Brain scans suggest doctors learn to shut down empathy
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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.
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30 Comments
Add CommentWhat is missing is TIME for empathy. I just had a family member in the hospital and the doctors, nurses and CNAs were spread thin. They were spread so thin that mistakes were made such as IVs run dry. There were times when I couldn't find a single person to ask for help. And yet the hospital was adding a new wing. No money for personnel though. I later talked to someone who had worked there who said that the CNAs are all part time with no benefits so that they can't even afford health care for themselves. There is no laundry service so they have to wear their dirty scrubs home and wash them themselves. Our medical system and its profit motive are without empathy.
Reply | Report Abuse | Link to thisYes but they say we have the best health care in the world? At least that's what the repugnicans say!
Reply | Report Abuse | Link to thisTake it from a Brit that there's plenty of lack of empathy on display in a healthcare system not run for profit.
Reply | Report Abuse | Link to thisIsn't it also likely that they don't feel empathy because they are inflicting pain in order to heal? They know in the long run that the pain will be positive. I know I'm a nurse, and that's how I tend to think of it.
Reply | Report Abuse | Link to thisMay I suggest a further resources to learn more about empathy and compassion.
Reply | Report Abuse | Link to thisThe Center for Building a Culture of Empathy
The Culture of Empathy website is the largest internet portal for resources and information about the values of empathy and compassion. It contains articles, conferences, definitions, experts, history, interviews, videos, science and much more about empathy and compassion.
http://CultureOfEmpathy.com
Also, we posted a link to your article about empathy to our Empathy Center Facebook page.
http://Facebook.com/EmpathyCenter
I started out as a healthcare technician years ago. And left. As I saw more and more people in need, I could see myself becoming desensitized. Always nice, but desensitized nonetheless. Seeing my empathy wane was more than I could bear. And the last thing patients need is a provider that is involved at an emotional level. I want my providers to see me objectively as a piece of live meat that needs to be fixed. What I think we really need is a healthcare administrative 'system' -including insurance administrators- that demonstrate empathy and compassion. That is where we are sorely missing humanity. Not at the provider level.
Reply | Report Abuse | Link to thisBut TR001, is it as bad on that side of the pond as Cosmic's experience? Maybe a lack of empathy as necessary for the health care professionals to do their work. But Cosmic describes a situation which is way over the top, as well as sadly typical.
Reply | Report Abuse | Link to thisResporting to political name calling invalidates anything you have to say. (Even though your point is well made and accurate)
Reply | Report Abuse | Link to thisMy experience in 3 different hospitals is different than the unempathetic situations described. Maybe it is just my perception of the individual situations. Never the less I found doctors very empathetic and not cold. The nurses and technicians and other staff equally so.
Reply | Report Abuse | Link to thisThere is a big difference between empathy and sympathy. An empathetic care giver understands your pain and deals with it. A sympathetic care giver understands your pain and chooses to share it to the detriment of both. An unempathetic care giver wouldn't care and would probably be inclined to not use anesthetics because they wouldn't care if it hurts and it is cheaper not to use them.
The stupid thing about this study and article is that acupuncture rarely causes pain. Anyone who has experienced acupuncture knows this. So what's going on is something completely different. Unless, of course, the real intention here is to cast aspersions on acupuncture, which wouldn't surprise me. Not much does these days when dealing with the medical profession.
Reply | Report Abuse | Link to thisI quote the article 'This constitutes an inherent trade-off in medicine because the human brain does not have infinite computational resources or time to perform both tasks equally well'.
Reply | Report Abuse | Link to thisI disagree with the above sweeping statement. There is no hard scientific evidence available to conclusively deny or reject the brains extraordinary abilities in this particular area. I believe it is possible for anyone, be they a doctor or a friend, to empathise and problem-solve equally well simultaneously. The mechanisms of this are unknown at present, one possibility is a switch. Many factors play a role in determining the efficiency of brain functions. Not everyone is the same. More reasearch is evidently required to delve in to the mysterious workings of the human brain as well as the mind. Are they authors speaking from the point of view of the 'brain' or 'mind'? Interesting.
Highly sensitive people should not go into health professions. If nurses and doctors reacted physically and emotionally to patients they could not last a shift. It would wear them down. I worked in mental hospitals and retarded institutions and if you carried your heart on your sleeve you'd burn out in no time. I saw a lot of burnout. Lots.
Reply | Report Abuse | Link to thiscreate a empthay box- where they will be able to feel what I feel on a daily basis and then we will talk . Smart guy(s). my pain, my everything. smart guy.
Reply | Report Abuse | Link to thisI don't know what "resporting" means, but repugnicians strikes me as a useful neologism.
Reply | Report Abuse | Link to thisA very large part of the problem in the lack of empathy on the part of physicians is sociological. The training of physicians is akin to hazing, which at times is downright sadistic. The eventual reward, dangled like a carrot at the end of this process, is an elitist membership in what can only be construed as a "false class" wherein physicians tend to grandiosely see themselves as members of the upper or ruling class of society, when they are mostly middle class at best. Also, they come away from their training viewing themselves as members of the intelligentsia which is quite seldom true. The gruelling, regimental training process that they endure usually leaves them little time to develop the erudition gleaned from the broader academia of a graduate university curriculum, from which they are ordinarily excluded. There are indeed exceptions to this but they are sadly rare. Physicians tend to socialize with physicians as if others cannot understand or appreciate them. Again, because of the excessive (and largely unnecessary) rigor and length of their training commitment they are often socially awkward amongst cosmopolitan, non-physican peers. There lack of empathy and tendency toward aloofness results from defense of the ego.
Reply | Report Abuse | Link to thisI feel like the authors of this article don't quite have a solid grasp on what it's like to be a healthcare worker, or at least trivialize the hurdles of being more empathetic. And I sure hope they're not implying that the healthcare system isn't successful because doctors aren't empathetic. I feel like they would've gained more insight and information by working in a hospital for a day. And I'm not talking about a bourgis, NASA technology-tricked out, 5-star service hotel-like hospital. If they want to know why healthcare workers don't seem very empathetic, dig a little deeper and look the system itself, and what it puts them through.
Reply | Report Abuse | Link to thisI really liked your response , as did I several others here too. Well done, better said! Thanks. A disabled person who needed to jump through flaming hoops 101 stories high to have someone RX me adequate pain meds. sure, oxycontin is being blasted in the media as it should <not?> be dut to the small criminal element doing stupid things and worse..... and then EVERY single doc .. well my stories are too painful and long for here. My current doc seems to fresh out of school & very empathetic ~ but still covers his back / practice and credentials like a hawk and ...
Reply | Report Abuse | Link to thisI think its about resilience too. Some HSPs make excellent caregivers due to their nature and gift. In fact HSPs are known to seek out caring roles be it humans or animals or the planet/environment. Its someones passion and strong desire that motivates that person in the first place.
Reply | Report Abuse | Link to thisThe way doctors put a firewall between he/she and the patient is called "instrumental dissociation". If such kind of protection measures were not implemented, MDs will share the pain and deaths of all patients like if the patients were close relatives, an unbearable suffering for a professional of medicine
Reply | Report Abuse | Link to thisAs a doctor who deals with pain management day after day, I found this article and the accompanying comments very interesting. As any medical worker will tell you, any sort of emotional relationship with one's patient compromises one's ability to make reasoned decisions on that patient's behalf. This includes empathising with the patient's pain, disease state, social circumstances, or whatever. It is this paradox that stands behind the long-held tenet that doctors should not treat their own family.
Reply | Report Abuse | Link to thisAs soon as emotion enters the equation, a lot of rationality goes out the window. As an anaesthesiologist, I have seen this several times in the operating theatre environment - it is just not possible to remain coldly clinical when the patient on the table has a significant relationship with any of the staff present. I have no doubt that I perform at my best in times of crisis when I am totally detached from the patient - and isn't this what the patient would wish?
As a retired therapist as well as retired adjunct in psychology and sociology, I recognize that the concept of empathy may be confusing. It is the willingness to put one's self in the place of a sufferer. This need not preclude the necessity of "clinical distance", which very well should be in place for making vital decisions. Many of the more empathic physicians to be found are counted amongst the volunteer physicians who have joined Doctors Without Borders. It is not necessary to become so enmeshed with patients that one dies a thousand deaths at every loss. Empathy is found in degrees rather than in an either/or situation. It should stop somewhere short of loss of perception - certainly short of what might be termed ego merger. The very best health care workers in hospice and palliative care are necessarily empathic and, yet, do not lose perspective. The idea that one must emotionally relegate a patient to a semi-nonentity status in order to arrive at sound medical decisions does violence to the physician-patient relationship. It also is at the very heart of the enormity of malpractice suits in the U.S. I would suggest that physicians "put a little love in their hearts" and then watch their premiums go down. I am not for a moment suggesting engaging in some sort of cynical play-acting as that would be quite transparent to many if not most patients.
Reply | Report Abuse | Link to thisIn the army I had the opposite problem. I was freshly trained as a lab technician. I first went to Korea and spent most of my time on "short arm" inspections, taking and checking Gonorrhea smears, mostly positive. Things were winding down there, so I was transferred to a Army bacteriology lab in Tokyo, where I processed 100s of numbered Petri dishes and vials a day, often looking for E. Coli in the food supplied by Japanese farmers. The necessary anonymity put me half asleep, which led to becoming a medical warehouseman.
Reply | Report Abuse | Link to thisThe findings seem consistent with evidence unearthed by behavioral neurologists that reason requires feeling to perform its function properly. While patients all want star specialists, what they should worry about is whether their care-givers have established a way to effectively communicate with one another about their patients.
Reply | Report Abuse | Link to thisTo me this is a simple issue of health care professionals simply running out of steam. Imagine if we were expected to feel empathy every time we heard about some victim of a crime, a natural disaster or an accident. Who has the energy for this? Maybe they're just tired! If you had to spend all day FEELING your patient's pain and suffering, especially when it is frequently horrific, what would you have left for your family and friends when you got home?
Reply | Report Abuse | Link to thisHere is my prescription: full time health care workers actually should work no more than 40 hours a week and never longer than an 8 hour shift, with a 1 hour break or 2 30 minute breaks. Outlaw 18 hour shifts, including and especially for residents.
These studies are telling, but unfortunately not all that surprising. One possible way to address this issue is integrating meditation in the medical education. Psychologists like Shauna Shapiro and Daniel Goleman have conducted studies demonstrating that meditation increases empathy, including studies with medical students.
Reply | Report Abuse | Link to thisI entirely agree with dick214. I am a retired clinical psychologist and worked with medical staff at all levels in a wide range of different specialties and for many years served on the complaints board for a regional health service. I am also very familiar with the research on empathy. I am convinced that the best clinicians, whatever their sphere of practice, are always able to retain an empathic perspective with damaging their technical judgement or skills.
Reply | Report Abuse | Link to this'without damaging' - apologies for typo
Reply | Report Abuse | Link to thisMore discussion needed on pain thresholds for different personalities. Empathy should be available at least as an abstract measure for encouraging cooperative and preventive medicine. Pain is a two way street. If the health care provider cringes, so will you! Pain in its full meaning is intelligent data waiting for reaction and not something to be numbed by politics, finance and religious dogma. A little properly applied anesthesia or placebo at the clinic may dramatically reduce the patient's time agonizing about the potential consequences of enduring a procedure where the goal would be to avoid the pain of infection in the long run. Some people may actually prefer sensing immediate pain wholesale by weathering it out in a scaled and proportionate manner. It is all in the delivery, which, after all, is no less a mature and rational form of empathy.
Reply | Report Abuse | Link to thisof course we all know that's true...if we watch House that is
Reply | Report Abuse | Link to thisA medical website allows your practice to break through the geographical barriers and become accessible globally: http://www.technicaldr.com/tdr/websites-for-doctors
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