We are all sitting in the classroom, staring at the Powerpoint. Our eyes lock on the trajectory of a line graph. It increases a bit and then plummets.
The graph we are staring at is a part of a lecture with some nebulous title like “Professionalism in Healthcare.” It is showing the results of a study that assessed the trajectory of empathy during medical school training. It looked like this: The line starts high and then after the pre-clinical years it plummets. I remember looking at this chart and for the first time, faced with the impending extinction of my empathy, feeling true “Fear of Medicine.” I would like to acknowledge this fear, the fear of losing empathy in a career in medicine.
When I graduated from college, I joined Teach for America and had no intention of going to medical school. At one point in the school year I invited local medical students into my classroom to teach my middle schoolers about the heart and lungs. They brought real cadaver organs, stethoscopes, and wore their white coats. A few of my students came up to me and said, “Ms. Shatten, I want to go to medical school!” I heard myself respond “Me too!” Being a teacher is arduous; as a science teacher, I could not see enough tangible change in my students. I felt as though I was pouring all of my energy into a bottomless pit of phone calls to parents, battles with the copy machine, and concocting yet another scheme to ensure that all of my students had pencils. The system was failing. I saw them 45 minutes a day in classes with at least 25 students. I did my best to meet them at their level and through the power of high expectations try to create a micro environment where they could achieve. But it wasn’t so. One student can’t stay seated for more than three minutes; another threw a book out of the window, and two more are in a full blown fist fight and it is only second period. It is only 7:45 a.m. That said, I felt that I retained ALL of my empathy and NONE of my energy. There are many parallels to medicine here— the difficulty of solving problems on an individual level that are a result of a systemic issue, the lack of control, the challenge of behavioral management. So, I applied to medical school fearing the sustainability of the career…
Three things have gotten me through with my empathy intact that I would like to share: 1- connecting to something creative, 2- keeping a cadre of like-minded people around, and 3- fighting for the bigger picture of social justice and public health both outside of medicine and also in the role as a medical professional.
First off, my personal her, Mae Jemison. She is a doctor, an astronaut, and a dancer. When she speaks about what makes a good doctor, it is drawn from her experience as a dancer growing up, learning to trust her body. Because of this, she believes in truly LISTENING to her patients. Dr. Abraham Verghese tells the same story of emphasizing the value in the ritual of the physical exam. Touching your patient, listening to your patient, engaging in empathy. Verghese is a doctor, an educator, and a writer.
Keep your hobbies! In his 2005 graduation speech to Stanford University, Steve Jobs talked about the impact that a calligraphy class he took after he dropped out of college had on his life. He said that it defined the aesthetics that were so fundamental to Apple and Pixar, but he only realized it by connecting the dots backward. We never know how the beautiful things in our life will impact the future, so stay connected with them. Connect to something creative.
Dr. Arthur James is an ob/gyn whose mission is to reduce African-American infant mortality. He advocates both on an individual level with his patients and also on a political level, relentlessly talking to legislators about systemic policy change. During Grand Rounds he was asked how he can possibly sustain doing what he does, while sometimes being shunned and ostracized by his colleagues and the greater academic and political community. His answer, “Keep a cadre of like-minded people with you, because speaking truth to power will make you feel insane.” While there may be no shortage of like-minded people for us here in Burlington, we must keep them close as we go off into the world because we all must continue to speak truth to power. Keep that cadre.
Which brings me to the third strategy for retaining our empathy: Invest in patient advocacy and social justice. Geoffrey Canada is the founder of the Harlem Children’s Zone, a teacher, an author and an activist. I saw him speak in the Teach for America Summit in Washington D.C. in 2011. He talked about his parents and their fight in the civil rights movement. He said that when they were fighting for their rights, they were willing to die for the cause. They were willing to DIE. He urged us young teachers to stay angry and to think about students every day. It is not about us…it is about the students. In challenging moments I try to remember the same thing. At the end of the day it is not about me, but about my patient and that advocacy is essential. In the quest of trying to weed through what it means to be a “good doctor,” I have landed on this notion again and again. In his autobiography, Oliver Sacks, a prolific neurologist, writes about one patient that he cared for in residency who had a terminal illness and was likely to die within a few days in the hospital. He confided in Sacks that he had never been on a motorcycle, but had always wanted to. Sacks snuck him out of the hospital for one last adventure. I am not touting joy rides with our patients, but the spirit stands.
Connect to something creative, keep a cadre of like-minded people, and fight for the bigger picture.
Medical school challenges us in many ways. It brings out the essence of our humanity as we get close to the edges of the life cycle. We have a hand in birth and a hand in death. We have had our hands on skin and on livers. And many of us have been witness to suffering in ways that we still have yet to process. I am confident that we will change the landscape of healthcare for the better if we are advocates and if we are empathetic. And we will be.
Since that first lecture essentially outlined the demise of our humanity, a meta-analysis was published that focused on whether empathy levels in medical students changed over time. The results of this study? Students remain empathetic after all. We did it.
- Canada, Geoffrey. Teach For America 20th Anniversary Summit. February 13, 2011.
- Hegazi, I., Hennessy, A., & Wilson, I. (2017). Empathy Levels in Medical Students: Do They Really Change Over Time? Empathy – An Evidence-based Interdisciplinary Perspective. doi:10.5772/intechopen.69625
- James, Arthur. UCSF OBGYN Grand Rounds. January 30, 2018
- Jemison, Mae. “Teach arts and sciences together”. TED Talk. May 2001.
- Jobs, Steve. “How to live before you die”. Stanford Commencement, 2005.
- Sacks, O. (2016). On the move: A life. New York: Vintage Books, a division of Penguin Random House LLC.
- Verghese, Abraham. “A doctor’s touch”. TED Talk. 2011.