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Does med school beat the empathy out of future docs?!

September 26, 2008

Niko Karvounis over at the Health Beat Blog has a great post about the impact of rigorous medical training on future doctors.

Although I do believe our medical schools are generally deficient in the amount of education they provide regarding emotional care for patients, another force is at work here.  Learning to practice medicine is hard.

I know that is not a particularly unique or insightful notion, however, this fact is under-appreciated by those outside the medical world.  It takes a lot of hard work, requiring nearly all of one’s effort and ability, to learn how to practice medicine…and I’m just talking about learning the science involved in medicine.  Learning biochemistry, anatomy, physiology, pharmacology, etc take quite a bit of effort.  Ok, a lot of effort.  This leaves little time and cogntivie capacity to take on all of the other things aspiring doctors should learn: small business management, ethics, health law, epidemiology, finance, and–most important of all–psychological and emotional care.

I agree that medical schools intentionally teach their students to emotionally detact themselves from their patients so they can focus on doing their job.  A certain degree of this is absolutely necessary.  But, I also believe the medical school curriculum is so jammed with vitally necessary things to learn that certain subjects get deferred.  In addition to this, medical students and young, inexperienced doctors are so intently focused on getting the science behind their patient’s condition correct that they tend to neglect the emotional care patients need.  Humans have a finite amount of cognitive capacity.  If this capacity is consumed with trying to determine the etiology of a certain condition and cross-reference it with a biochem class from three years ago, little is left over to consider emotional care.

So then, why are some doctors better at this than others?  All young doctors should be equally bad at taking into consideration all of the physical and emotional conditions a patient may have, tending to focus on physical ailments over psychological ones as noted above.  However, as doctors mature, become more experienced, and develop better clinical skills, they should have more capacity to devote to psychological and emotional conditions.  But, by the time this happens, a physician has already spent years seeing patients and developed their own rhythm to patient encounters.  If good emotional care practices weren’t formed early, it may take considerable effort to incorporate them.

Adding classes to the med school curriculum may help.  The best answer may be to develop specific protocols for med students that incorporate emotional care into standard practice.  Our most expediant solution at this point is to provide young physicians with good mentors.  Older physicians should take care to always make sure any student under them is taking care of the whole patient.

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