Thoughts and insights from medical students
You can take a horse to water...
During the course of a clinical skills teaching session, I was struck by the onus placed upon the use of empathy by medical students during patient consultations.
Since the first year of medical school, the advocacy of empathy during consultations with simulated patients has been a recurrent theme. While I can appreciate the potential benefit of empathy to a patient if it is real and hence valid, I fail to see the merits of employing empathy irrespective of what the medical student really feels. Since Carl Rogers wrote his seminal paper on empathy in 1959, very little has emerged in the way of new theories around this subject. In his paper, Rogers espouses the concept of self as “the organized consistent conceptual gestalt composed of perceptions of the characteristics of 'I' or 'me' and the perceptions of the relationships of the 'I' or 'me' to others and to various aspects of life, together with the values attached to these perceptions. It is a gestalt which is available to awareness though not necessarily in awareness. It is a fluid and changing gestalt, a process, but at any given moment it is a specific entity”. (Rogers, 1959)
Put simply, every student arrives at medical school from a wide variety of backgrounds. They come from different countries, different family dynamics, different exposure to life experience and most importantly, different perspectives regarding the world and people around them. It is thus unreasonable to expect all students to be able to display empathy to a given patient because all the students have come from such widely disparate backgrounds. If, through upbringing for example, a student has just not been exposed to empathy themselves by their significant others, I just can’t see how they can genuinely show it to patients, simulated or otherwise.
A few years ago, I had a major operation and so became a patient for about a fortnight. During this time, it was interesting to observe the empathy shown to me by a wide variety of health professionals. Some showed empathy to my position and evidently felt it. That is to say, they weren’t just showing it to fulfil a GMC requirement. However, I also encountered the opposite whereby a given health professional would feign empathy for my position. The transparency of such an empty gesture was both unwelcome and unappreciated.
My point therefore is to question why we as medical students are being encouraged during patient interviews to show empathy at all times. If it is merely to gain an extra mark or two in an OSCE station, this is rather sad and pointless. But if it is being espoused in the vain hope that repetition will one day suddenly make it genuine, I fail to see how. As Rogers said, our self is a fluid and changing gestalt but it is also a specific entity at any given moment. In other words, we are who we are. If this person is not the living embodiment of empathy as a result of their erstwhile life journey, we have to accept this. Otherwise, we must surely begin the process of screening potential medical students for empathy at the time of interview. Clearly, such a suggestion would be both absurd and unworkable.
I therefore return to my original assertion that the promotion of empathy for its own sake during consultations can’t be employed on a “one size fits all basis”. Furthermore, I have grave reservations as to why it’s use is being endorsed in this way in the first place. My fear is that it is a way of our profession trying to make itself look good rather than just trying to be itself.
To try and demonstrate my point, I would draw attention to the many compulsory plenary sessions which we attend as medical students. These are classroom based sessions when groups of up to a dozen or so students are exposed to a variety of important medical subjects for the purpose of promoting group discussion. Almost without exception, such sessions entail one or two students embracing the discussion while the others watch the painful progress of the second hand on the clock. It is almost always the same one or two students. I do not take the other students to task for their non-engagement but rather question the wisdom of such compulsory sessions if it is blatantly obvious that the majority of those attending are doing so only out of obligation. As the old saying goes, “You can take a horse to water but you can’t make him drink”. These efforts by those who run and put together our courses are visibly not working. It is not legitimate to claim that a student has engaged with a subject such as subjective patient pain if they have literally just attended and not even pretended to engage. This is a tick box in all its glory whose worth to progress is negligible. Of course for the minority of students who do engage with these sessions, they will doubtless take something away from the session. However, even though the others will take little away from the session, at least they have been themselves and not engaged to comply with some GMC expectation.On reflection, perhaps the time has come to re-evaluate how we approach these subjects. If they really are as important as we purport them to be, we need to have another look at the way in which we incorporate them. Of course, there may be other reasons such as tiredness which may contribute to non-engagement. However, the basic person within will remain the same. For all the research which has followed the work of Rogers, nothing has significantly changed his assertion from 1959. With this in mind, isn’t it about time we accepted that people are different and forcing them to be the person they are not is a doomed policy?