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Decline in Empathy of Medical Students

As important as a physician’s empathy is for a patient, as seen by the benefits for patients described, medical students’ ability to empathize decreases as they go through medical school as well as during residency. Possible reasons for this decline include:

1)      The implicit emphasis on detachment, self-interest, and objectivity in certain hospital teaching settings

2)      Distress – Often students come into medical school with a large capacity to empathize, but when they face the clinical reality of medicine, they may shift to having more of an objective outlook on medicine and using more technology, for instance. This reliance on technology may further limit human interaction. Students may have idealistic expectations coming into medical school but then react with detached concerns and decreased empathy as they face several disappointing situations.

According to Neumann et al., “encountering morbidity and mortality heightens trainees’ feelings of vulnerability. As a result, students and residents may overidentify with patients, causing them to suffer more from distress themselves; they thus become unable to provide rational health care or protect themselves by dehumanizing patients” (Neumann et al. 999).

3)      Fragmented patient-physician relationships, especially during the clerkship year, either when the patient’s stay is short, or when the student must rotate among several patients and is not able to know patients well enough to form an emotional understanding with them.

4)      High workload and stress of medical training

According to Joachim Bauer’s hypothesis, “existing empathic ability can suffer serious damage through extreme experiences of callousness or inconsiderateness. Furthermore, anxiety, tension, and stress can significantly reduce the signal rate of mirror neurons: “Once pressure, fear, and stress are present, everything that depends on the system of mirror neurons stops functioning: the ability to empathize, to understand others and to perceive subtleties” (Neumann et al. 999)

Graphic representing decline of empathy during medical training (Neumann et al.)

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Bibliography

1. Neumann, M., Edelhäuser, F., Tauschel, D., Fischer, M.R., Wirtz, M., Woopen, C., Haramati, A., Scheffer, C. “Empathy Decline and Its Reasons:  A Systematic Review of Studies with Medical Students and Residents.” Academic Medicine. 86.8 (2011): 996-1009.


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