...and in MS3, you lose your empathy

[jfoxcpacfp]

Just finished a very interesting and (I thought) insightful book into how some doctors think while practicing and the effect of various factors on doctors' emotions. It is What Doctors Feel by Danielle Ofri, MD who practices at Bellevue Hospital in NYC. I particularly found doctor humor interesting and the change in MS3 from classroom to hands-on experience and the impact on empathy (according to scientific studies, not her opinion, but she has written an article for Slate on the subject). Wondering if anyone else has read the book - are her findings realistic?

She also discussed The House of God, which I have on my to-do list. Apparently, it's a classic read for doctors. True?

[DMFA]

House of God is mandatory reading.  Yes, it's cynical, but negativity has to be addressed, not ignored.

And yes, when you actually start seeing patients, you do learn that a lot our education, effort, and empathy is wasted...but that doesn't invalidate it for all the times when it makes a profound difference.

[conniebird]

Have read House of God. I prolly have a different opinion than most because of my background, so don't mean to offend anyone. Everyone has a different tolerance for mental stress and "abuse" that can occur during training. Depends on your genetic makeup, how you were raised, etc. I do think most MDs are "tough" or become tough to deal with training.

I had a bob/different career for 4 years before embarking on training, as well as more life experiences than most of my peers. Not saying I left med school unscathed, but I did feel like I was able to handle certain things better than most of my peers because I was a little older, etc. Although I did have a mini melt down when I realized how hard derm was to get into and it was looking slim that I wouldn't get in (another story).

In a high volume outpatient practice it's easy to just  churn through patients but I still get humbled by my patients and their diagnoses (yes I treat more than just acne and warts!). I also see sick patients in the hospital which I really enjoy.

[shantster]

I've never read the book so I'm not sure the conclusions she draws from it, but these are my thoughts on the subject. I think this is still going to be highly individualized based on each person and specialty, and a big goal of training should be to make sure you match your own personality with the current career path.

[VagabondMD]

I read Ofri's book about a year ago (maybe longer) and found it to be quite realistic. If anything, she is more thoughtful and empathetic than most. At one time, she was a regular contributor to the NYT Health section, but I do not recall reading her column for some time.

[Zaphod]

House of God is very outdated as far as training paradigms go, so most residents now wont live through those kinds of conditions. Also, he was a bit of a cynical person, however, there are some excellent takeaways in that book that are shrouded in cynicism but really are great.

[The White Coat Investor]

Shrouded in cynicism and pornography!

Some empathy is lost as an MS3 as you come in contact with real patients. That's totally natural. You realize there are some crazy, violent, scamming, malingering, anxious folks out there. Plus you get used to death, dying, very sick, bleeding etc so it doesn't phase you quite as it did before.

But to really beat the humanity out of you I think you probably need to do an intern year in residency.

[squirrel]

conniebird wrote:

Have read House of God. I prolly have a different opinion than most because of my background, so don’t mean to offend anyone. Everyone has a different tolerance for mental stress and “abuse” that can occur during training. Depends on your genetic makeup, how you were raised, etc. I do think most MDs are “tough” or become tough to deal with training.

I had a bob/different career for 4 years before embarking on training, as well as more life experiences than most of my peers. Not saying I left med school unscathed, but I did feel like I was able to handle certain things better than most of my peers because I was a little older, etc. Although I did have a mini melt down when I realized how hard derm was to get into and it was looking slim that I wouldn’t get in (another story).

In a high volume outpatient practice it’s easy to just  churn through patients but I still get humbled by my patients and their diagnoses (yes I treat more than just acne and warts!). I also see sick patients in the hospital which I really enjoy.

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Have to agree a little here (though I am not in derm).  "Non-traditional" student as well so I also feel I approached med school differently than many of my fellow MS3s and probably had developed more adult coping skills as well as time management.  I have not read House of God (though maybe some day will).

 

I would say that I find my own empathy wanes if I work too much.  This also may be part of the reason.  Though compared to intern year it is easier as you can skirt out of the hospital better, MS3 often is the first time when med students have to answer to others, and have their schedule and time dictated by their education and not the other way around.  The hours can be demanding for those who maybe only had a full time job during summers in the past until that point.  Empathy only lasts so long if you are sleep deprived and fatigued.  Also for some first really dealing with patient, agree with other posters that you begin to see how much you are dealing with variable personalities (and personality disorders) in the patients and families you encounter.

[G]

House of God is certainly a bit dated (e.g. as far as I can tell, interns never get less than 8 hours of sleep every day these days....)  However, I loved it and believe it to be mandatory reading for doctors.  I read it as a third year student, as an intern, and again after about 10 years as an attending.  Appreciated it for different reasons at each of those stages of life.

However, as my surgery clerkship director said--describing how sleep is vastly overrated, and spending time outside the hospital is heretical--"that guy that wrote House of God really had a bad attitude.  I mean, he wasn't even a doctor, he was a psychiatrist!"

Sorry, psychiatrists, but I hope that makes you chuckle too, because that was coming from a guy who had been divorced 2 or 3 times.

[Kamban]

I have not read the book but I feel that certain people are born or instilled in early years with empathy and caring, and these people hang on to it throughout their life. And some want to go into medicine just to have good money and good lifestyle. These people hardly have any empathy and no amount of special classes in medical school will cure that. There is also a certain percentage of people who go into medicine with altruism and wanting to save the world, get jaded and lose it by the time they finish residency.

I was lucky to be raised to respect others and not have any medical school debt. My lifestyle till now has been simple and I have not chased money needing to pay back loans. I have not sent a single patient to collections and take the attitude " you win some, you lose some and overall you come ahead". But I can certainly see the other side of the coin, with physicians having $300-400K in medical school  loans and wanting to earn money in order to pay them back quickly. Sometimes they don't know where to slow down after earning the huge amounts.

[Josh0731]

Kamban wrote:

I have not read the book but I feel that certain people are born or instilled in early years with empathy and caring, and these people hang on to it throughout their life. And some want to go into medicine just to have good money and good lifestyle. These people hardly have any empathy and no amount of special classes in medical school will cure that. There is also a certain percentage of people who go into medicine with altruism and wanting to save the world, get jaded and lose it by the time they finish residency.

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This is overly simplistic and tries to make things too black/white when life is gray/grey.  In my experience people don't fall into categories so easily.  For instance, you could have a fluid mixture of all of the sentiments you describe within the same person, with differing proportions evolving over time.  Have some empathy!

I seem to recall that one of interesting things about being an MS3 is that you are suddenly thrust into regular contact with populations of people you never previously had reason to be around.  I met my first PCP user, paranoid schizophrenic, etc, etc, etc that year, and it does give you a lot of food for thought.  But if there are MS3s sitting around philosophizing about their empathy at this stage in medical training I cringe to think what years of 80-hour weeks are going to do for them.  Its a war without end and they've really only had the first skirmish.

Not to sound like a prude, but House of God suffers terribly from 1970s free love soft core, IMHO.  Its an interesting book for capturing that time period in medical training (long since passed), but I wouldn't call it a particularly 'good' or 'must-read' book.