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Tuesday, May 23rd 2006

"Teaching Doctors To Care"

It’s exactly what the title of the Time article says.

Claire Brickell, 25, an aspiring neurologist in her third year at Harvard Medical School, already knows far more about health care than most of us…But when it comes to communicating with patients, Brickell has a problem: she’s too healthy. Like most of her classmates, she has spent very little time as a patient. She has never had to weigh the advice of a trusted friend against conflicting orders given by a cold and distant doctor.

Enter Santa Ocasio, 56, a Dominican immigrant who is fighting a protracted battle with Type 2 diabetes. In a pilot program that is the leading edge of a broad curriculum overhaul at Harvard Medical School, Brickell has been paired with Ocasio for nearly five months. She sees her as a patient every week at the Spanish Clinic of Boston’s Brigham and Women’s Hospital and tags along on visits to her specialists. In fact, the goal is for Brickell to be there every time Ocasio encounters the health-care system. It’s not just a way to learn about treating diabetes; it’s a crash course in the myriad frustrations of a patient caught in the maw of modern medicine–confusing prescriptions, language barriers and an endless parade of strangers in white coats.

Can you really teach empathy? This is a lovely program, but it accomplishes only in allowing the medical student to get up close to a single patient’s experience. And of course there are similarities in the ways most patients deal with chronic conditions (such as diabetes). But it isn’t cut and paste. I don’t think we need to be taught empathy; if the school’s are doing their jobs effectively they graded that on admission.

It is just that over the time of our training it appears to die. Part of that is habituation. Part of that is emotional necessity. Part of that is the training itself. Empathy is not sympathy, it is the actual ability to put oneself in someone else’s emotional shoes. For people witnessing suffering that is quite a burden over the long run it seems to me.

The training itself, while getting better, is still, in many specialties, centered around turning out a kind’ve Type A physician. In some ways a too touchy feely neurosurgeon would be a little concerning to me, right before I went into the OR. Give me someone confident, with great hands, whose going to fix the problem and move on; but maybe that’s not exclusive of what Harvard is trying to do.