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A Crash Course in Empathy

Docs-in-training learn the other side of an emergency room

SUNDAY, June 3, 2001 (HealthDayNews) -- To anyone who has ever spent hours in an emergency room waiting to see a doctor, this may sound like sweet revenge.

Administrators of a new program require doctors-in-training to do just that -- sit for hours while waiting to be treated. They hope the experience will give the students better understanding and compassion for what their patients must endure.

The program started in 1998 as a two-year pilot study at the University of Florida's Medical Center in Gainesville. But now, the exercise of assigning new residents a "pretend" physical ailment and making them wait in an emergency room alongside real patients with real health problems has become part of the training at the medical center's department of emergency medicine.

An initial study of the pilot program, published in a recent issue of the journal Academic Emergency Medicine, showed that residents indeed responded: They became more empathetic toward patients, changed their approach to patient care, and also perceived themselves as better doctors.

According to principal investigator Dr. David C. Seaberg, associate chairman of the university's department of emergency medicine, students often enter medical school feeling altruistic and compassionate -- qualities that bring many to the profession in the first place.

But then the pressures of the grueling training take a toll.

"The isolation, long hours, chronic lack of sleep, fear of failure and constant exposure to human tragedy they experience during medical school and residency broaden the emotional distance between doctor and patient and serve to extinguish those qualities," Seaberg says.

"When it gets really busy in the ER and there are 20 patients waiting, some resident may pick up a chart and say 'Ugh! What is this sore throat doing here! We're too busy.'

"But it's not that people aren't working hard, it's just that they're overwhelmed," Seaberg adds. "In training , we start to think of our patients in terms of diagnosis and treatment and not as patients. But we need to consider that the patient has been waiting for hours to be seen and deserves the same respect and courtesy as any other patient there."

In rating the value of the emergency-room exercise on a 100-point scale, the residents in the pilot study gave it an average of 50. And, Seaberg says, there were a few who didn't appreciate the experience at all.

"A couple of the residents were very unhappy with the exercise and thought it was a waste of time," he says. "But most felt it helped them recognize what our patients have to go through just to see a doctor."

Although attempts to increase empathy among people who've decided to dedicate their lives to helping others may seem like an easy task, experts say such efforts are actually very complicated.

"People do come into medical school wanting to be very compassionate," explains Dr. Brian Fink, an associate professor in the Department of Emergency Medicine at the University of Michigan Medical School.

"But medical training is very grueling, especially the residency part, and there is some amount of deterioration or desensitization of the individual. It's paradoxical, because it's just what you would want not to happen, yet it does happen.

"What's interesting is that it's probably necessary, because for someone to function on a day-to-day basis with really bad diseases and tragic things happening all around them is hard. If you were to absorb all of that, you probably wouldn't last very long in terms of your emotional stability," Fink says.

"It's really part of the art of medicine to have that balance between being compassionate and very caring for the patient but not let it get you to the point of not being able to function," he adds.

Judging from recent studies, however, Seaberg's program is not in vain. A 1998 report by the Society for Academic Emergency Medicine found that 64 percent of people say physicians lack compassion or warmth. And 72 percent think doctors spend too little time explaining prognosis, diagnosis and treatment plans or do not describe them well enough.

What To Do

Read more about emergency medicine in these HealthDay stories.

Or visit the Society for Academic Emergency Medicine for more information about medical students and emergency medicine.

And here's an interesting article from the Oxford University Press: From Detached Concern to Empathy: Humanizing Medical Practice.

SOURCES: Interviews with David C. Seaberg, M.D., associate chairman, University of Florida's department of emergency medicine, and chief of emergency services, University of Florida Medical Center, Gainesville; Brian J. Zink, M.D., associate professor, department of emergency medicine, University of Michigan Medical School, Ann Arbor; December 2000 journal Academic Emergency Medicine; University of Florida press release
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