Blog do Curso de Medicina da Universidade Estadual de Maringá para a discussão de temas de Educação Médica, Educação das Profissões da Saúde e áreas correlatas.
Blog of University of Maringá Medical School for the discussion of issues of Medical Education, Health Professions Education and related areas.
quinta-feira, 6 de outubro de 2016
Medical students need to learn the potent medicine of empathy
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
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.