The Erosion of Empathy in Medicine

Brendan D. Murphy, Guest
Waking Times

…despite the obvious vital importance of feelings to the human condition, little can be found on the subject in modern and medical psychology textbooks. We are being held back by a structure that is ill-suited to our needs. What is needed is the energy and vision to support the emerging paradigm…It is clear that, as doctors, we need your help. –Dr. Robin Kelly, The Human Hologram

What Happened to the Doctors?

Something is drastically wrong with medical education as it currently stands1, and the effects flow into the professional arena. For decades medical students have been notorious for having abnormally high rates of illness, both physical and mental compared with the rest of the population. Depression is one problem that is well known. Dr Robert Mendelsohn stated in Confessions of a Medical Heretic (1979) that he saw a higher rate of illness in first year medical students than any other subgroup. At the time his book was published, medical students’ suicide rates in the US were reportedly second only to American Indian children who were sent away from their reservations to attend high school.

The sheer physical separation of many college/university students from their families and friends leaves them much more vulnerable to the adverse influence of teachers with agendas, toxic peer influence, and of course the pharmaceutical industry which controls medical education.

Problems in medicine are not restricted to medical students, however.

If today we doubt the value of the modern medical ethos and the effectiveness of current mainstream medical practice, we have decades of context backing us up and no shortage of statistics. Even as early as 1979, when Mendelsohn was eviscerating the medical profession for its brutality, incompetence, dishonesty, etc., the health status of the professional medical community (in the US) in itself was reason enough to doubt its methods. 1 in 20 physicians were deemed psychiatrically disturbed, more than 30,000 were alcoholics, and around 1% were narcotics addicts. A thirty year study concluded by finding that almost half of doctors were either divorced or unhappily married, over a third used drugs such as amphetamines, barbiturates, or others, and a third had suffered emotional problems severe enough to warrant a minimum of ten trips to a psychiatrist. Suicide rates for doctors were double the average for white Americans. For female physicians, the rate was four times higher than normal for women over age 25.[iii]

Is this what “healers” look like?

Mendelsohn attributed most of this disaster to the cutthroat moral and psychological climate of medicine, its power politics, bribery, and corruption. He believed that by the time students got to pre-medical training, they had already learned the cheating, vying for position, and competitive practices needed for medical school. He further pointed out that the admissions tests “virtually guarantee” that the students who do make it through will be bad doctors1, funneling through personalities that are autocratically leaning, and unable and unwilling to communicate with people, having the drive to succeed but not the integrity or will to rebel when they should.[iv]

Judging by the real-world results, it is clear that medical schools are geared to churn out automata-like drug and surgery pushers with few scruples, little nous, truant empathy, and no originality, who are willing to sell their humanity out to the Church of Modern Medicine. When you factor in that in 1979 the half-life of medical information/education was regarded as being a mere four years, you have the recipe for an autocratic and severely outdated profession (and industry) that is eminently resistant to important new information, truth, and, perhaps above all, change.

Student Stress and the Erosion of Empathy in Medicine

There has been some recent research done into the impact of medical training on undergraduates. The results are not flattering. In White Coat, Mood Indigo, an investigative piece by fourth year medical student Julie Rosenthal and her co-author Dr Susan Okie, we find that medical students are more prone to “depression” than their peers, with around 25% reportedly having it. Psychiatrist Laurie Raymond believes that students’ coping strategies and health worsen as they linger through medical school. They are overworked, stressed, socially isolated, and sleep deprived.[v]

Angela Nuzzarello, a psychiatrist and dean of students at Northwestern University’s Feinberg School of Medicine in Chicago comments that “all medical students aren’t sleeping.” “They are overwhelmed, they are working hard, and they aren’t having fun socially…Of course they are fatigued.”[vi] Is this how to create healers?

In a study by M. Hojat et al. called The Devil is in the Third Year: A Longitudinal Study of Erosion of Empathy in Medical School the question of empathy was investigated. The results:

…consistently showed no substantial change in empathy between orientation (year 0) and the end of year 2. However, a considerable decline in mean empathy scores occurred in the third year of medical school. No significant trend toward improvement in empathy scores was observed in the fourth year. The decline in mean empathy score from year 0 to the end of year 3 is greater than one-half standard deviation unit (0.54), which is considered substantial and practically important.

Conclusions: It is ironic that the erosion of empathy occurs during a time when the curriculum is shifting toward patient-care activities; this is when empathy is most essential.[vii]  (emphasis added)

To repeat: right when medical students really need a good handle on empathy and “bedside manner,” they are reaching a point of stress and burnout that has significantly eroded their empathic capacities.

The coldness of many doctors and nurses has reached legendary proportions. The 1980s sitcom The Golden Girls (1985-1992) featured a memorable scene in which the character Dorothy rebukes her dismissive ex-physician for not taking her seriously and making her feel like a fool for thinking she was sick. Seeking answers, Dorothy was eventually diagnosed with CFS, re-assuring her that she was not in fact neurotic or delusional, and did have something going on physically. Subsequently she happens upon her ex-doctor in a restaurant and interrupts his dinner to deliver an impassioned and scathing monologue, stating acerbically at one point: “I don’t know where you doctors lose your humanity but you lose it.”

http://youtu.be/Zovd9eKvy8s

We can tell Dorothy now that we know doctors effectively have their compassion schooled out of them – if they even have much to begin with. Whatever embers remain into their professional years are effectively neutralized by legal restrictions and the code of practice which prevents doctors from being allowed to advocate the most humane, cutting-edge, intelligent, and effective remedies.

The highly stressed, highly competitive—and socially alienating—environment of medical education explains a lot regarding the erosion of empathy. It is simply hard to even want to feel and see things from another person’s point of view when you are stressed. The more stressed you are, the more diminished that basic capacity is. But there are other indicators that show up prior to that third year decrease in empathy.

A recent survey of first- and second-year medical students at the University of California found that about one quarter were depressed. Laurie Raymond, a psychiatrist at Harvard Medical School said that students “see themselves going into a very narrow tunnel. A lot of the depression we see halfway through the [first] year — it’s a reaction to having constricted themselves down to studying these subjects in a very intense way. It’s pretty unidimensional [unbalanced].”[viii] (emphasis added)

There is a powerful cluster of stressors affecting medical students: lack of sleep, chronic stress, living from test to test, academic pressure, encounters with death may trigger previous loss/grief, intense peer competition, no time to nurture the self and recuperate, isolation during residency, student debt, working with constantly changing teams of residents and physicians, intensive time commitment, worry about finding time to start a family, and so on.

According to Nanette Gartrell associate clinical professor of psychiatry at UCSF, the most intense period of distress occurs “during the third and fourth years, when students rotate through the hospitals and clinics.”[ix] The unspoken attitude or code for the students is that since they are the “healers” they should deal with it and just be able to cope. Talking about depression has been taboo for decades—a culture that is only now slowly changing.

There is also the disillusionment that can result from discovering that practicing medicine isn’t quite what one expected it to be. One of the students Rosenthal interviewed found herself thinking: “Man, this life isn’t exactly what I imagined it would be, and now I’m stuck and have all these debts. I don’t like what I’m seeing in the hospital; that’s not how I want to practice medicine.”[x] Given that Big Pharma has long had the reigns of the medical system, it is not surprising that students should experience a jarring clash between idealized expectations and the grim reality of everyday allopathic medicine in practice.

Mendelsohn’s observation decades ago was that fear is the primary psychological attribute of a doctor. Given what medical students are put through in their training, this seems unsurprising. Fears encountered by prospective (and actual) doctors include fear of failure, fear of law suits, fear of missing a diagnosis, fear of misdiagnosis, fear of their authority being undermined, fear of peer disapproval, and fear of having to “find honest work,” as Mendelsohn cynically put it. (Read his excellent book – above.)

In return for swallowing the bitter pill of fear, doctors—as the Priests of the Church of Modern Medicine—have been given the reward of arrogance, which eventually all too often turns into contempt and disregard for their fellow human beings. Why should a doctor who toiled through medical school for all those years suffer the recalcitrance or questions of the uninitiated? Mendelsohn believed that the resentment (based in fear) that doctors feel for each other when they are medical students is eventually transferred on to patients when they do finally secure their own practice.[xi]

Outsiders become the biggest threat to doctors once they are out of the competitive environment of medical school. The entire system of “education” and training breeds a unique neurosis, comprising arrogance and underlying insecurity. One can only imagine the horror felt by, for example, a medical doctor who has specialised in oncology as the realization dawns that the cut, poison, burn paradigm is basically a gigantic fraud, and far humbler, safer methods are being used by the unwashed masses to heal themselves without a doctor’s intervention (cannabis oil comes to mind). In at least one survey, some 60-70% of doctors said they would avoid chemotherapy if they had cancer. Doctors themselves succumb to cancer with monotonous regularity – their medical theology and applied interventions clearly do not protect them.

Stemming the Erosion of  Empathy in Medicine

While there are measures being introduced by various medical schools to mitigate stress on medical students and assist them in self-regulating their moods, including mindfulness training, “sleep hygiene,” nutrition, and other lifestyle factors being addressed, they do not tackle the underlying toxicity of the profit-driven medical industry which shapes the basic experience and course of medical education and professional standards of care.

Having student support groups in which people can share their feelings is a small step in the right direction, as is mindfulness training, if we want to have empathic, functional doctors who actuallyhear their patients. Courses in listening skills would also be highly recommended. Medical students would benefit for decades after attending, just as an example, a Landmark course, the basic foundation of which is the art of actually listening and genuinely connecting with people through vulnerability and empathy. However, these measures would still do nothing to address the outdated and flawed medical dogmas and rituals that students must eventually employ in their professional capacity, nor do they address the overarching process of indoctrination that misleads students into the arrogant attitude that allopathic doctors are indeed true healers – and the only true healers at that.

The reality is that most doctors are damaged and/or burned out by their very medical training, which also lacks up-to-date information on the most effective healing methods – a dangerous and toxic brew not just for doctors but those they will be treating.

The Medical Mafia cares more for procedural rituals and sacraments than human connections and basic morality1. The ethos of “I’m just doing my job – and I know better than you” seems to grant medical staff and social workers (child “protection”) carte blanche to wreak as much havoc as they like and do it with impunity, as many of them do.

Clearly a medical education system that undermines such basic human virtues as empathy is a system in need of drastic overhaul. Doctors disconnected from their humanity are much more use to profit-oriented Big Pharma and the dogmatic Church of Modern Medicine than they are to living, breathing men and women seeking healing.

“Physician, heal thyself.”