compassion
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The Compassion Deficit: A Student’s Perspective

My friend sent me an article recently. It is actually quite an interesting read. Here’s the TL;DR version: it is about how there is a seemingly large drop off of empathy and compassion in medical students in the first flush of third year. It doesn’t really offer much in the way of a solution, instead tailing off towards the end by just suggesting most people would rather a doctor take care of them than an iPhone. The point I wished to address is what I am now calling Clinical Science Fatigue or CSF. (What? That abbreviation is already taken? Not on my watch, sir.)

CSF (yes, I’m still going to use it) begins after Basic Sciences. Whereas Basics Sciences is about books and classes, Clinical Sciences is about patient care and guidelines. Your main teachers now are your residents and attendings. And yes, while they may be teaching you in an academic manner (one-to-one, small groups, lectures, didactic sessions, etc.), they are also teaching you nonverbally. No, that does not involve pointing at graphs. Whether you realize it or not, you are learning to emulate these people on some level. We as students watch how they walk, how they talk, how they comport themselves with patients, which attitudes are acceptable and which are not. In short, we are learning the rhythms and dynamics of the place. Certain statements become acceptable and certain jokes become acceptable, pending the context. This seems so inappropriate at times that your pre-medical school self would be shocked at your callousness.

However, there is an added component. It is a stressful job and a person’s health is a heavy burden to bear. Every once in a while, the need to decompress builds up and venting becomes the only alternative to exploding. No matter how much you think you might understand what a resident is experiencing, the one thing we cannot fully appreciate now is the gravity of that responsibility. Above all, although it’s not necessarily the only way, I believe that such venting every now and again should not get in the way of patient care. You get rid of your frustrations so you can think more clearly to help the patient.

That does not mean that you necessarily have to join in! That is peer pressure, sir or madam. (If they jumped off a bridge, would you too?) You do not have their job, you do not have their stress, and so you shouldn’t really have that kind of response – especially since, unless you are preternaturally gifted in social awareness, you do not have the savoir-faire to pull it off. Indeed, most of the time it is not wanted or expected for you to do so – the venting venter, having vented, moves on.*

It is true that we are not supposed to judge people – but it is hard. As Frasier said, ‘we are still human, aren’t we? We have to do what feels good sometimes, don’t we?’** The balance that I think is most difficult to learn is between personal and professional. Whatever you think privately should not be allowed to interfere in your professional capacity. This is why it is a blessing especially to have good residents. Cherish your good residents, as I have cherished mine. They can show you a template, just by how they act, to help you toe that line. While attendings will also do this, they are at a level that we cannot fathom or, at least, that I cannot fathom. This is a thing that I believe not only every good doctor does, but every consummate professional: the ability to not let anything hinder them professionally and to keep their personal-ness separate. (As true as it is grammatically inaccurate).

Of course, not all people have the same reactions. You may know someone who you think you say too many inappropriate things and someone who says nothing at all. Everyone is different. Again, let the good ones show you the way and find your own balance. Furthermore, we are at a stage where you can’t afford to not be professional. Don’t let cynicism overcome you – we are at a stage where you shouldn’t afford to do so. You have been given such a wondrous opportunity, and it seems a shame to let a jaded attitude prevent you from enjoying it. Also, you have so many more years to go, why start now? (Although that is the same attitude I have towards the gym and eating healthy, so what do I know really.)

Phew, that’s done with. Was I hitting you too hard over the head with that one? I know it’s not very subtle, but be as “Under the bludgeonings of chance, my head is bloody but unbowed.”*** That is a pretty good motto for CSF, 3rd, and 4th year in general.

*A reference to The Moving Finger Writes, a poem by Omar Khayyam

**Frasier S3E4. Great episode. Diane comes back. Who is Diane? Watch Cheers.

***Invictus. Not the movie, the poem. Although it does sound cooler in your head if you imagine Morgan Freeman saying it.

by Prakash Jayanthi, Class of 2014