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While the world population steadily increases, the supply of health care workers to meet their needs is not keeping pace, with primary care particularly undersupplied in both the US and the UK. In response, some schools have recruited more medical students—only to find that you can lead a student to preclinical classes but you can’t make them choose primary care. So what influences medical students in their choice of speciality?
A recent study by Daniel Chen et al found that students with higher empathy scores tended to choose more people-oriented specialties, such as primary care and psychiatry, over more technical specialties like surgery or pathology. These kinds of studies have been done before, but this one is on a relatively large scale, questioning 1162 students at Boston University Medical School over several years. In line with previous studies, they found that medical students’ empathy scores drop in their third year—the year they actually go onto wards and deal with real patients. While women tend to have higher empathy scores throughout, the drop in empathy occurs in both sexes—and the drop is greatest for those that have lower scores to start with.
And it’s not just doctors, third-year nurses have also been found to have lower empathy scores than first-years (apparently law students start out with lower scores and show no change after three years). Trying to figure out why this happens is like finding the murderer in an Agatha Christie novel —there are just so many suspects: the challenging and intense work environment, lack of sleep, callous mentors, frustrating patients—and the need to protect against being emotionally overwhelmed. In the end, it’s probably like ‘Murder on the Orient Express’ where everyone is guilty.
Chen et al also found that students with higher empathy scores were prepared to shoulder more debt at the end of their training. That could suggest that more empathic students are less motivated by money. This could also be a factor in choosing primary care which has lower potential earnings than many other specialisms.
Many medical schools do have programs aiming to sustain and develop empathy in their students, ranging from creative writing and role playing to shadowing patients on the ward. One recent addition to these strategies is the Donor Luncheon. This is where students have lunch with the family of the donor before going on to dissect them in anatomy class. Sheil Crow et al compared two groups of students—those who had the Donor Lunch with the donor’s family and those that just had the lunch. They found significant differences in how these students thought about the donor. Students who had met the family had a stronger sense of the donor as a person and a patient.
The fascinating paradox of empathy in the medical profession is the need to inflict short-term pain for longer-term gain. To this end, doctors routinely dampen down their response to a patient’s pain. But we also know that patients are more likely to get well when they feel their doctor cares about them. For example, patients with more empathetic doctors were found to recover more quickly from a common cold. In that study, researchers found doctor’s empathy was acting via the patient’s immune system.
At present, the battle to sustain doctors’ empathy in the face of compassion fatigue is already being lost during training. If we want more doctors at the front-line of patient care, then schools need to provide a learning environment that develops and sustains empathy during medical training, especially in the clinical years.
