Do physicians need empathy?

The answer depends on the papers you read. A 2011 paper [Acad Med. 2011;86:359–364.] found that higher empathy was related to better clinical outcomes for diabetic patients. Good news, yes? Well, it seems so until you read the paper and discover that the research was based in a sample of 29 family physicians (but 891 patients). The paper had good methodology but how far can we get with 29 people? In contrast to this, a 2012 paper [Medical Teacher- 2012; 34: e116–e122] looking at the importance of empathy on changing specialty among medical students (858/1321 students from 5 medical schools) found that is wasn't important and changed little over the course of one year. Finally,  a 2013 paper [Medical Teacher-2013; 35: e946–e951] examined empathy among 72 medical students longitudinally (during 5^th and 6^th year). The study threw two interesting findings; (1) students were reported less empathy over time, which the authors report as being due to additional clinical responsibility, more patient contact and more management decisions, and (2)  students who self-rated as having more empathy received lower competence evaluations  from their peers. In my opinion (not the authors), it sounds like the organisation is very effectively teaching them that empathy is not so important.

Three very different studies, with the first one relating to family physicians and the second two concerning medical students. Difficult to know what to conclude, but food for thought none the less. If we actually reinforce medical students not to be have empathy, maybe we should ask why?

Surgeons and illicit drug use

A recent paper in BMC Medicine [Franke et al. BMC Medicine 2013, 11:102] indicates that German surgeons use illicit and prescription drugs for both cognitive enhancement and mood enhancement. The researchers used two different methods, but overall the prevalence is estimated between 15-20%. The research didn’t have a satisfactory response rate (36.4%), but the fact that nearly 1 out 5 surgeons are using drugs in this way is a cause of concern. The survey looked a list of factors that influence such use, and pressure to perform at work, pressure in perform in private life and gross income were positively related to drug use. Interestingly the following factors were not associated with drug use; gender, age, family status, living with children, type of employer, employment status, hours of work, satisfaction with professional success, and evaluation of career opportunities. The authors of the research don’t mention it, but one is left wondering; (1) how did the surgeons ‘learn’ that such behaviour is appropriate/acceptable, and (2) what lessons such behaviour teaches future generations of surgeons. However, it’s too simple to lay the blame on the surgeons, and we must appreciate the way that patient expectations and public expectations about zero errors contributes to a performance culture which has its roots in medical education.