Rethinking compassion in medicine

Two recent events made me think about how traditional medical care and medical education address the issue of compassion.

The first was at the annual dinner for the Kenneth B. Schwartz Center when they gave out their annual Compassionate Caregiver Award, and reviewed the accomplishments of  previous awardees.  These individuals have all made remarkable differences in the lives of patients and families through their empathy and personal connections.

The second event was reading about the passing of Florence Wald, the former Dean of Nursing at Yale who organized the first hospice in the United States in 1974 because of her interest in compassionate care at the end of life.

While there has been much discussion about:

  • Shortages of primary care clinicians
  • How medical school graduates are increasingly going into specialties
  • Medical schools are thinking of replacing the requirement that applicants have taken organic chemistry with requirements for more biochemistry or genetics
  • A survey of physicians finding that over the next three years 49% plan to reduce the number of patients they see or stop practicing entirely, and 60% would not recommend medicine as a career

All these relate to the structure and content of physician education and training.  And I have two proposals:

First, while  medical school education has progressively shifted from teaching in hospitals to more out-patient and community care, I think doing more to show medical students and residents the rewards of community primary care would be a good step for increasing the number and prestige of primary care clinicians.

And second, while medical schools require students to go through rotations in pediatrics, Ob/Gyn, medicine, surgery and psychiatry, I don’t know of any that require students to go through a hospice rotation.  This may be because medicine and society try to discount death as a failure, but a hospice rotation would be a great opportunity for teaching students about empathy and compassion, and shifting the discussion of death within the context of medical education so that it is viewed more as part of the continuum of life.  In addition, having medical students in a rotation where they are not reporting to (and trying to impress) senior physicians, but rather working with nurses and social workers, also might provide them with a better perspective on teamwork in healthcare delivery – as well as a dose of humility.

The value of hospice (or palliative care) rotations for students does seem to be growing.  An article from 2006 reported that the University of Arizona was thinking about requiring a hospice rotation.  And the American Association of Medical College’s web-site has an article from 2004 about how Mt. Sinai has integrated palliative care into their curriculum.

Does anyone know of any medical schools that require hospice rotations for medical students or have integrated these types of programs into their core curriculum?  (BTW – A major focus for the Schwartz Center is grand rounds and other educational programs about compassionate care and patient-caregiver communications for both established clinicians and students.)

And lastly, it should also be recognized that expanding young physicians communications and empathy skills should help them work better with their patients, (and patients’ families), which could help reduce unnecessary and costly care.

Dr. Michael Miller started HealthPolCom Consulting in 2000 after 12 years in health policy positions in Washington, DC.  He works with an extensive network of policy and communications consultants. He blogs regularly at Health Policy & Communications, where this post first appeared.

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7 replies »

  1. For matters subtle and not, my family’s PCPs are our heroes,and they know it. Quarterbacks in a confusing and often dysfunctional heslh care system.

  2. Joesmith MD’s comments typify what is bad about doctors. I don’t need a high school volunteer to be compassionate — I need doctors that I see to show compassion through great listening and empathy comnbined with their technical knowledge.
    How about the doctor who told a patient she had macular degeneration and it was progressing fast? She asked, how long — meaning help me understand the progression of this illness in human terms. But his response was, it might be time to start looking for a guide dog!!
    Why should we pay these doctors thousands of dollars (as “dr. joesmith” quotes) to be sarcastic, insensitive, and arrogant asses. As for the comment that you cannot teach compassion — wrong. I teach empathy and compassion all over the US and Canada. It is teachable. The medical community seems to think that compassion is a separate job. It isn’t. It is the way that medical professionals are supposed to do their job — you know health CARE!
    And the update on the macular degeneration diagnosis: After 3 days of constant crying, the patient went for a second opinion. This doctor said she had a different form of degeneration and gave her much better advice. She then also found THE specialist in that form of degeneration, goes once a year for the latest assessment and updates, and is doing quite well.
    Think on it. Empathy is a key part of medical “CARE”.

  3. We didn’t do hospice “rotations” because medical school was a lot more basic than that. However, I know that we had at least a couple of talks about hospice, palliative care, and end of life legal and ethical issues in both medical school and internal medicine residency.
    I’m a pretty good advocate for hospice I think, but it’s not easy. Since I’m not an oncologist, I’m generally referring people for non-malignant reasons. If you know a family well, it’s relatively easy to bring up the subject of hospice, but often it’s a family who’s really new to the practice and that can be tricky.

  4. This is a stupid idea and yet another liberal feel good approach that wont produce any real results and instead wastes everybody’s time.
    Working in an ICU setting or a heme/onc ward is more than enough exposure to end of life issues, and its ridiculous to suggest that med students dont get any exposure to it.
    Furthermore, you cant teach compassion. Forcing med students to do stupid hospice rotations wont create more “caring” physicians.
    If you want somebody to hold patients hands and sing cumbayah all day, then get some high school volunteers instead of paying thousands of dollars to have an MD do it. Using an MD to provide those services is a waste of time and money.
    P.S. Katie B is a nurse and doesnt know jack about medical education. You dont see me spouting off on nursing education because 1) I’m not a nurse; and 2) med students dont know what goes on in nursing education

    • Its unfortunate that you (presumably a doctor according to your “MD” title) feel this way. The truth is, patients look up to their doctor when they are suffering and need guidance and compassion and im pretty sure that’s what doctors are paid “thousands of dollars” for–to provide CARE!

  5. The answer to your last question is no, most medical education does not include elements of death and dying, end-of-life, palliative care, and engaging the patient and family/loved ones in discussing these topics and making decisions. You have to admit that the thrust of medicine in our society is cure, cure, cure. Failure is not an option. As we enter an era where more of our population is living longer, 80s, 90s, 100s, we have to admit to ourselves that death is a part of life, and we must spend as much time and resources on death as we do on curing. I applaud your idea of medical students learning from nurses the value of compassion and caring, in particular around death and dying in the hospice setting. I would like to see that advanced!

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