Thursday, December 6, 2012

Empathy Declines During Medical School?


According to Dr. Jean Decety, empathy is an innate human emotion that involves feelings of concern for other people, knowing what the other is thinking or feeling, blurring the line between oneself and the other, etc.  He claims that empathy has deep, evolutionary, biochemical, and neurological underpinnings.  Empathy is mediated and moderated by multiple systems in the brain.  When we see others in pain, we are predisposed to find their distress aversive and learn to avoid actions associated with this distress.  If we looked at crying, for example, it would be an evolutionary disadvantage because an extended wail would attract predators.  Instead, however, crying ends up being a tool for the evolution of empathy; this expression provides a signal which motivates helping behavior in others.
How can Physicians employ empathy when their job, at times, calls for the most painful (surgical) procedures?  Dr. Decety did research on empathy in clinical practice and found that empathy declines during medical school.  It is challenging for doctors and nurses to engage with their patients empathetically because they are dealing with the most emotionally distressing situations such as, illness, dying, and suffering.  In one of his experiments, he found that Physicians showed no activation where the control group showed activation to touching body parts with a needle vs. a Q-Tip.  Too little or too much empathetic arousal can be detrimental to the medical practitioner’s well-being.  A couple of the benefits of lack of arousal are: no feelings of alarm or fear, frees up processing capacities to be of assistance, and no compassion fatigue.  A lack of empathy can also result in an underestimation of pain in others, poor relationship with patients, and the filtering out of emotional information.
On the other hand, a recent study shows how physician’s empathy is associated with positive clinical outcomes for patients.  Researchers from Thomas Jefferson University were interested in investigating the effect of physician empathy on patient outcomes. The study was published in Academic Medicine and focused on diabetic patients.  According to one of the research professors, Mohammadreza Hojat, “This new, large-scale research study has confirmed that empathetic physician-patient relationships is an important factor in positive outcomes.”  In this study, researchers used the patients’ hemoglobin A1c test and cholesterol levels.  They also measured physicians’ empathy level through the Jefferson Scale of Empathy (JSE).  A direct correlation was found between physicians’ JSE score and the control of the patients’ levels: the higher the physicians’ JSE score the better the control of patients’ hemoglobin A1c and cholesterol level.
Combining Dr. Decety’s research and the study from Thomas Jefferson University, we can see that although engaging in empathy may be difficult for physicians, it does have a positive effect on patients’ clinical outcomes.  Therefore, physicians should practice some level of empathy with their patients.  Empathy is an innate human emotion and serves a beneficial purpose in human wellness.


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