Creating a More Empathetic Medical Workforce

This article originally appeared in the Huffington Post on Oct. 7, 2014.

By Paloma Toledo and Kara LaBarge

In the last few weeks, thousands of new students have started medical school.

Medical education has recently broadened its narrow focus from just-the-facts, to a patient-centered model of care, meaning that unlike the old days when we made decisions for our patients, today's doctors are trained to think about the patients' needs and values. In order to be effective, doctors need to be knowledgeable about medical facts, but also need to know how to communicate effectively, and be empathetic. In essence, the new generation of doctors is being trained to be nicer doctors.

But there's something wrong. Students are not graduating from medical school as empathetic physicians. Over the course of their training, they become less empathetic, as opposed to more empathetic, and the reasons for this are unclear.

Maybe it's because in the first two years, students have their heads in their books memorizing facts. The stress and anxiety about passing exams may make them less empathic because they are simply emotionally drained.

Things get worse in the clinical years. You would think these budding future physicians become more empathetic when they finally talk to patients. But instead they become hardened. I understand how this happens. Sometimes, in order to care for a patient, you need to distance yourself from the situation. I work in labor and delivery. As a mother, I can't fathom the pain of delivering a baby who died late in the pregnancy, yet it happens, and I need to care for these women. I can't let myself be overwhelmed by the sadness of it all. I wouldn't be able to care for my patient effectively. This emotional distancing, coupled with stress, anxiety, sleep deprivation, plus lack of empathetic role models slowly chip away at student's empathy.

Empathy matters. For improved patient satisfaction and for improved medical outcomes. Physicians who were trained with empathetic skills in a fertility clinic were found to have higher patient satisfaction and communication skills than those who were not trained. Patients were more satisfied with the information given to them by their physician, as well as with how the physician explained that information to them. Likewise, another study found that patients treated by physicians with higher empathy ratings were more likely to have better medical treatment outcomes than those treated by physicians with lower empathy ratings.

So what can be done to prevent this deterioration in empathy in medical trainees?

One method often used to increase empathy is perspective taking, which can be taught in one of two ways. In experiential learning, students are asked to either imagine what it would be like if they were the patient. Essentially, the students are asked to walk in the patient's shoes. The second method is to simply lecture the students on active listening and communication skills. These methods, which may sound so basic, really work. Studies have shown that these lessons, easy to slip into a student's hectic schedule, make both patients and doctors-to-be happier.

Another possible intervention targets students earlier in training. All medical students spend time learning anatomy on a cadaver in the anatomy lab. The cadaver is dehumanized. The cadaver is a tool for learning anatomy, yet it is often forgotten that this educational tool was a person, who gave their body to train the next generation of physicians.

At our institution, at the end of the first year of medical school, students participate in an anatomy closing ceremony. Medical students recognize the anatomy donors and their families with musical performances, readings, and a flower ceremony. The cadavers regain their personhood as medical students say a word of thanks before placing a white rose into a vase in memory of their donor. Some students even have the opportunity to speak with family members of their donors about their anatomy experience. We don't know for sure, but maybe these reminders such as these before the end of first year could help combat students' loss of empathy over time.

In the changing face of medicine, we need to incorporate more empathy and human experience into medical education in order to create more compassionate doctors. The evidence supporting better communication is strong. It's hard to argue that greater patient satisfaction, better medical outcomes, and even reduced litigation are not important. The challenge is finding effective, sustainable strategies. The myriads of patients that these soon-to-be doctors will one day serve deserve it.

- Paloma Toledo is an assistant professor of medicine at Northwestern University. Kara LaBarge is studying medicine at Northwestern University.