Ross University Blog

Teaching Empathy in Medical School Benefits Future Patients - by Dr. Joseph Flaherty, RUSM Dean

May 20, 2014

Dr. Joseph A. Flaherty, Dean and Chancellor at Ross University School of Medicine

Dr. Joseph A. Flaherty, Dean and Chancellor at Ross University School of Medicine

It has become increasingly clear that physicians’ interpersonal skills are essential to their practice of medicine. The link between the lack of such skills and adverse outcomes has come into focus in recent years in relation to medical malpractice claims. Dr. Gerald Hickson and his colleagues at Vanderbilt University have shown that patient complaints are as likely to be related to physician behaviors as the more serious medical problems being treated. They have developed an intervention program that has proven to be remarkably effective.  It starts with peers talking candidly to physicians identified at high risk for such complaints.

Most physicians at high risk are unaware that their lack of empathetic behavior might be the cause of patients’ complaints. Malpractice is only the tip of the iceberg when it comes to concerns patients have about their encounters with physicians. The larger issue is the number of patients leaving doctors’ offices feeling that they have been misunderstood, unheard, and were not being involved as partners in the decision making. Partly addressing these concerns, the United States Medical Licensing Examination (USMLE) has made significant changes in its Step 2 Clinical Skills exam, now focusing on interpersonal behavior as much as clinical thinking and problem solving.

At the core of efforts to improve physician behaviors and communication is the question of whether empathy is innate or can be taught. The answer to this question is the same as for most complex behaviors; there is an innate component that may set range limits of behavior within which there is great opportunity for environmental influences, including education. Some of the most compelling films I have viewed on the development of empathy show the responses of children of different ages to a frustrated and crying child. Younger children react only by  looking up to see what is going on, while older children approach the crying child and offer a toy or a pat on the back. These types of empathic behavior, which have been shown to increase with age, and to develop earlier in girls, have wide individual variations, which may continue into adulthood.

Those who view interpersonal skills such as empathy as innate favor a selection process for medical school that looks for these skills in prospective students.  This is done by means of an interview which, while I believe is helpful, I do not think that it can accurately select for empathy. Forty years ago, when the vast majority of doctors went into primary care, perhaps they self-selected for their interest in the human dimension of practice. Popular television shows at the time, like "Dr. Kildare" and "Marcus Welby MD" highlighted this phenomenon. Currently medical education is taking good advantage of high technology and the scientific skills needed to practice good medicine. Not surprisingly, television shows like "HOUSE," which featured a phenomenal diagnostician with weak interpersonal skills, or the more likeable character in the UK series Doc Martin are popular among students.

Can we teach empathy to our students? Yes!  Last year Batt-Rawden and his colleagues in the UK published a review in Academic Medicine of 18 studies on the teaching of empathy, showing that you can improve empathy in medical school as well as reverse its decline. Effective programs to achieve this goal included basic interview courses, and learning through drama, writing, creative arts, and mentoring experiences. Evidence from other research suggests close observation and videotaping of student patient encounters, with feedback provided in small groups, can help students to focus on the subtleties of patient communication, to more correctly perceive patient affect, and to ask clarifying questions that permit mastery of one of the essential tools of empathy -- correctly identifying patient affect and responding to it.

Can we do better at Ross University School of Medicine? Of course we can. We should also take full advantage of the experiences we have in place starting with interviewing the patients in our host country, Dominica, and continuing through the tremendous diversity of practices and patient demographic experiences in the US and UK. We need to emphasize this aspect of learning to the advantage of our students and to the benefit of their future patients.

Tags: Leadership

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