The dreaded empathy-gap has been on my mind lately. It’s well-documented that in their third year, the average medical student undergoes a significant drop in empathy. This was on my mind a lot last year, but this year has gone by so quickly and with so many other concerns, like getting my patient write-ups done, and finishing question sets, that I hadn’t thought about it much, at least in such specific terms.
The job of a third year medical student often seems to be to bother patients and get in their way. There are several ways to justify this: that there is simply no other way to educate doctors, that a university affiliation raises the quality of care, and that students often have the time to speak with patients and listen and connect in way that is often positive for patients. The first two arguments I can accept as true, but the third is the one that I think matters.
But sometimes you just don’t get the opportunity to be more than a bother while trying to learn. Today was colposcopy day in our OBGYN rotation. This meant that we took turns sitting in with the doctor whose job it is to look at cervixes. When the patient got there, she made it clear that she did not want students observing the exam. My classmate and I were pretty disappointed, and he suggested in a whisper that the doctor should try a bit harder to pressure patients to agree to let us watch. That didn’t sit well with me. Maybe explain the context, the need to future doctors to learn stuff, but pressure or guilt made me uneasy.
My classmate pointed out that we didn’t have to ask permission to watch surgeries, even though patients’ bodies are pretty exposed. Yes, I said, but it’s different if you’re unconscious. And colonoscopies- we didn’t ask the patients for permission there, either. We should have, I argued. If I were having a colonoscopy, and woke up from the twilight anesthesia, which is common, I don’t think I’d find it a pleasant surprise to see med students staring at my butt. I mentioned that I had been admitted to the hospital twice here, so I identified pretty strongly with the patient’s perspective, as well as that of the doctor. I suggested a softer approach: if we could talk to the patients before hand, connect with them a bit, maybe they’d feel better about letting us watch. But the second patient also refused to let us watch, and it was true that this was a lousy use of time.
The third patient came in, a bit hesitantly. Now, I’m an introvert, and a bit shy on top of that, but I’ve gotten the hang of looking at a patient and giving them a smile in a way that seems to build rapport pretty quickly. I pulled up a stool along the side of the desk, halfway between her and the doctor, and asked her how she was. Joked around with her a bit as the doctor read the chart. And when the doctor asked if we could watch the exam, she said she needed a moment to think, but in the end she let us watch. The doctor kept her draped when not directly examining her, and I made a point of not looking more than necessary.
At the end, after she had dressed and was gathering her things, I told her, “thank you for letting us watch, it’s an important thing to learn, and I know it’s also really . . . personal.”
And I thought about how I’d worked to win her over, and how that had probably helped us have the opportunity to watch. And an image came into my head of a slick, used-car-salesmen, fake-charming doctor, and I felt a bit revulsed. Was that what I was learning to do? To gain peoples’ trust while my focus was on myself, and not on them?
And my classmate, who I don’t mean to be judging, even though I disagreed, his willingness to put aside discomfort for the sake of learning also matters, and I think I might struggle to prioritize that. I can steel myself to remove staples from someone’s head if that’s what the patient needs, but when it’s an indirect benefit like there being more doctors in the world, balanced against a person who is present, and sick or scared, and uncomfortable, I find it hard to see past that. And there is so much here to balance, to keep in mind, and to hold in your heart.