empathy decline in med school

A forum to discuss Chronic Cerebrospinal Venous Insufficiency and its relationship to Multiple Sclerosis.

empathy decline in med school

Postby Cece » Sun Jun 19, 2011 2:10 pm

www.ncbi.nlm.nih.gov/pubmed/21670661
Acad Med. 2011 Jun 10. [Epub ahead of print]

Empathy Decline and Its Reasons: A Systematic Review of Studies With Medical Students and Residents.

Abstract
PURPOSE: Empathy is a key element of patient-physician communication that is relevant to and positively influences patients' health. The authors systematically reviewed the literature to investigate changes in trainee empathy and reasons for those changes during medical school and residency.

METHOD: The authors conducted a systematic search of studies concerning trainee empathy published from January 1990 to January 2010, using manual methods and the PubMed, EMBASE, and PsycINFO databases. They independently reviewed and selected quantitative and qualitative studies for inclusion. Intervention studies, those that evaluated psychometric properties of self-assessment tools, and those with a sample size <30 were excluded.

RESULTS: Eighteen studies met the inclusion criteria: 11 on medical students and 7 on residents. Three longitudinal and six cross-sectional studies of medical students demonstrated a significant decrease in empathy during medical school; one cross-sectional study found a tendency toward a decrease, and another suggested stable scores. The five longitudinal and two cross-sectional studies of residents showed a decrease in empathy during residency. The studies pointed to the clinical practice phase of training and the distress produced by aspects of the "hidden," "formal," and "informal" curricula as main reasons for empathy decline.

CONCLUSIONS: The results of the reviewed studies, especially those with longitudinal data, suggest that empathy decline during medical school and residency compromises striving toward professionalism and may threaten health care quality. Theory-based investigations of the factors that contribute to empathy decline among trainees and improvement of the validity of self-assessment methods are necessary for further research.

No word on if they were neurologists....
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Postby CureIous » Mon Jun 20, 2011 10:12 pm

I can certainly relate. On a recent visit to my Dr., on company time, in the middle of an 84 hour work week, needing immediate attention for a very messed up knee which I desperately need to keep going thru the end of this month, was greeted instead by a substitute Dr. (surprise!), filling in for him last week.

Which would be great, except I only see MY Dr., only made an appt. with MY Dr. and that was not MY Dr. who walked through the door. (The front office didn't bother to tell me this when I booked the appt.)

All I really wanted to do, was a quickie xray of the knee area. Easily done, and much information can be gleaned from said xray, namely what is NOT there, and if there's a nice even meniscus, alignment of the bones, yadda yadda. Believe it or not, they DO take xrays of the knee to evaluate the condition of the knee.

Not 30 seconds into the consult, after explaining how my knee was injured, how there was an audible POP, (which I know is prolly ligaments, ACL or whatever), and please can I have an Xray for my own edification, because 12 hour shifts 7 days a week leave zero time for scheduling MRI's and orthopedic consults, I was instantly given a lecture on the "dangers of xray radiation exposure". Sigh. Well intentioned I suppose. She also mentioned that my Dr. was "indisposed" and if I wanted to see him I would be waiting a very very long time.

I then replied that indeed, I am quite familiar with xrays, ct's, radiation and all that, having had quite a few of the damn things in my life (CT mylegram, head CT, fluoroscopes etc.), to which she instantly cut me off with, "oh, so now you are a medical professional with a degree?".

She must have been reading my chart in the Dr.'s laptop, because the SECOND I mentioned Stanford in the "patient pedigree" list, it was over. Oh boy was she pissed. She snapped the laptop shut, suggested that I just go ahead and wait for my Dr. and stormed out of the room.

The entire consult took about a minute exactly. Geeze lady, I also needed the laceration in my finger stitched up (didn't make it that far), maybe some painkillers would be nice too for the AGONY I am in while walking around a sandy uneven jobsite for 12 hours with a knee that causes a very noticeable limp, and is up on ice the moment I get home. Oh and the staph infection in my right eye, can we take care of that too?

Instead, it was the "Dr. visit with an urgent care type of hurry up attitude, just shut up and let me do the talking here", followed by the aforementioned storming out, and here's the kicker. When she left, she said over her shoulder to "just go ahead and wait for Dr. ____ then".

Trouble was, he wasn't SEEING patients that week. That was on purpose to make me rot in that room thinking he would come in any second. lol. I got the hint in about 2 minutes. Walked out to front counter, made an appt. with MY Dr. for 4 days later, who scripted me painkillers, eye drops, steroids, and gave me an ortho reference for future use. No mention was made of the earlier visit, but he did take the time to examine the knee and said it was indeed not right. I came in later for an XRAY, the tech, per my request, left the xrays conveniently positioned in the viewer in the hall "so I could take a look at them myself on the way out", and all was well.

Her attitude, that " I have the plaque Mr. patient, so please just sit down, shut up and worship the plaque", wasn't no way near as bad as her rushed, ER style visit. As cold as they come. No ears, all mouth.

I will limp my way through the end of this month, as there is nobody left on the job to replace me, and the money is damn good, then will get all that soft tissue imaged and taken care of. I was only mad about the waste of precious time because of my work situation and what it took to even get me in there at that hour "on the clock". The rest, couldn't care less about, but it is interesting that you posted this. The age of caring, listening Dr.'s who "visit" with you, pay REAL close attention, absorb as much info as possible to form the most accurate evaluation possible, is coming to a close.

Replaced by cookie cutter patient mills.

Oh btw, every time I have a visit on Friday, there are 2, or sometimes 3 pharma sales reps who stroll in unannounced, and every time, my hour long wait is dragged another 30 minutes, while listening to them holding my Dr. hostage in the hallway with endless pharma blather. It's quite endearing! lol.
RRMS Dx'd 2007, first episode 2004. Bilateral stent placement, 3 on left, 1 stent on right, at Stanford August 2009. Watch my operation video: http://www.youtube.com/watch?v=cwc6QlLVtko, Virtually symptom free since, no relap
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Postby blossom » Tue Jun 21, 2011 12:42 pm

scarey!! and i fear the best is yet to come. with all the medi care cuts etc. if small defenese for some of the dr.'s is warranted they are dictated by the hospitals they work for and the ins. co.'s so the care you get and testing, treatment and time spent with a patient is not adequate. so a big part of our care they want to do is really out of their hands. "but their attitude is in their control."

but, i have met up with more dr.'s "especially neurologist" that needed an attitude adjustsment.

we go to a dr. because we are sick--we need their help. the last thing we need is to be upset by an unsympathic, big headed arrogant smart alec.
if someone has to be taught to be nice or decent maybe they are in the wrong line of work. kindness and attitude can begin the healing process in many cases.

we are between a rock and a hard spot at times.
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