How Can Medical Schools Graduate Students Who Are Empathic?

By Michael Blumenfield, MD | June 7, 2010

Empathy is the ability to put yourself in someone else’s shoes and understand what they are feeling. This is something that psychiatrists try to do in our everyday work. Those of us who have worked in medical schools have struggled with the question of whether or not we can teach this to young men and women who are learning to be doctors or whether it is something that they either have or do not have. Certainly I have seen medical students who seemed to be decidedly lacking in this quality, just as I have seen students to whom it came very naturally and some who were far more empathic than I was as a student or even after years of experience.

Choose Empathic Students in the Admission Process

I have gone through many phases in trying to figure out how medical schools can graduate doctors who have this empathic quality. My first thought was to try and influence the selection process so students who seemed to have this natural quality would be chosen. I had the opportunity to join the admissions committee of the medical school where I taught and participated in the interviewing and selection of prospective students.

Actually, there were a few psychiatrists already on the committee along with other medical specialists and basic scientists who would be training the students in their preliminary non-clinical years. It was relatively easy to determine which students had this quality in abundance and which students did not. I could see the tears in a student’s eyes as he or she told me about experiences which he had known someone who had been ill or disadvantaged and how this had motivated him to want to be a doctor. I remember the caring response of one student to me as I was suffering with allergies with my eyes running on a particular day that I was interviewing her. On the other hand I could detect the intellectual response of students who ticked off their many volunteer activities or told of their dedication to finding the cure of cancer because it would then increase life expectancy. However, when it came down to the votes on the committee, a student being the most empathic would never trump the one with potential to become a world famous doctor.

Trying to Teach Empathy in the Classroom

I had opportunity to see if it were possible to teach students to be empathic. It was traditional in our medical school for psychiatrists to teach students interviewing technique both in formal lectures and at the bedside. In preparation for a formal lecture I made a video tape (we were not yet using DVDs) in which I had some senior students act as doctor and patient in a hospital room in various scenarios. In one of them the “doctor” asked the “patient” if anyone in her family had a cancer. The patient began to cry and said her daughter died of cancer. I then showed three possible responses. In the first one the doctor just continued with the interview and kept asking questions. In the second scenario, the doctor got up and excused himself and said he would come back later when the patient was feeling better. In the third case the doctor offered the patient a tissue and said that he was sorry. Obviously the third vignette was meant to be the correct one, and most students seemed to get it. However, a group of Asian students approached me after the lecture and told me that they did not agree with the choice of the best vignette. In their particular culture it was a sign of respect to let a patient be alone in that particular situation. Excusing one self and walking out of the room was the correct response as far as they were concerned. So I began to realize that this was not an easy task.

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by Ron Pies | June 07, 2010 11:10 PM EDT

Thanks, Dr. Blumenfield, for a very thoughtful and nuanced discussion of this complex construct called "empathy". If we define this as an intrapsychic state of some sort, it may indeed be impossible to "teach"someone to be empathic.

If we define it in more "behavioral" terms, such as being tactful and not humiliating patients, we may at least be able to inculcate medical students in appropriate demeanor and conduct. (As you may know, in the rabbinical tradition, humiliating another person is considered the equivalent of bloodshed).

I remember, as a third-year medical student, hearing one of my classmates speaking to a very sick inpatient. My classmate said he would return a bit later to finish his interview with the patient. When the patient asked "What time?", my classmate replied, "What difference does it make? You're not going anywhere!"

I would have settled for tact and professional demeanor at that point, Dr. Blumenfield!

But perhaps there is a way to go deeper than this, with our students. My thought: use poetry as a way of emotively creating the conditions for empathy. We have done this with medical students at SUNY Upstate Medical University, in a creative writing course that involves both reading and writing poetry. I think it works, though I can't prove it!

Best regards, Ron Pies MD

by Jill Davis | June 08, 2010 5:47 AM EDT

Having just graduated from medical school, I feel I am far less emapthic now than I was when I started this process of medical training. I consistently had attendings push me harder and harder, so that there just was no time for empathy. There was too much to do, too much studying required, there was always another patient then another patient, constant exhaustion and no balance in the students life. If I had the opportunity to have a more balanced and healthy life during school, I may have been a happier and more balanced student which who translate into a more balanced approach to patients with more caring and empathy.

by Sara Hartley | June 10, 2010 12:00 PM EDT

It is disappointing to read such a naive perspective on interpersonal engagement from a psychiatrist. It suggests the swing from psychological-mindedness to biological training has diminished our capacity to contribute to medical education. Reading poetry or writing in journals (Blumenthal never mentions Rita Charon's efforts to expand sensitivity) can be lovely activities, popular with many students. But it is a genuine CLINICAL SKILL founded on the basic science of attachment, anxiety/defense, intersubjectivity and unconscious communication that should be taught to medical students as they plunged into comnplex patient encounters. Of course canned phrases are phony. 'Acting empathic' is an oxymoron. Dealing with one's true reaction to a patient (assiduous self-reflection) is the hardest first step. Then deciphering a simple response from this strumming generates authentic engagement...empathy. Apparently, Dr. Blumenthal has not focused on transference-counterftransference experience in his clinical life. It is from this substantive literature that we must generate useful elements to help medical students become competent in complex interpersonal situations. Sara Hartley, MD Clinical Faculty UCB/UCSF Joint Medical Program

by John Raasoch | June 10, 2010 5:00 PM EDT

I recall my 1st clinical rotation in medical school & chastised by an endochrinology prof. I abreviated my PE on a dying patient after he had undergone 4-5 previous workups. He died that night & I was dressed down in the AM for "missing a chance to see the pathology"! John Raasoch MD

by John Raasoch | June 10, 2010 5:35 PM EDT

In response to Ron Pies - equating humiliation with bloodshed - I would not attiribute this only to "rabbinical tradition" but considerate it endemic in all of Israel on both sides of the Green Line and probably rampant throughout the Middle East. John Raasoch MD

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How Can Medical Schools Graduate Students Who Are Empathic?

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