Saved for later: Empathy Decline and Its Reasons: A Systematic Review of Studies With Medical Students and Residents, published in June 2011 issue of Academic Medicine.
Abstract: "Empathy is a key element of patient-physician communication that is relevant to and positively influences patients' health. The authors systematically reviewed the literature to investigate changes in trainee empathy and reasons for those changes during medical school and residency. The authors conducted a systematic search of studies concerning trainee empathy published from January 1990 to January 2010, using manual methods and the PubMed, EMBASE, and PsycINFO databases. They independently reviewed and selected quantitative and qualitative studies for inclusion. Intervention studies, those that evaluated psychometric properties of self-assessment tools, and those with a sample size <30 were excluded. Eighteen studies met the inclusion criteria: 11 on medical students and 7 on residents. Three longitudinal and six cross-sectional studies of medical students demonstrated a significant decrease in empathy during medical school; one cross-sectional study found a tendency toward a decrease, and another suggested stable scores. The five longitudinal and two cross-sectional studies of residents showed a decrease in empathy during residency. The studies pointed to the clinical practice phase of training and the distress produced by aspects of the "hidden," "formal," and "informal" curricula as main reasons for empathy decline. The results of the reviewed studies, especially those with longitudinal data, suggest that empathy decline during medical school and residency compromises striving toward professionalism and may threaten health care quality. Theory-based investigations of the factors that contribute to empathy decline among trainees and improvement of the validity of self-assessment methods are necessary for further research."
Showing posts with label the clinical encounter. Show all posts
Showing posts with label the clinical encounter. Show all posts
17.6.11
The Ganzfeld Procedure
A curious short film that suggests the difficulty of representing empathy, at least in film: To show it, we seem to need to caricature it -- at least in this form and medium.
From BBC Electric Proms.
From BBC Electric Proms.
A. C. Doyle & Sherlock Holmes
Rare footage in which Doyle explains the connection between Sherlock Holmes and his training in medicine, with a curious digression on psychic phenomena.
24.6.09
Fry & Laurie, Really Only Slightly Mad
Over lunch today with a friend, as I was picking over ideas for a new novel, I realized I was dreaming up a mash note to psychoanalysis wrapped around a murder mystery. (Oh, come on -- what else could it be?) My friend pointed me to Fry & Laurie's psychiatric sketches. These guys sure had a lot of fun with psychoanalytic psychiatry. I see their sketch "Slightly Mad" as a riposte to the question posed in Freud's "On Creative Writers and Daydreaming": What is the difference between the "normal" work of the creative writer and the pathological productions of, say, a writer like Daniel Paul Schreber, on the one hand; and the work of the psychoanalytic psychiatrist, on the other? (The title image on that last link is emphatically NSFW, unless you work in a Dadaist art gallery. What was Penguin thinking?)
The crux is the business about writing letters to the paper, about 3 minutes in.
Freud kept the patient on the couch, kept himself out of view, and recommended only the occasional provision of interpretations. Modern face-to-face psychotherapies don't protest so much. Here's Fry & Laurie on the result -- the relevant bit starts at 0:57:
At 2:21 there's a playful reference to the "Bender Gestalt Test," which is real, but Fry's invitation to draw a line seems more like a request to play Winnicott's Squiggle Game. Laurie retorts that Fry is using "some sort of psychiatric jargon that you've picked up from the Reader's Digest," which at once notes the confusion and elides it, in a send-up of just the sort of incomplete repression Freud sees in jokes and parapraxes. At 3:00, the preamble ends on the word "masturbation," and the power struggle comes to the fore. "I'm the doctor, and you are the patient." The roles reverse dizzyingly. The question of names comes up at this point: Who is "Dr" and who is "Mr"? The rest of the session raises, only to deconstruct, every piece of stage business in the psychoanalytic psychiatrist's theater: the authority to summon the secretary, to make clinical notes, to prescribe medication, to end the session, to offer appointment times. By 4:53, the joke's on us -- but I won't spoil it. Take a look.
The crux is the business about writing letters to the paper, about 3 minutes in.
Freud kept the patient on the couch, kept himself out of view, and recommended only the occasional provision of interpretations. Modern face-to-face psychotherapies don't protest so much. Here's Fry & Laurie on the result -- the relevant bit starts at 0:57:
At 2:21 there's a playful reference to the "Bender Gestalt Test," which is real, but Fry's invitation to draw a line seems more like a request to play Winnicott's Squiggle Game. Laurie retorts that Fry is using "some sort of psychiatric jargon that you've picked up from the Reader's Digest," which at once notes the confusion and elides it, in a send-up of just the sort of incomplete repression Freud sees in jokes and parapraxes. At 3:00, the preamble ends on the word "masturbation," and the power struggle comes to the fore. "I'm the doctor, and you are the patient." The roles reverse dizzyingly. The question of names comes up at this point: Who is "Dr" and who is "Mr"? The rest of the session raises, only to deconstruct, every piece of stage business in the psychoanalytic psychiatrist's theater: the authority to summon the secretary, to make clinical notes, to prescribe medication, to end the session, to offer appointment times. By 4:53, the joke's on us -- but I won't spoil it. Take a look.
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