{"id":9986,"date":"2011-07-18T10:58:17","date_gmt":"2011-07-18T09:58:17","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=9986"},"modified":"2011-07-18T10:58:17","modified_gmt":"2011-07-18T09:58:17","slug":"jonny-martell-compassion-fatigue","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2011\/07\/18\/jonny-martell-compassion-fatigue\/","title":{"rendered":"Jonny Martell: compassion fatigue"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/www.bmj.com\/site\/blog\/icons\/jonny_martell.jpg\" alt=\"Jonny Martell\" width=\"160\" height=\"160\" align=\"left\" \/>The medical school sausage factory is fattening me up and rolling me into shape. Another year has passed. I am gaining knowledge and growing in experience. And losing my empathy.<\/p>\n<p>Apparently I shouldn\u2019t beat myself up over this.\u00a0It\u2019s par for the course, a common side effect of the rites of passage journey into medicine.\u00a0The journal <em>Academic Medicine<\/em> lays it out bare in, &#8220;<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21670661\">Empathy decline and its reasons,\u00a0a systematic review of studies with medical students and residents.<\/a>&#8221; Of eleven studies conducted among medical students, nine found a significant decline in empathy over the course of training.\u00a0<!--more--><\/p>\n<p>The reasons provided for this threw up no great surprises.\u00a0 It seems that medical school, especially clinical training, can cause significant &#8220;distress&#8221; and it is this that lies behind the fall in empathy.\u00a0\u00a0Situations that might lead to this distress include:<\/p>\n<ul>\n<li>&#8220;Mistreatment by superiors or mentors: Medical students may experience situations of harassment, belittlement, degradation, humiliation&#8221;<\/li>\n<li>&#8220;High workload: Students and residents face long working hours, with an associated lack of sleep and inadequate relaxation time.&#8221;<\/li>\n<li>&#8220;Vulnerability of medical students and residents: Values of idealism, enthusiasm, and humanity are present in students at the beginning of medical school, but these may diminish as trainees are confronted with clinical reality (characterised by illness, human suffering, and death) and their focus shifts to technology and objectivity rather than the humanistic aspects of medicine.&#8221;<\/li>\n<\/ul>\n<p>Illness, human suffering, and death\u2026 in hospitals, who would have thought?\u00a0<\/p>\n<p>Brushing aside such crusts of cynicism &#8211; surely signs themselves of compassion fatigue &#8211; it was interesting to read of a likely candidate for empathy\u2019s neurophysiological correlate, the mirror neuron.\u00a0 According to one hyphothesis, these can take a beating from the stress of training and their signal rate can reduce significantly.\u00a0The review cites another study in which doctors\u2019 brains were shown to down regulate &#8220;the sensory processing elicited by the perception of pain in others.&#8221; As many others have pointed out, such a process might well be an important adaptive pay off: over identifying with patients\u2019 suffering can lead to burn out and bad decision making. The patient suffers more.\u00a0\u00a0<\/p>\n<p>All this begs the question &#8211; is this just a normal part of the initiation process into medicine?\u00a0 Or perhaps medical students are caught up in a larger social phenomenon?\u00a0 <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20688954\">A 30 year long look at American college students<\/a> found this to be the case.\u00a0 The review quotes the \u201cemotional anaesthesia\u201d of today\u2019s young people, put forward by the study\u2019s authors as a result of the age in which we live. A part of this is the \u201cinformation flooding\u201d of today\u2019s communication technology culture that increasingly curtails space and time for the perception of our emotions. (Apologies for this blog.)<\/p>\n<p>On a more encouraging note, studies do point to the possibility of tackling the decline.\u00a0For medical students, who invariably feel like they should be doing something, sitting\u00a0around doing largely nothing might be a difficult pill to swallow.\u00a0 However, it is precisely that, in the form of mindfulness based stress reduction, that shows the most encouraging results for interventions in empathy and stress management. Adapted from Buddhist mindfulness principles at the University of Massachusetts Medical School, this secular meditation based programme performed well in a <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15256293\">meta-analysis<\/a> assessing its role in helping people cope with disability and distress. More recently it has been adapted to create another mindfulness based programme that has won NICE\u2019s backing for recurrent depression.\u00a0Meditation on the NHS?\u00a0 As a <a href=\"http:\/\/www.independent.co.uk\/life-style\/health-and-families\/features\/transcendental-meditation-were-the-hippies-right-all-along-2307898.html\">recent feature in the <em>Independent<\/em><\/a>\u00a0asks of the increasingly popular transcendental meditation, were the hippies right all along?<\/p>\n<p>In fostering awareness and ideally prevention of impending burnout, these approaches also serve to tackle the prevailing and arguably self defeating ethos characteristic of medical culture.\u00a0 This is that self denial and performance under stress are inevitable and therefore essential traits of doctors.\u00a0Given the spate of positive outcomes associated with improved empathy from doctors, I wonder why they\u2019re not teaching us more about this at medical school.<\/p>\n<p><em><strong>Jonny Martell<\/strong> is a medical student in London.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>The medical school sausage factory is fattening me up and rolling me into shape. 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