compassion

Manoj Jain writes in yesterday's Washington Post that compassion should be one of the "four C's" of medicine (the other three being competency, communication, and convenience) and yet is often forgotten or lacking. Yet some studies suggest that perhaps it's something that we can learn in a course or simply need to be reminded of:

Compassion can be taught... but it also can be lost. A 2008 study of 419 medical students showed that women had twice the empathy scores of men and that scores declined at the end of the third year, when students had begun regular exposure to patients during clinical rotations — exactly at the point where they needed more not less empathy. The 2008 study is not the only one showing this decline, but the trend can be prevented: A study of 209 students at the Robert Wood Johnson Medical School found that empathy was maintained among third-year students who received specialized training.

- Manoj Jain, "Doctors often struggle to show compassion to patients", Washington Post, 5/16/11

Speaking from my own experience, I know that I have been been progressively shutting down my empathy to remain functional throughout the first two years of medical school: anatomy, a summer in animal research, patient interviews in the psychiatry ward, and hearing a lot of people's pain and struggles.

I enjoy free clinic because we do in fact have enough time to talk with patients and hear their stories and experiences. I think my physical diagnosis course also was very positive in that we had hour-long patient interviews. Yet I can't imagine seeing 60 patients in two hours (a la my friends' surgery rotations) and even being able to be medically competent, much less conversational or compassionate.

Bottom line: I think to retain or regain compassion, one must be very intentional about it. The entire medical training system (with some positive exceptions added in our curriculum) really tends to beat it out of you, fast. I don't think that we can expect to remain compassionate or kind by default, not under stress, time pressure, exhaustion, and the kind of survival mode that trainees end up in much of the time.