quinta-feira, 6 de outubro de 2016


Medical students need to learn the potent medicine of empathy

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A few years ago at a large teaching hospital in Texas, a medical resident asked a nurse how to order an autopsy for a patient they were currently treating. It was a reasonable request. Autopsies help further the understanding of disease. There was just one problem: their patient, who was very much alive, was lying nearby. He’d overhead the request, and that’s how he found out he was soon going to die.

This story illustrates a broader crisis in medical education. Today, most schools myopically focus on turning out technicians. Through textbooks, lab experiments, and lectures, budding doctors learn the hard science of medicine. They memorize body parts, processes, and conditions, then dutifully demonstrate their knowledge in high-stake examinations.

This purely technical approach can obscure the human side of medicine and erode empathy — the ability to understand and care about what makes a patient tick. In fact, the empathy levels of medical students actually decline as they progress through school. Many become emotionally disengaged from the people they’re caring for — and that disconnect can impair care.

Forging a strong emotional connection with a patient can be just as important to the healing process as prescribing the right drugs or performing the right surgery. A 2012 study published in the journal Academic Medicine found that the rates of serious complications among diabetic patients were almost 50 percent lower among those whose doctors had high empathy levels compared to those whose doctors had low levels. Improving physician empathy has been shown to help overweight individuals with diabetes drop more weight, arthritis patients experience less joint pain, and those with high blood pressure reduce it.

A 2014 study published in the journal PLoS One examined a baker’s dozen of clinical trials in which doctors were taught empathy-building techniques, even simple ones such as making regular eye contact. Their patients fared significantly better than doctors who didn’t receive such training.
How does empathy do this? A patient who feels emotionally connected to his or her doctor is more likely to disclose important medical information and to follow the doctor’s advice. That connection can serve as the basis for true teamwork, with the patient working proactively with the medical team to improve health. Simply put, patients who feel cared about feel better and do better.

There’s also great promise in osteopathic medicine, which couples traditional medical interventions with skilled, specialized, hands-on treatments for the body’s complex system of nerves, muscles, and bones. “Healing touch” isn’t just a metaphor. This simple physical action evokes trust in patients.

Without empathy, doctors run the risk of alienating their patients. The relationship can become one-sided, with the physician simply dictating treatments and the patient following orders. Core emotional needs can be ignored, leading patients to feel lonely and downtrodden. And that deterioration of mood can make it less likely that they will experience positive outcomes from treatment.
Can medical schools teach empathy? Of course. Relationship-building and effective communication are skills. They can be taught, learned, and practiced.

To teach empathy and related “soft” skills, schools should consider starting up emotional intelligence boot camps — intense, immersive training programs that students complete before their formal medical schooling begins.

Such a program would assign students tasks that encourage them to build communication skills and directly address patient needs before they start classes and interact with the entire health team. Budding doctors would spend several months in a hospital or clinic bathing the infirm, changing bed sheets, taking blood pressures, and doing other tasks that help them connect with the humanity of their future patients. Equally important, this would foster constructive collaboration with nurses and other staff and build a firm foundation for respectful interprofessional teamwork.

At the New York Institute of Technology, our college of osteopathic medicine encourages students to engage in empathy-building exercises outside of the classroom. Our chapter of the Gold Humanism Honor Society recognizes students and faculty members who care for patients with compassion, empathy, and integrity. Our students also run a ceremony each year in which first-year students honor their “first patients,” the people who donated their bodies to science. It reminds the students that cadavers aren’t just training tools — they’re a precious gift from selfless donors and their families.
The quest for empathetic physicians should probably start even earlier. Medical schools could reassess how they select students, using metrics for hard skills like grades and Medical College Admission Test scores as guides, not exclusive criteria. Schools should create a well-rounded picture of each student by putting serious weight on his or her past work activities, personal interests, in-person interviews, and personal references. Being open to applicants who don’t fit the traditional mold, such as older people with previous careers, is another strategy.

To help mold the physician of the future, medical schools must rethink their books-before-people approach. A myopic focus on the technical aspects of fighting disease can lead to worse patient outcomes. Good doctors should be proficient in both the scientific and humanistic facets of medicine — truly caring for their patients while looking for a cure.

Wolfgang Gilliar, DO, is the Dean of the College of Osteopathic Medicine at New York Institute of Technology.
Wolfgang Gilliar can be reached at wgilliar@nyit.edu
Follow Wolfgang on Twitter @NYITCOMDO

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