Friday, July 8, 2016

Empathy, Research and the Medical Teacher

           In recent times, it is recognized that the quality of empathy is crucial for the successful delivery of health care.1 Empathy is a natural quality present in every medical student that needs to be fostered along with academics. It is known that students in the final year no longer feel as empathetic as they were when they joined the first year of medical course.2,3 The cause for the decline in empathy lies in the structure of modern medicine that is based on the laws of physical sciences requiring the use of predominantly logical thinking and action. Since subjectivity has to be excluded to learn objectively there is little room for development of subjective feeling leading to a neglect of intuition and empathy. Because of the tendency for decline of empathy during the course of medical education, several methods have been suggested to improve empathy among students and physicians. 4

Adding to the factors contributing to decline of empathy is the lack of understanding of the three psychological aspects of being a doctor: (1) Doctor treating the patient (Medical Practitioner), (2) Doctor updating himself to treat better (Continuing Medical Education) and (3) Doctor analyzing data and understanding new aspects of diseases and their treatment (Research).

The first aspect of treating the patient is the basic urge that drives the student to take up the career of medical profession. This interest in treating patients is what the society first expects from the medical profession. The purpose of medical education is to train doctors who can treat patients having different diseases with competence and compassion. The first task of the regulatory authorities should expectedly be to ensure that the medical colleges are equipped with appropriately qualified manpower (as well as infrastructure) to carry out this task.

The second aspect of being a doctor is the urge to keep abreast with new developments in the medical field so that he/she is able to improve the care given to the patients. This is a desirable trait and every doctor naturally has this to a greater or lesser extent. However for a qualified doctor who is already equipped with compassion and basic competence, the need to update oneself with medical knowledge is arguably best left to his/her own judgment.

The third aspect is the urge to learn from the information available while treating patients to understand unknown aspects of diseases and devise new treatment. Many doctors do this either by observation of patients over years or by methodically collecting data in designed studies, analyzing them and publishing their findings in journals.

The first aspect of being a competent and compassionate doctor does not depend on the second aspect of being updated with latest knowledge and even less on the third aspect of having interest in research and publication. Individual doctors who may be good in research may be found lacking in the ability to adequately care for the patient and vice versa, since different skills are required for these two functions.

When the regulatory bodies for medical education and practice do not understand the above three psychological aspects of being a doctor, it spells trouble. Though familiarity with research is needed, making publication of research papers compulsory for deciding the standing of a medical teacher seeks to whitewash all medical teachers into one category of having the capacity to do research whether or not they have the core capability of providing adequate patient care. In reality there is heterogeneity of medical teachers; some are good in patient care, some in doing research. Medical students learn different sets of skills from different teachers.

Given the central importance of empathy in patient care, the regulatory bodies have to ensure that under-graduate medical students are trained to treat patients with knowledge as well as empathy and the medical teachers set an example in this respect for students to learn from. While the medical teacher needs to be updated on the latest medical knowledge, the ability to do medical research is not a must for imparting basic medical education. Post-graduate medical education needs teachers who are capable of managing all types of cases while imbibing new medical knowledge with the added ability to impart their knowledge to post-graduate students. An ability to do research is only an added skill that may be taught to the students. Any doctor is welcome to take up research in a full-fledged manner if he/she is so inclined but that should be the individual’s choice.

Making publication of research papers mandatory for medical teachers is basically unsound. It can only ‘force feed’ research into those who are not inclined to it and spawn low quality and questionable research publications. It will shift the focus away from the need to train competent and compassionate doctors, which is of core importance from the point of view of a good health care system. The number of years of teaching medical students should remain the criterion to decide on the standing of a medical teacher, and not the number of research papers published by them. A nuanced approach by the regulatory bodies in matters of health care, medical education and research would help to avoid loss of the quality of empathy among doctors and medical students and prevent deterioration of the health care services.


1. Hojat M. Ten approaches for enhancing empathy in health and human services cultures. J.Health Hum Serv Adm. 2009 Spring:31(4):412-50
2. Chen D, Lew R, Hershman W, Orlander J. A cross-sectional measurement of medical student empathy. J Gen Intern Med. 2007 Oct;22(10):1434-8. Epub 2007 Jul 26.
3. Chen DC, Kirshenbaum DS, Yan J, Kirshenbaum E, Aseltine RH  Characterizing changes in student empathy throughout medical school. Med Teach. 2012:34(4):305-11.
4. Ziółkowska-Rudowicz E, Kładna A. Empathy-building of physicians (Parts I to IV). Part I--A review of applied methods Pol Merkur Lekarski. [Polish] 2010 Oct;29(172):277-81.

5. Medical Council of India: Minimum Qualifications for Teachers in Medical 
Institutions Regulations, 1998


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