"The purpose of life is ... to be compassionate, to have it make some difference ..."
Ralph Waldo Emerson
Instituted in 1995, Empathy Sessions were developed in response to an observation by a group of faculty that medical students seemed more compassionate than their physician peers. It appeared that the prolonged training period of a physician, with its emphasis on scientific knowledge, stamina, and independence contributed in a negative way to the “hidden curriculum” and resulted in a dispassionate, less caring physician. In an attempt to reverse this tendency, we created a voluntary small group experience called Empathy 101. As students progressed through the curriculum, they requested that the sessions be continued, and Empathy 201, 301, and 401 were added in 1999.
Resources and Other Links
|Complications: A Surgeon's Notes on an Imperfect Science by Atul Gawande. Henry Holt and Company, LLC, New York 2002.
|Empathy and the Practice of Medicine edited by H. Spiro et al. Yale University 1993. Selected chapters are read which focus on the experiences of physicians in caring for the whole patient.
|Is Medicine a Spiritual Practice? by D. P. Sulmasy. Academic Medicine 1999;74:1002-1005. An article that deals with how a spiritual connection between patient and doctor can give meaning to the work of medicine.
|Kitchen Table Wisdom by Rachel Naomi Remen, M.D. Riverhead Books, New York 1996. Selected stories are read to stimulate discussion about the training of physicians and how they deal with suffering in their own lives and in the care of their patients.
|My Own Country: A Doctor's Story by Abraham Verghese. Simon & Schuster, New York 1994.
|On Doctoring edited by R. Reynolds and John Stone. Simon and Schuster 1991. Selected stories relating to cultural issues such as race, gender, age, income, social status, occupation and how these variables impact the patient-doctor relationship.
|Sacred Space: Stories from a Life in Medicine by Clif Cleaveland, M.D. American College of Physicians, Philadelphia PA 1998. Selected stories that help illuminate the impact of culture, training, suffering and dying on the personal growth and development of a physician. Defines the patient-doctor relationship as a circle of caring, a sacred space, with the patient at the center.
|The Diving Bell and the Butterfly by J. D. Banby. Alfred A. Knopf, New York 1997. The story of a man who is neurologically “locked in;” his view of the world focusing on relationships and communication.
|The Measure of Our Days by Jerome Groopman, M.D. Viking Penguin 1997. Stories are discussed which reinforce the concept that the physician is an actual therapeutic agent in the healing process.
|The Spirit Catches You and You Fall Down by Anne Fadiman. Farrar, Straus and Giroux, New York 1997. Excerpts will be read which illustrate how culture differences can adversely affect the delivery of health care.
|The Tennis Partner: A Doctor's Story of Friendship and Loss by Abraham Verghese. Harper Collins, New York 1998.
|Tuesdays with Morrie by M. Albom. Doubleday, New York 1997. The entire book will be read as a stimulus for discussion regarding issues of end of life, personal growth and relationships.
Year 1: Empathy 101
Sessions are based on readings that stimulate discussions relating to issues such as death, culture differences, suffering, suicide, terminal illness, physician burnout, physician errors, and the physician as an integral part of the treatment or focus on cultural differences, palliation of pain at end of life, treating suffering and recognizing the patient’s spirituality.
- Patient Awareness
- Emil P. Lesho, D.O., “Fathers, Doctors, and Time.” Annals of Internal Medicine 2001; 1347: 623-624
- Rachel N. Remen, M.D., “The Gift of Healing.” Kitchen Table Wisdom: Stories That Heal 1996: 63-65
- Clif Cleveland, M.D., “Shock Therapy.” Sacred Space: Stories from a Life in Medicine 1998: 70-72
- Anton Chekhov, “Misery.” On Doctoring, 3rd ed. 2001: 36-41
- Rachel N. Remen, M.D., “Silence.”
- Carolyn T. Cleary, M.D., “A Medical Lesson.” Annals of Internal Medicine 2000; 132: 840
- Duncan Darbishire, “But Her Eyes Spoke Another Language.”
- Ernest W. Crow, M.D., “Don’t Hold Back Your Tears.” The Pharos 2000; 31
- Richard B. Weinberg, M.D., “First Love.” Annals of Internal Medicine: On Being a Doctor 1977; 1264: 327-329
- James W. Lynch, M.D., “Regaining Compassion: A Piece of My Mind.” JAMA 1988; 27918: 1422
- Atul Gawande, M.D., “Education of a Knife.” Complications: A Surgeon’s Notes on an Imperfect Science 2002; 11-18
- David Hilfiker, M.D., “Mistakes.” On Doctoring, 3rd ed. 2001: 325-336
- Mark Linzer, M.D., “Honors.” Academic Medicine 2002; 771: 81
- Neil S. Prose, M.D., “Paying Attention.” JAMA 2000; 28321: 2763
- Roger D. Kiser, “The Little White Box.” Chicken Soup For The Caregiver’s Soul 2004; 143
- Fay J. Ellis, “Academic Careers Need Not Compete With Family Life.” Academic Physician & Scientist 1998; 1, 4-5
- Marjorie Gross, “Cancer Becomes Me.” The New Yorker 1996
- Christine S. Seibert, M.D., “Simple Gifts.” Annals of Internal Medicine 2000; 132: 757
- Hanna Sherman, M.D., “Balancing Act.” American Academy of Pediatrics News 2005; 26: 34
- Marcia Quereau McCrae, “Teeter-Totter.”
- Kim Wyatt, “Essay.”
- Arna Bontemps, “A Summer Tragedy.” On Doctoring, 3rd Ed. 2001; 110-118
Year 2: Empathy 201
Communicating when language is not the only barrier
- How do you communicate with people whose basic beliefs are vastly different from yours?
- How do you overcome fear of physicians?
- How do you provide competent care for a patient whose parents are non-compliant and appear to be endangering a child?
- What do you do when medical interventions could cause more harm than good?
(Excerpt from The Spirit Catches You and You Fall Down from A Life in Medicine pp 286-295)
Going beyond the presenting situation and first impressions
- How do you avoid generalizations when you see a typical presentation?
- How far is a physician expected to go in helping patients recognize/deal with potentially harmful lifestyle issues?
“The Intervention.” JAMA 280(17): 1477 http://jama.ama-assn.org/cgi/content/full/280/17/1477
To Feel or Not To Feel
- Should physicians show their feelings to patients and families?
- How do you deal with families when things are going wrong?
- Where is the line between being a compassionate physician and being “too involved”?
“The Cross-Cover Resident.” JAMA 290(8): 956 http://jama.ama-assn.org/cgi/content/full/289/8/956
“Cord.” JAMA 287(14): 1773-1774 http://jama.ama-assn.org/cgi/content/full/287/14/1773
Why Do Good Doctors Go Bad?
- Prevalence of mental illness, etc., in the physician population
- Dealing with a colleague with a problem
- Punishment vs behavior modification (Diagnosis and Treatment)
Complications: A Surgeon’s Notes on An Imperfect Science pp 88-106 (Chapter 5: When Good Doctors Go Bad)
Prejudice and Patient Confidentiality
- How do you respond to patients whose lifestyles you do not condone and may not understand?
- How do you deal with colleagues who do not respect patient confidentiality?
- How do you deal with friends, colleagues and family who are display prejudice toward certain patient populations?
My Own Country (pp 299-310 and 332-342)
Recognizing and Managing Medical Student Stress and Burn-out
- How do you make “Life as it should be in addition to life as it is”?
- How do you respond to situations that seem inhumane to a patient?
- How do you recognize and deal with “burn-out?”
- Have you seen/experienced burn-out in residents and physicians with whom you have worked?
- How do you deal with stress?
“Fiction as Resistance.” Annals of Internal Medicine 137(11): 934-937 http://www.annals.org/issues/v137n11/full/200212030-00022.html
Learning by Doing
- How do novices learn?
- How do you deal with the statement “There should be no learning curve where patient safety is involved?”
- Practice vs Talent
Complications: A Surgeon’s Notes on An Imperfect Science (Chapter 1: Education of a Knife)