In a recent column I described my experience dealing with a severe illness in a health care system that was often devoid of the compassion I needed but rarely received. Many of the doctors were probably very kind and caring people who had the compassion stripped away – first by unreasonably demanding training and then by great stress on the job.
An article this month in the journal Academic Medicine described how medical students generally enter school with a great deal of emotional empathy – indeed, it’s a big part of why they signed up. But the researchers found that empathy has diminished dramatically by the end of the third year.
Dr. Marsha Snyder knows that all too well. She began her career as a nurse. Throughout her training, she was taught to care for the emotional needs of patients. She said nursing students were encouraged to share their own emotions with faculty and colleagues as well.
She excelled as a nurse, so she decided to go to medical school. There, she said, the training was purely cognitive – not one word was spoken about the patient’s emotional experience or spirituality. When she got the courage to ask about either the doctor’s or the patient’s emotional needs, she was laughed at or belittled. And when she began her residency – in psychiatry – she felt completely isolated, she said. “Neither the patient nor I had any emotional support.”
That was more than 20 years ago. Today there is a movement to try to humanize medical training.
At Jefferson Medical College, Dr. Birgit Rakel teaches students about care of the soul, nurturing one’s wholeness and the difference between healing and curing. All the courses are taught in small groups, and an attending physician leads what can be intensely personal discussions about loss, grief, vulnerability, and the healing power of silent listening.
A unique kind of patient conference called Schwartz rounds – Kenneth B. Schwartz, a cancer patient in Massachusetts, made it a mission to strengthen the emotional bonds between doctors and patients – is used at 139 sites around the country, including several local teaching hospitals. Unlike typical rounds, in Schwartz rounds everyone who worked on the case talks not about the patient but about their own emotional experience. It is a rare opportunity for caregivers to have an open dialogue about the emotions that go with being a caregiver.
At the University of Pennsylvania, where Snyder went to medical school, there is a required 18-month course called “Doctoring.” Each beginning medical student is assigned to have at least one home visit and monthly contact with a family living with a chronic illness. Their only purpose is to try to understand what it’s like to live with illness. And yet, says Dr. Paul Lankton, who directs the course, “in the process, they get to know the patient as a person and not just a container for a disease.” The most important lesson, he says, is that disease occurs not just in bodies, but in lives.
Several hospitals around the region also offer a program called “narrative professionalism.” In small groups, medical residents write about an episode in which they struggled with deeply emotional or moral dilemmas. Sharing it with the group, they come to understand that colleagues struggle with the same insecurities they have. And because they have 10 minutes to reflect on their experience, some of the essays poignantly capture the humanity of the doctor-patient relationship.
Finally, St. Luke’s Hospital in Bethlehem, Pa., is developing the Center for Physician Success and Well-Being. The plan is to provide practicing physicians with emotional support services, education and even psychotherapy when needed, and to run workshops on resilience and healing for both doctors and patients.
Its director is Dr. Marsha Snyder.