Walking a mile in their patients' shoes: empathy and othering in medical students' education

Abstract

One of the major tasks of medical educators is to help maintain and increase trainee empathy for patients. Yet research suggests that during the course of medical training, empathy in medical students and residents decreases. Various exercises and more comprehensive paradigms have been introduced to promote empathy and other humanistic values, but with inadequate success. This paper argues that the potential for medical education to promote empathy is not easy for two reasons: a) Medical students and residents have complex and mostly unresolved emotional responses to the universal human vulnerability to illness, disability, decay, and ultimately death that they must confront in the process of rendering patient care b) Modernist assumptions about the capacity to protect, control, and restore run deep in institutional cultures of mainstream biomedicine and can create barriers to empathic relationships. In the absence of appropriate discourses about how to emotionally manage distressing aspects of the human condition, it is likely that trainees will resort to coping mechanisms that result in distance and detachment. This paper suggests the need for an epistemological paradigm that helps trainees develop a tolerance for imperfection in self and others; and acceptance of shared emotional vulnerability and suffering while simultaneously honoring the existence of difference. Reducing the sense of anxiety and threat that are now reinforced by the dominant medical discourse in the presence of illness will enable trainees to learn to emotionally contain the suffering of their patients and themselves, thus providing a psychologically sound foundation for the development of true empathy.

Trustingly bewildered. How first-year medical students make sense of their learning experience in a traditional, preclinical curriculum

“…Participation in this ‘community of practice’ [10] fosters a dynamic student identity that evolves over the years. This identity is influenced by the cognitive input of explicit teaching practices, but even more by each individual’s largely unconscious internalizations of the behaviors, language, and conceptions of knowledge and quality inherent in medical teaching, clinical practice, and the informal aspects of academic and student environments [3,8,11–13]. The evolving medical student identity is the stem from which develops the future physicians’ full-fledged professional identity, capability and outlook, embodying the tacit norms of physicianship [14,15], of good and right medical actions [16,17], of what it means to be ‘a real doctor’ [18,19].…”

Distress in working on dementia wards – A threat to compassionate care: A grounded theory study

“…Those values are putting patients first, valuing every person, a commitment to quality care, striving to improve lives, inclusion and compassion (Health Education England, 2014). However, the conceptualisation of compassion as a trait, which is either present or absent in an individual, is contrary to evidence that both nurses (Smith, 1995) and doctors (Shapiro, 2008) tend to begin their training with good levels of compassion but that this diminishes either during the course of training or in the early years after qualifying (Maben, Latter & Macleod Clark, 2007). It is therefore important "to understand what interferes with learners' impulses and desires to express empathy towards patients" (Shapiro, 2008).…”

From Silence into Language: Questioning the Power of Physician Illness Narratives

“…Bestselling physician illness narratives capture the popular imagination with the specter of the heroic physician, the "pastoral figure," as Kalanithi puts it, rendered even more mythically powerful because of being wounded by illness and thus possessing genuine empathy. The fact of Kalanithi's mortality-that he writes fully aware that he will not survive his cancer-serves as an antidote to a traditional barrier to physician empathy, namely, the deeply embedded belief that the role of the physician is to cure and that anything else implies loss of control and failure [25]. Yet Kalanithi, not unlike other nonmedical writers facing unexpected suffering, seeks to situate his intimate viewpoint within a greater tradition of literature and storytelling [26,27].…”