I found this on Medscape Website,interesting.So try to read it.
Written By: Sonal Singh, MD
An Intensive Care Unit in Kathmandu, Nepal
I sat outside the doors of an intensive care unit (ICU) of a tertiary care center in Kathmandu, Nepal, on a cold morning. My relatives had invited me, a resident-physician from the United States, to assist in taking care of their loved one. I noticed an elderly woman crying nearby. Her son had died on his way to the hospital. The exact circumstances surrounding his death were unknown, but he was only 17 years old. She was crying because she could not afford to pay for his funeral. People had gathered around her, and someone proposed to hire a taxi to take the body to the funeral pyre. The taxi would cost approximately US $25. Everyone from the crowd contributed spontaneously, but the collected money fell short of the required sum. I tried to avoid the mother's tearful eyes, but I caught a glimpse of the body of her dead son. My lavish lunch for later seemed out of place, and I gave the remaining sum. As the driver hauled the crying mother and the corpse away, I was reminded that these incidents were a part of everyday life in this part of the world. Plagued by decades of poverty and a recent political insurgency, the poor spend all of their savings trying to access high-priced medical care for their loved ones, including those who have died, often to no avail.
An ICU in the United States
I flew back to the United States the next day and returned to the grueling life of residency. Earlier in my residency, I had taken care of an elderly, non-English-speaking Bosnian woman who had immigrated to the United States a year prior to our meeting. She was admitted to the ICU with respiratory failure and worsening pneumonia. She had no prior hospitalizations. Our communication about her complex care was limited to telephone conversations with her adolescent granddaughter, the only English-speaking member of the family. She improved medically with intravenous antibiotics and respiratory support but became increasingly confused, agitated, and tearful and wanted to leave the hospital despite our efforts to convince her that it would be medically unadvisable. We were puzzled by her behavior. We tried to use a telephonic interpreter's service only to discover that she had never used a phone in her life. We showed her how to use the phone. Later, I discovered that holding her hand and sitting down with her for a few minutes would calm her down. She recovered well and was discharged home. Initially, the team had done all the medically appropriate interventions, but we did not make an effort to communicate with her except for brief phone calls to her granddaughter. Perhaps it was the language barrier. Perhaps we were too busy to do it.
Forced to Reflect
These seemingly unrelated incidents thousands of miles apart raised questions. Did I lack empathy? Had my sensitivities dulled from years of rigorous medical training? I wondered whether there was a similar decline in empathy extending to other aspects of my life. Was my experience an isolated one, or did my colleagues face similar dilemmas? The answers to these questions surprised me.
Sympathy vs Empathy
We enter medical school with a desire to care for people in need. The challenges we face during clinical training can lead us to become less empathic and more detached from our patients. Derived from the Greek (em-into, pathos-feeling), empathy in the context of healthcare is "a cognitive attribute, which involves an understanding of the inner experiences and perspectives of the patient as a separate individual, combined with a capability to communicate this understanding to the patient.[1]" Although empathy and sympathy are used interchangeably in the context of physician-patient relationships, there are subtle differences.[1] Empathy is the process of developing rapport through the ability to intuit another person's feelings and read nonverbal cues. Whereas sympathy, according to the American Heritage Dictionary, is "a relationship or an affinity between a person in which whatever affects one correspondingly affects the other.[2]" Thus, empathy is "feeling with," whereas sympathy is "feeling into." However, empathy does not imply feeling sorry for our patients. Indeed, many patients respond negatively to sympathy and being "pitied."
The Decline of Empathy in Medical Training
Studies report that empathy declines among medical students[3] as well as residents.[4] Hojat and coworkers[3] examined changes in empathy in a class of third-year medical students. Using a validated questionnaire, the Jefferson Scale of Physician Empathy (JSPE), they demonstrated a small, but clinically significant reduction in total empathy score over the course of that year.[3] Similarly, Bellini and Shea[4] used a different measure of empathy, the Interpersonal Reactivity Index (IRI), of 60 residents at 6 time points during their internal medicine residency training. The IRI scores showed a decline in empathic concern that persisted through residency.[4]
There are several reasons for this decline in empathy. Current medical education emphasizes detachment and objective clinical neutrality,[5] and places greater emphasis on technologic rather than humanistic aspects of medicine.[6] A lack of role models, educational experiences, and the development of a sense of being part of a privileged group (elitism) are among the factors that may contribute to a decline in empathy during medical education.[6,7] Increased student and resident numbers at a time of shrinking resources, focus on research at the expense of teaching and learning, managed care, increased litigation, and defensive medicine may all affect the learning environment.[8]
Does Empathy Really Matter?
The positive role of empathy in doctor-patient relationships and patient outcomes is well known. Empathic trainees emphasize the contribution of psychosocial factors in health and illness[9,10] They may be more receptive to the biopsychosocial rather than the biomedical model of disease.[10] Empathy is also relevant to clinical performance because empathy scores were positively associated with ratings of clinical competence in core clinical clerkships.[11]
Can Empathy Be Learned?
Although research findings on the effects of educational remedies to promote empathy are inconclusive, the majority of these studies report a positive result from targeted empathy training.[3] Feighny and colleagues[12] found that training in the early years of medical school enhances behavioral empathy among students and improves their communication skills. Wilkes and coworkers[13] reported an increase in medical students' empathy when they had their own personal hospitalization experiences. On the other hand, Markham[14] reported that a behavioral science course in medical school did not change students' orientations toward the patient as a person. These inconsistent results may be due to the nonspecific measure of empathy used in different studies or a lack of specificity in educational objectives.
Can Empathy Be Learned?
Although research findings on the effects of educational remedies to promote empathy are inconclusive, the majority of these studies report a positive result from targeted empathy training.[3] Feighny and colleagues[12] found that training in the early years of medical school enhances behavioral empathy among students and improves their communication skills. Wilkes and coworkers[13] reported an increase in medical students' empathy when they had their own personal hospitalization experiences. On the other hand, Markham[14] reported that a behavioral science course in medical school did not change students' orientations toward the patient as a person. These inconsistent results may be due to the nonspecific measure of empathy used in different studies or a lack of specificity in educational objectives.
My Lovely Sayang
