Blog | Thursday, May 30, 2013

The third year of medical school--jaded yet humane


Recent research suggests that medical students lose empathy during the third (the main clinical year) of school.

Talking with end of the year third year students might make you think differently. Understanding the psychological changes that likely occur during the third year should make you think differently.

Medicine seems easy during the pre-clinical years. You get smokers to stop and prevent COPD and coronary artery disease. Patients just need to listen to our advice and their clinical outcomes will improve. The answers are clear (and either a, b, c, d or e) during the preclinical years.

But the third year exposes our students to the realities of human beings and our society. No longer are patients homogeneous in their willingness and ability to change. No longer do all our stories have happy endings.

Our first exposure to clinical medicine creates angst, shock and disbelief. We often see the brutality of disease, and recognize that many patients with severe disease could have prevented their affliction through life style changes. We see patients come in with drug overdoses, the same patients who demand that we give them more opiates for the pain. We see the ravages of alcohol, smoking, obesity and illegal drugs.

This exposure leads to many students and residents becoming jaded. At first we focus on the apparent futility of making diagnoses and giving recommendations. We focus on our society not having provisions for the unfortunate to receive necessary outpatient care and medications.

But as you talk with third year students you hear their struggles with the jadedness. You hear them trying to emulate physicians who have passed through the jaded stage and who have regained their empathy.

We should not despair about the physicians of the future. We should continue to help them cross through this jarring yet necessary first exposure to the world of disease and the world of health.

For what we do remains noble. Most patients want to improve their lives and adhere to our appropriate recommendations. We often do make a major difference.

Today I gave a patient a rather tough love speech about the root of his problem. We opined that he may not respond "appropriately." The residents were particularly jaded, because they see the patients who do not listen and change. But we all forget that we often do not see the successes, unless they occur in our clinic population.

We must remain optimistic and accept a batting average that is reasonable. Each patient deserves our humanity. Some patients make it difficult, and I will admit that sometimes we fail. Some patients push our buttons and turn on the jaded switch.

But I believe that our students will continue to work through the challenges of becoming a truly empathetic physician. And we should not bemoan the psychological changes of the clinical experience but continue to help our students and residents to grow and succeed.

db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Associate Dean for the Huntsville Regional Medical Campus of UASOM. He also serves as a frequent ward attending at the Birmingham VA Hospital. This post originally appeared at his blog, db's Medical Rants.