If possible, think back to a time you or a loved one had to be in a hospital for a significant amount of time. What do you remember from the experience?
Many people report an eerie feeling about their stays in hospitals. Even if everyone treating you was kind, attentive, hard working, efficient and competent, you may still have had a sense that—compared to other situations in which people were intensely looking after you—something was different about being in the hospital. With all the measuring, palpating, listening for abnormal body sounds, injecting, and imaging of your innards, you may have felt treated like a kind of object, rather than a complete person. You may have felt, in a word, dehumanized.
Dehumanization is generally a negative state of affairs. Few patients like to be objectified, and when in a hospital, most desire empathy from their caregivers. It is for these reasons that the regular reaction to dehumanization in medicine is to condemn it outright. The medical establishment regularly institutes various forms of empathy-awareness programs.
A curious observer might ask a more basic question: why is a lack of empathy a perennial problem in clinical settings in the first place? Why the perpetual need for empathy education? Certainly not every profession has these hurdles, nor requires such measures.
Recent research on how medical professionals’ brains function sheds light on these questions. Specifically, two experiments by Jean Decety and colleagues of the University of Chicago have examined the neuroscientific basis of pain empathy in physicians.
In one experiment, physicians who practice acupuncture (as well as matched non-physician controls) underwent functional magnetic resonance imaging (fMRI) while watching videos of needles being inserted into another person’s hands, feet and areas around their mouth as well as videos of the same areas being touched by a cotton bud. Compared to controls, the physicians showed significantly less response in brain regions involved in empathy for pain. In addition, the physicians showed significantly greater activation of areas involved in executive control, self-regulation and thinking about the mental states of others. The physicians appeared to show less empathy and more of a higher-level cognitive response.
This finding raised a further question. Perceiving pain in others typically involves two steps. First people engage in the emotional sharing of pain with another person, and then they make a cognitive appraisal of the emotion. Do physicians automatically feel empathy for the pain of others, but then quickly suppress it? Or is the cognitive suppression of empathy even deeper; has it become more automatic? Is it possible that the physicians no longer even experience the first step of empathy for pain that regular people show on their brain scans?
The investigators repeated the same experiment but rather than looking for changes in brain blood-flow by using fMRI, they assessed the brain’s event-related potentials (ERP). Results showed that when viewing the painful needle sticking, the physicians did not even show the early empathy response. The physicians had apparently become so good at empathy suppression that there was no early response to worry about.
Why might these effects exist? It could be that, compared to other professions, the people that gravitate to healthcare tend to be less empathic. This seems unlikely. Furthermore, studies of physicians show that they are often the most empathic and caring towards the beginning of medical school, and that they become steadily less empathetic with more clinical training. The more likely culprits are therefore the nature of medical training and the intrinsic demands of the profession.