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TRULY GOOD MEDICINE:
Listens while making eye contact // responds empathically to concerns // establishes trust // improves health outcomes in measurable ways

The Need for Compassion

By Meera Lee Sethi // Illustrations by Paul Blow // Spring 2013
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Illustration by Paul Blow

It has been more than 20 years since the Association of American Medical Colleges last revised its Medical College Admission Test. The MCAT has traditionally focused on basic scientific concepts—asking, for example, how stomach acidity changes the function of the enzyme pepsin. But starting in 2015, those aspiring to the Hippocratic oath will also have to tackle some 67 questions that test their knowledge of how behavioral, social and cultural factors might influence patients’ health.

Suppose that word about a recent HIV diagnosis has spread to someone in a different social group; imagine a heterosexual man, for example, hearing that a gay acquaintance has found he has the virus. Would this news leave the first man more fearful about his own chances of contracting the disease, or less? To tackle this problem, students must understand the psychological phenomenon of “comparative optimism”—which tends to make people underestimate their own vulnerability to a disease compared with someone in a group they don’t identify with.

The new MCAT structure reflects an increasing concern within the medical community that the profession, ever more technically proficient, has lost touch with the human dimensions of providing care. That missing element—empathy—lets physicians understand patients’ unique perspectives and feelings, seeing them as whole human beings rather than an amalgamation of symptoms. An empathic physician understands and a compassionate physician communicates that understanding to patients and acts on it in a way that’s therapeutic.

Empathy is there in abundance when first-year medical students meet patients, says Beth Lown, an internist at Mount Auburn Hospital in Cambridge, Mass. “They lean forward, make eye contact and listen intently,” she says. “You can see them resonating with the person in the bed. They’re like mirrors.” But by the time those students get their medical degrees, the mirrors don’t reflect nearly as well. Research has suggested that a novice physician’s ability to empathize with patients wears down during training, and a recent study noted that clinical empathy begins to decline during the third year of medical school—typically when students turn from academics to providing direct clinical care to patients.

Other research indicates that this trend continues during residency and establishes habits of approaching patients that last throughout a physician’s career. University of Rochester scientists who analyzed audiotapes of interactions between oncologists and people with lung cancer, for example, found nearly 400 occasions in which patients expressed concerns. But physicians responded with emotional support only 1 out of 10 times; they were much more likely to offer what the researchers called “biomedical questions and statements.”

Those missed opportunities don’t surprise Lown, medical director of the Schwartz Center for Compassionate Healthcare, a nonprofit organization that works to nurture positive relationships between patients and their clinical caregivers. In 2010, a survey Lown helped conduct found that although the vast majority of patients and physicians consider effective communication and emotional support “very important” to successful medical treatment, only 53% of patients and 58% of physicians said they believe the U.S. health system is a compassionate one.

Clearly, physicians must be technically proficient. The question has always been whether that expertise must come at the expense of being able to connect emotionally with patients. The eighteenth-century surgeon William Hunter famously argued that dissecting corpses would give his students “necessary inhumanity.” And in 2001, Jack Coulehan and Peter C. Williams, professors in the department of preventive medicine at Stony Brook University, contended that an unspoken bias toward detachment and objectivity runs through the curricula of most American medical schools—leading some trainee physicians to emerge thinking of themselves “primarily as technicians.”

A dozen years later, amid remarkable advances in medical technology, physicians may be all the more likely to see empathy as expendable. Yet new research is showing that the human side of doctoring also has observable, quantifiable effects. These latest studies are demonstrating that empathy training may improve the quality and effectiveness of care. And while compassion isn’t a magic pill, it may help address some of the problems of a medical system that the nonpartisan Institute of Medicine has said “falls short on such fundamentals as quality, outcomes, cost and equity.”

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Are Physicians Wired for Empathy?

Brain studies suggest that doctors learn to suppress normal responses to patients’ suffering.

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1. “Physicians Down-Regulate Their Pain Empathy Response: An Event-Related Brain Potential Study,” by Jean Decety, C.Y. yang and Yawei Cheng, NeuroImage, May 1, 2010. Decety, for whom empathy has been a longtime focus, finds that physicians’ brains dampen their immediate physiological responses to others’ pain and suggests that this may free them to engage in medical decision-making with a clearer mind.

2. Empathy in Patient Care: Antecedents, Development, Measurement, and Outcomes, by Mohammadreza Hojat (Springer, 2007). A survey of clinical empathy that moves from an examination of its possible evolutionary and biological mechanisms to the thorny subject of measurement. Hojat is particularly concerned with how empathy can be taught in medical education.

3. From Detached Concern to Empathy: Humanizing Medical Practice, by Jodi Halpern (Oxford University Press, 2001). Halpern argues that a purely intellectual understanding of patients’ emotions isn’t enough to cultivate empathy. Instead, she calls for physicians to have an “engaged curiosity” about their patients’ experiences.

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