to be a trend on the rise in medical education and I have found it useless and demeaning. To analyze a personality trait, break it into step-by-step points, and have students role play situtation does not promote that trait. It may lead to students responding predictably to a given scenario but does not foster any true emotion. Other ploys to teach such personal and vague feelings will not be successful.
I believe that competency, honesty, and responsibility are traits that are measurable by an individual's actions. These are absolute prerequisites to medicine. So long as an individual meets these standards, I am not interested in their motivation.
Posted by: Nathan | Dec 6, 2006 4:33:10 PM
From an interview with John Banja
"I see two kinds of narcissists in medicine. The first is a representative of what is an increasingly bygone era. This is the “advanced” narcissist: an arrogant, imperious, prima donna physician around whom the world turns. We can all recognize this person, and while I am told they are still around, I rarely meet one.
The second kind is much more common. This is the very bright, compulsive, hard-working individual who lives in a very stressful world, who carries entirely too much stuff around in his or her head, who—and this is a great tragedy—is immensely self-preoccupied or internally focused with all that needs to be done, whose baseline emotional state is one of mild to moderate anxiety, and who has forgotten to be empathic. That lack of empathy is his or her outstanding trait. It is not that this person wants to seem distant or uncaring, or rude or arrogant. Rather, his or her adaptation to the environment has resulted in a set of coping behaviors that seems to exclude patients and their families. This is a person who has forgotten how to listen, who is used to dominating conversations, who interrupts constantly, who uses technical language that patients cannot begin to understand, and who always seems to be in a hurry to be somewhere else. This physician has forgotten how to monitor his or her relational skills.
This person’s narcissism consists in his intense experience of himself. He “feels” himself and his world intensely, so that when an error comes along, two things happen: first, the natural self-protectiveness that any of us feel when we’ve screwed up is particularly aroused in this person (so that he might search for a way to rationalize or excuse the error to avoid its disclosure), and second, if he does discuss what happened to the harmed party, his poorly developed relational skills may trigger an empathic disaster.
RW: Do you think medical narcissists are largely born or bred? Does the profession attract or make them?
JB: The literature on narcissism suggests that it’s probably a product of nurturing more than anything else. This nurturing could occur early in childhood or it could occur in medical school or, most probably, in residency. Robert Millman has discussed a phenomenon he calls “acquired situational narcissism,” illustrated by professional athletes and movie stars, whom he has counseled over the years. These folks often are born into socio-economically disadvantaged situations, but in their early 20s, for example, they find themselves millionaires and the center of attention. And they begin to develop pompous, condescending, very self-preoccupied types of behaviors. He believes that it’s a function of the situation that they are in. I often think that the physician lives in a peculiar, if not downright unhealthy, emotional environment. First, it’s a very stressful world. Second, doctors are often surrounded by people who are overly polite or overly respectful, if not simply genuflective. They’re also exposed to individuals who are challenging, irritating, annoying, or difficult—patients projecting their misery and anxiety on them and asking all kinds of challenging questions. Medical narcissism develops as either a poorly regulated response to the adulation (for all the marvelous things health providers know they do) or as an overly defensive response to the countless threats to the professional’s self-esteem that occur every day.
Posted by: timo glock | Dec 6, 2006 5:14:49 PM
I don't think that compassion can really be taught in medical school. I agree with the post that stated that some doctors may be narcissistic out of their preoccupation with the demands of their work and stress, therefore leading them to give the appearance of not caring about the patient. However, I believe that many doctors actually do have compassion, it is the display of it in a fast-paced medical environment that is diffucult for them to master.
Compassion, I think, comes through experiences. I work at a hospital, and I had to learn how explain to patients in laymen's terms what procedure they were going to, how to comfort a patient with more than, 'I'm sorry you are in pain.', and things like that. Should every pre-med have a prerequisite of clinical experience to learn these things? Maybe. I don't know what the answer is for physicians to learn compassion, but definitely working in a clinical environment before a stressful 3rd year medical school experience would benefit.
Posted by: KT | Dec 6, 2006 6:02:43 PM
