It's that time of year when future doctors are applying to medical schools. More than ever, the prevailing wisdom of selecting students from the top of their classes, with the best scholastic grades and highest standardized test scores, is being challenged. But the public cry for more humanistic and compassionate care is lost when admissions committees emphasize test-taking skills at the expense of assessing an applicant's humanity and empathy.
A recent study indicates that incoming medical students vary on their attitudes toward the value of physician empathy when they begin medical school. The study suggests that curricula in medical schools promoting empathic care may be much more effective if students' preexisting attitudes are taken into account. The researchers found that close-mindedness, low dispositional empathy, discomfort with uncertainty, and comfort with medical authoritarianism independently predicted first year medical students' attitudes toward the benefits of empathy in medical encounters.
With today's challenges of caring for increasing numbers of patients with addictions, obesity, and chronic lung diseases (patients for whom empathy is often in short supply because they are perceived as contributing to their own illnesses) it is imperative that tomorrow's doctors understand the societal factors that lead to these conditions and develop greater capacity for empathy and relational skills to motivate these patients to value their health and make life saving changes.
Many medical school applicants are completely unprepared for the interpersonal and relational challenges they'll face in medical school. Shouldn't part of their intensive training include preparation for the patients who will challenge a doctor's empathy? For all medical students planning to succeed as humanistic physicians and scientist researchers, I'd argue that empathy training for these burgeoning physicians is just as important as basic biochemistry.
Some medical schools have already initiated additional criteria for deciding whether an applicant is up to the task of becoming a humanistic doctor. Several national medical schools have recently adopted the new new Multiple-Mini Interview -- first developed at McMaster University -- as part of the admissions process. During the interview, applicants are presented with a scenario or task, including interacting with simulated patients who present interpersonal challenges to the applicant. The applicant may have to deliver bad news, confront the patient actor, or gather sensitive information -- a far departure from undergoing only one interview wherein an applicant may hit it off with the interviewer, but may mask underlying interpersonal deficits that may later show up with patients.
So who are we attracting to the profession? The medical field today requires an ability to amass an extraordinary amount of knowledge, an ability to integrate information to make decisions that will predict the best future outcomes for patients, and reasoning skills that promote transfer of knowledge from one situation to another, with expert pattern recognition and also recognition of when patterns don't fit.
In the past, far less scientific knowledge existed. In fact, the practice of bloodletting and usage of leeches on patients ceased only in the late 19th century. Medicine was primarily an art form, in which the care, concern, and compassion of the physician were the most active ingredients in establishing a relationship of care and concern and healing patients. Because humanistic practices may be associated with a time when medicine had little else to offer, they've become disparaged and somewhat neglected in medical curricula.
In today's healthcare, the public demand for more patient-centered and compassionate care has resounded for more than a decade. Many medical advances have substituted technology for handholding. Use of the electronic health record has challenged physicians to be fully present and to engage with patients with the curiosity that expert doctoring requires. Many physicians are now checking boxes on a computer rather than listening to the patient's narrative, even though most physicians would agree that the patient knows more about his or her body and symptoms than anyone else.
The time has come to alert medial school applicants that medicine is foremost a humanistic endeavor, not a daily diet of diagnostic mysteries to be solved. While sharp minds are certainly needed to unpack the inevitable diagnostic dilemmas that present, the challenges of the daily practice of medicine are often the interpersonal relationships with people who are scared, worried, anxious or depressed about their symptoms. Treating such patients as bearers of simple symptoms requiring a medication or procedure misses the bigger picture. A therapeutic relationship often does more to quell the inner storm of fear and terror than the promise of a new medication. We need doctors who embrace both the science and art of medicine. Our lives may depend on it.
Helen Riess, M.D.
Associate Professor of Psychiatry
Harvard Medical School
Director, Empathy & Relational Science Program Massachusetts General Hospital
Chief Scientific Officer