Bioethics Forum Essay
Amid the Pandemic and Racial Injustice, Greater Empathy in Medical School
“This is the most empathetic you will ever be.”
It has been nearly three years since a well-meaning attending said these words to a lecture hall of newly white-coated student doctors. He said it with a chuckle. Was he joking? It was hard to say.
Hearing this dismal remark in my crisp white coat as a first-year medical student, I recall yearning to be the exception. I aspired to be that doctor who would always honor my patients by treating them with the utmost respect and empathy. But I was also acutely aware of the immense toll that medical training can take. Numerous studies have examined empathy over the course of medical training. Single-institution studies (here, here, and here) have demonstrated a statistically significant decline in empathy over the course of medical school and in surgical training. The issue of physician burnout pervades not just medical training but also the years after training. This chronic erosion of empathy has resulted in the attitude that apathy is not just tolerated but, in some cases, even justified.
In the last several months, my medical student colleagues have challenged this notion. Empathy does not need to dissipate as we endure medical training. Both the pandemic and the national reckoning over racial injustice and police brutality have touched every aspect of life as we know it, and medical training and education have been no exception. Medical students have adapted to numerous curriculum changes, including months of minimal to no contact with patients, classmates, and faculty. Through it all, there has been an unspoken need for us to rise to the occasion and participate in social and political discourse in this time of physical isolation.
In light of the social and political change in our current climate, a new group of leaders is emerging in medical education. Medical students around the country have been creative and resourceful in the face of this pandemic, utilizing our unique position to do what we can to enhance human connection during an otherwise rather isolating and grim time. Medical students have donated their time to babysit for health care workers and buy groceries for the elderly in the community, as well as remotely write notes and discharge summaries to help inpatient resident teams. At my own institution, students have enhanced human connections by volunteering in the ICU, holding iPads so patients could see their loved ones one last time.
Around the country, physicians and medical students have organized peaceful protests by health care workers in support of the WhiteCoats4BlackLives movement. As professionals and as fellow human beings, we knelt on one knee, channeling the frustration that stems from these repeated tragedies. We felt a duty to underscore the national flash point over systemic racism, as well as the personal struggle to recognize our own implicit biases. Moving into the 2020 election, medical students have been working to increase voter registration among not just medical students, but also patients (especially hospital inpatients) on a national scale. These efforts to be actively engaged in our democracy help to fulfill our duty to be advocates for our patients. The more we empower our patients to vote, the more their needs will be reflected in our country’s leadership.
As the medical student community becomes more engaged than ever in the happenings of the world beyond the hospital, it has become increasingly clear that social justice and policy are not separate from health care. And as such, our identities are not simply defined by our “health care provider” status. The culture of what it means to be a medical student is changing. We have begun to reject the previous pattern of exclusively focusing educational efforts on learning the science of medicine. As demonstrated by the disproportionate effect of Covid-19 on Black and brown communities, structural and systemic issues are tied inextricably to medicine and public health. Our role as medical students and future physicians carries a responsibility outside the office, hospital, and operating room. Increased involvement and awareness of the medical student community in public health issues has already led to a renewed sense of empathy for our patients.
By applying the theme of lifelong learning to other human experiences in population health, socioeconomic disparities, and health policy, we can constantly expand upon our ability to maintain empathy for our patients. Just as we stay up to date with medical literature and board certifications, we also have a duty to continue to learn about and mitigate health disparities. In 2020, medical students have placed more of an emphasis on community engagement than in years past. While these priorities have not formally been tied to medicine in the past, our responsibility should expand such that these efforts can continue to be a priority and be incorporated within our unofficial job description. These human experiences beyond the walls of the hospital make an equal if not greater impact on society, while also acting as a source of empathy and as a protective factor against physician burnout. As a community, we ought to continue to deliver the empathy this moment demands—through our continued willingness to listen, to constantly learn about others, and to do better for our patients.
Shruthi Perati is a fourth-year medical student at Albany Medical College. She will graduate with an MD with Distinction in Research in May 2021 and plans to pursue a career in general surgery. Twitter: @ShruthiPerati
Megan K. Applewhite MD, MA, FACS, director of the Alden March Bioethics Institute and an assistant professor in the department of surgery at Albany Medical College, contributed to this essay.