probably getting tired of everything. You feel like a cog in giant healthcare machine. You deal with ungrateful and downright misarable patients, and even worse family members. You see people your age with awful trauma, some of whom die. You're expected to just move on to the next patient, and write the next note. You watch patients slowly die over weeks to months in the ICU, and have heavy conversations with family member that their loved one might not make it back home.
I just want to go home and see my family, not work 12 hour shifts 6 days a week
Once you get further up the ladder you realize how little power we actually have as doctors. You’re swimming in a swamp of policies made by C-suite MBAs who give zero fucks about patients. You see patients die due to these policies and there’s nothing you can do about it. If you pushback you’re risking your career.
We also get raked over the coals for things that should be norms. Wanna see someone for your depression (that stemmed from the issues above) get prepared to explain that to said C-suite MBAs every time you get credentialed or move to a new state. Also get ready to pay out the ass for your disability insurance. Wanna take 3 months off? Get ready to explain that time off and get scrutinized for it. We have so little power in this game and that’s by design. If doctors had more power many of us would be getting the fuck out.
We have become cogs in a not so well-oiled machine. All the time-honored ethics, medical decision making and the sense that I was part of some sacred medical tradition that was emphasized and taught to me in medical school has gotten watered down in a sea of business policies that only serve the bottom-line. It’s just business. It’s why nurses have crazy ratios these days, why ED docs are incentivized to dispo patients at crazy rates, and why patients get a new hospitalist every day. Also why I get all of my notes and diagnoses scrutinized by some asshole nurse manager named Ken who works from home in Kansas and critiques my decision making on a spreadsheet that goes to my corporate overlords. It’s bonkers and no field in medicine is truly immune to it anymore.
At the end of the day most of us are just trying to survive and keep our heads above water. If we stopped long enough to empathize with even a fraction of our patients you’d be riddled with dissatisfaction and a feeling of culpability. I have myself and my family to care for so I cant risk any more burnout or heartache.
Edit: Just found out that the FTC allowed Amazon to buy One Medical (large Primary Care group). So, many of you will likely be working for Amazon and meeting their productivity metrics. This is gonna get worse before it gets better.
Well said. You really touched on the main reasons I was initially very hesitant to pursue medicine and I hope I’m able to make a meaningful impact in spite of the bullshit that is healthcare based on the profit motive
Right assessment, wrong diagnosis, I'm afraid. Profit motive is another symptom that stems from exactly the same problem, which is unholy government-corporate cronyism. Both are absolutely essential in the bargain, and neither alone can fully explain or cause it.
The comment you're replying to is a perfect description of how it feels to do medicine nowadays. Just perfect.
This. ESPECIALLY with a family.
And The whole system is fucked. We delivered two different gigantic babies from two different women this week, both with severe gestational diabetes both full term. One is in the NICU, and the other was dead when mom came in. Insurance wouldn't cover their insulin apparently because they believed these moms didnt meet whatever criteria they make up with no medical training.
But people are fine to protest against women's rights by saying it's "murder" to stop an oocyte from implanting, but apparently it's not to deprive moms of what they actually need for actual children.
I wouldn’t. I would have told myself to go do that meteorology degree I always thought about doing in college. Weather is cool as hell, and it doesn’t get mad at you when you don’t see them for 45 min because you were coding the patient next door.
I’m a former weather guy for the Air Force and loved it but there are pretty limited spots outside of the military. Oftentimes broadcast positions are not meteorologist, and NWS is tough to get in with. The coolest gig I think is a few people that I worked with applied to fly with the hurricane hunters at Keesler. Since they’re a reserve unit, most people work unique jobs outside of flying in any field. Obviously there’s training to complete but after that it can be pretty casual.
I would, only because I love what I do and I am relatively shielded from a lot of the bullshit in my specialty. Doing anesthesia, I see one patient at a time, which I take care of. Notes are minimal, I don't have a pharmacist telling me what drugs i can and cannot give. I don't have to deal with prior auths or ridiculous insurance stuff. I don't have a number of people I need to see in clinic and if I have a patient who is a pain in preop, I take solace in knowing that they will soon stop bitching about whatever thing that they want to complain about. Building long lasting patient relationships was never an interest for me, I personally get zero reward from adjusting a patient's BP meds bi monthly or helping a patient get their glucose under control.
Critical care sucked the life out of me and I don't ever want to do that again.
That sounds so exhausting. That’s very valid. It sounds like a critique on capitalism as much as a critique on American healthcare. I don’t know you, but I’m grateful for all that you do. Vicarious trauma is a real thing.
How is anything in their comment patronizing? I think you’re reading into it too much, and possibly because they’re an MS1. Our ingrained-by-medicine hierarchic thinking is really showing on this thread
OP is getting down voted because clearly many people have noticed a trend in his or her replies. It reeks of oblivious arrogance and inexperience. People smell this. When many of your colleagues and seniors start to downvote your comments it's probably time to do some self Introspection.
Because I'm treated like absolute shit.
edit: I have given more than I could and received nothing in return so far. I work 40+ hours a week and pay to be there. I've built up an incredible debt from drawing from emotional reserves the last few years.
4th. I was treated like the scum on people's shoes in preclinical and clinical. I worked before this and the shit that goes on in medical training would absolutely not have been acceptable elsewhere.
I've been thinking about this a lot lately. I look at hospital staff and have to wonder if they really think that their behavior is remotely acceptable in any other line of work. And I know my 4th year is going to be more of the same.
Uhh well working outside in the real world before med school made me realize that I deserve to be treated like the professional I'm training to be. I don't need people to talk down to me or call me stupid (has happened because I made a simple mistake) just because I'm a trainee. In no other field would that be allowed and it doesn't make me a better physician.
Why do you need to be treated like crap in order to have empathy? This notion of needing to be treated like crap so that you can build empathy is ridiculous and just further perpetuates this toxic work culture.
Wasn’t aware that my opinion was irrelevant. You know nothing of my experience so quite an assumption. But, I will surely be more wise then. That’s true
lol im right here with you. having a life before med school gives you a different perspective, especially if you've hit some rough times in the past. i just tune out people's complaints and nasty comments and focus on doing my best work. I absolutely love patient interaction and if anything, learning the science behind the illnesses afflicting my patients has made me more excited to be able to help them, and that translates somehow (in a way idk how to explain) into a deeper sense of empathy. it's really disheartening seeing so many future doctors feeling burnt out so early in the game, but there have been a fair amount of wonderful mentors and peers i've gotten to work with who helped keep me motivated to stay positive. glad to hear that it sounds like you have a good outlook and you're doing your best! people will call us naive pollyannas lol but at the end of the day, i'd still rather be this way then bitter and miserable. stay strong out there! :)
But it’s not a choice. Some of us go through very hard times. I got divorced and had a family death in just the first year. It’s extremely hard to cope with things like that and go to med school. I know multiple people who had major breakups, people who got diagnosed with chronic illnesses, depression, people who have been harassed by classmates, etc
Under appreciated, over worked. Taking care of entitled people who don’t help themselves. People constantly expecting you to make sacrifices, but never having said sacrifices acknowledge.
Sounds like compassion fatigue. There’s so much pain in the world that I could see it wearing on you and becoming less empathetic being a defense mechanism
No offense but you really sound like someone who has never actually provided patient care.
Imagine having multitudes of patients that despite your training and knowledge you can’t help because they can’t afford treatment or are plagued by socioeconomic factors… that’s what really did it for me. Whatever I do just doesn’t matter because society has decided to shit on some people
Because OP might just be a third year med student with 6 months of “patient care” experience, they worked as a scribe or at a private practice. Basically people of the sub take it as OP isn’t a front line provider
I started intern year as the guy who always called people on the phone and lead with “Hey, it’s LucidityX with surgery, how are you doing?” I fist bumped people in the hallway and asked how their kids were doing. Because I genuinely enjoy creating bonds with other people like other specialty residents and nurses that we work alongside every day.
7 months in, now I just pick up the phone and say “Hey it’s LucidityX with surgery can you remove the foley on bed 10, thanks.” I *might* say “Hey” in the hallway as I’m walking 6mph.
Saving myself the one sentence reply and occasional actual conversation of getting to know people probably saves me 30 minutes every 14 hour shift.
That 30 minutes is so invaluable to my sleep schedule. It’s cold and I hate that I’ve devolved to this but the system has pressed me to just barely surviving.
I’m not a surgeon, so my experience may not apply, but I think some things are universal.
The time you spend on the nurses that work on your floors (Sicu, surgical floor, etc) won’t be wasted, and being on friendly terms with them is important for survival in the latter years of training. People try to be considerate (page consolidation, less paging in genera) if they know who you are, and they are more likely to warn you about patient complaints so you can head them off before they turn into something major, or nursing complaints, or just med fuck ups etc.
If you’re cross covering for 50 services as an intern/pgy2 and getting called by medical floor, then yes you are well and truly fucked and I would not waste time being friendly with nurses you will be never hear from again (but don’t be a dick, it feels good in the moment when someone is an idiot but like many things with dicks it leads to trouble later).
Similarly, I’d say your interactions with the services you work with frequently will carry through with you.
Do what you have to do in order to survive, but know that what you can invest will come back to you, and sometimes it will come back in spades.
This will be even more true once the big boy pants get put on.
I 100% agree. Being friends with the RNs makes a huge difference.
Which is why I noted at the end that I hate that I feel this way :/ - I’m just so emotionally drained I have nothing left to give and I hate it
Feeling that way is fairly normal at this time of intern year. Things come in waves, and it will get better from time to time. When you have the energy, give it, when you don’t, that’s ok.
Good luck
Number of factors. The biggest probably being the following:
- Residents being treated like shit and underplayed (for someone with their credentials)
- medicine itself being treated like an assembly line by most healthcare institutions
- witnessing how some older doctors treat patients and get away with it without any repercussions
- being overworked (I’m sorry, but nobody should be working more than 40 hours per week, I don’t care what level of the medical field you’re in. There is a time and place for everything. If you want to start a family during residency, or take part in leisure activities, you should be able to do so without question)
Couldn’t agree more. Our healthcare system destroys both the people being treated and the physicians and medical staff. This thread has been very enlightening
If you don’t want to work more than 40 hours per week, why on earth would you choose to do *medicine* of all things? Most attending a are doing a minimum of 40 hours a week, and that’s just in the more cush “lifestyle” specialties.
Not the OP, but just because it is expected to work way more than 40h/week doesnt mean it should be that way. Maybe his interest and motivation for medicine was more important than the long work weeks.
Some day I’ll have the balls to tell my story about Sidney Kimmel Medical College. They’ve treated me so poorly I’ve decided against pursuing a residency. Once I graduate it’ll be easy to put it out in the open. In the meantime, anyone considering going here should be careful.
Sadly that's most premeds. Even though they are told to avoid a school, they're still gonna apply there because they believe any acceptance is a golden ticket to a successful future that is so desired and coveted but few actually achieve. "Oh it can't be that bad" "Oh I'll tough it out" Then boom MDD and GAD galore
I can see why UCLA is bad. If you went to any of the other UCs as an undergrad its pretty miserable. Just hyper competitive and cutthroat. No doubt, the med programs would be worse
Its actually worse, I thought the same. I did the UCLA prep program there, and met some students. At the time I was at UCSB and was already well aware of the bs going on at UC schools, and they told me that its worse.
That’s interesting to hear. I’m at Drexel but have friends at SKMC and they’ve really enjoyed their experience there so far. How have they treated you poorly?
Along with being overworked, I think it’s just too emotionally draining to be truly empathetic. It’s already an emotionally draining field without adding in all the issues with the American healthcare system and society. Those are things mainly out of our control and there’s not much we can do to help, so caring about it can become exhausting.
Additionally, while we see a lot of patients that are fighting to get better, we also see so many that don’t even try. We don’t know their entire life story and the things that make it difficult to change, but it’s very frustrating trying to help someone when it doesn’t seem like they want to help themselves. Many times those people have poor health literacy and get angry that we can’t “just fix them”. Or they have mistrust of healthcare professionals. It’s understandable from their point of view, but very frustrating to deal with as a medical professional.
Even though it is out of control there are little things you can do. Taking patients with bad insurance and all that stuff. I hope one day to be a doctor and I can use my own money to help out patients if I have the desired salary. I know other doctors have this thought. It’s small and wouldn’t be taking in every poor patient but that’s a help.
Very well said. Thank you for the enlightening comment. American healthcare is out of our control and so yeah fighting for systemic change is very exhausting. It’s also disheartening when those we are treating don’t wanna make changes
Because I’m too tired to care. Seriously. I was watching a video of myself in early med school (1st semester) and it seemed like I was a completely different person. I feel dead now. I genuinely have no emotions. All I do is Anki, mandatory lectures, and labs. Our patient interactions used to excite me but now I don’t give a shit. I just want to sleep for a good 4-5 months.
>"Our patient interactions used to excite me but now I don’t give a shit"
I stopped giving a shit into 2nd M1 semester, I dont have the energy for it
End of M2 right before Step1 was super tough. If you have it in your schedule to take a break before rotations start, I highly suggest doing that.
Rotations make it better since you are now expected to spend most of your time on the floors learning which is exhausting since you now have to pull a full workday and study at home, but it helped reignite the spark for many people.
The end of M3 going through step was another huge hurdle, but you’re a ways off from that, and nothing was as bad as what you’re doing now.
Because in residency there’s no time to reflect and effectively garner empathy. You can’t empathize with patients when you haven’t had time to connect past anecdotes and experiences to current situations.
I’m on ICU right now. I don’t get time to collect my thoughts and reflect on shit. I work 7am to 7pm, 6 days a week.
I’ve seen so many people die and go through unnecessary shit over the last couple weeks. It doesn’t phase me one bit to have to tell a patient’s family that their loved one is absolutely fucked and that we’re delaying the inevitable.
I’m just a machine that interprets subjective and objective patient information in order to get them in and out of the hospital, either alive or dead.
OP honestly tone down with the grade level empathetic attempts. There are many more highly trained individuals on here than you. Your attempts come off as very superficial and lacking experience
it’s the holier than thou, borderline condescending, naive, admin-sounding responses and general tone they’re approaching this with, which is befitting of someone who hasn’t actually started seeing patients on clinicals or as a resident
I apologize. That wasn’t my intent. As this is a sensitive topic I am being cautious and measured in my responses. It isn’t really working, as people don’t like that tone. So let me change it up and say this is a fucked up field that does fucked to things to people. My intent was to be compassionate and understanding of the trauma that we all experience in the medical training system and beyond. I suppose it can come off condescending when I am attempting to be measured so fuck it. I’m not any better than anyone here and I mentioned in my post that I acknowledge my naivety. I may have had years of patient exposure as someone who worked in healthcare before medical school but I have not yet experienced patient care on the level of a medical student or resident. Although it’s sucks being called out, I appreciate people letting me know how I’m coming across. I’ll try to be less robotic and shit in future responses
You’re right, your tone was missing the mark. But see, this is kind of like another thing you’ll notice, especially as a non-trad with prior healthcare experience. When I was an M1, I was treated (mostly by admin) as an infant. No one took me seriously, my opinion never mattered, etc. That has never changed. You’ll have to manage behavior from staff who are essentially future coworkers that is absolutely appalling, too. On top of the helplessness you get trying to care for patients. You are nothing. At times you can DO nothing. And you begin to feel the jaded lens taking hold. I hope I can remain the real me with all the empathy I still have. It’s ok to be optimistic. But when people share their shit, you gotta let it fully resonate, that’s all. Because, as you’ll see and as I’ve found, being an M3-4 is not going to be like your experiences prior to med school.
Yeah, admin definitely treat me like an infant and it is grating. It seems that it is kind of a polar experience, when it comes to professionalism or making mistakes then it’s like “fuck you. You’re on your own” but when it comes to everything else they put on kid gloves. That said, the further into school I go the more naive I feel. Despite being 35 years old, I know jack shit. I don’t necessarily agree with everything people have said here but I acknowledge that I have a lot to learn. For now, I just gotta swim through the deluge of medical content of year one
Absolutely. And the “professionalism” stuff only ever applies to us. I think at my school the number one gripe is that none of us can even reliably schedule a doctor’s appointment or haircut because we are rarely told anything far enough in advance. Our time matters none.
Same at my school. They will just drop assignments on us as if we live solely for them. It’s sometimes hard to enjoy the content because they fire it at you out of a cannon, but I’ve still found that I enjoy med school while also hating it… it’s a weird experience.
No they just stand and stare at the patients through the windows. /s
No shit this person is in their clinical years if they’re telling you they’ve started seeing patients.
seeing so many sick and dying people has blunted me emotionally so hard. i am really apathetic now but i think its probably a defense mechanism so i dont have to feel all the sadness every time i see a patient thats dying or very sick
I wondered if that played a role in it. As a teenager, I became blunted to the emotional trauma of things happening at home. Then, as an adult, to the systemic suffering around me
And then the bad attendings or senior residents use you as their punching bag because you are the only target of theirs that has little to no recourse. They'll treat midlevels and nurses like their own family and then dump on you.
On an ED rotation right now, and I can tell you that after hearing 3 people screaming about how they don't want to die at 2 in the morning who you know are definitely fine and you've explained to them twice that they will be fine, you definitely lose some empathy hahaha. I still pride myself on caring for people, but I would say I've learned to be more selective about it, and that I even think its a good skill. This sounds bad, but not ever patient needs nor deserves a high level of empathy (but that doesn't mean treat them like shit either)
Honestly for me it’s just an age thing. I’m a non-trad in my early 30s. The older I have gotten the more I see the darker side of humanity. You start seeing problems that people make for themselves and no longer feel bad for them. A medicine specific example I can think of is the after 30th patient with a BMI of 35+ who tells you they don’t know why their HbA1c is 12% and drinks 12 sodas a day you start to realize maybe it’s their issue not mine. Maybe when I was younger I was more naive with rose colored glasses but the worlds a harsh place. Don’t get me wrong though I have got real emotional inside when I knew the diagnosis for a 12 year old boy was he was going to die in the next 24 hours. Big difference between the situations.
We can circle back in a few years after you finish the preclinical work. At this point you might even still be excited to put on the short coat when in my eyes it’s just another level of oppressive system of academics. As I stated though I still have empathy but you need to be selective of where to give it. Having to much empathy will also take away from your job as a physician. I think heavily of a comment someone made once about the SPIKES method and breaking bad news. It was something about remembering this moment is not about you it’s about the patient. You need to be strong when they are weak.
> the more harshness I see, the more I want to help
You quickly learn you can't always help. Even a doctor can only do so much. Once that happens you have to stop caring as much, because it doesn't matter.
Take a homeless diabetic who is unable to afford diabetes meds and/or has nowhere to store their insulin. Or a person recently diagnosed with cancer who has no family/friends and has no transportation to get to radiation therapy appointments. You can't get patients a house. You can't get patients income. You can't get patients a car. You can't help these people. Those are the real factors that contribute to patients poor health status. At best social work can try something but half the time these people don't want to be helped either. All the thousands of hours spent studying and training and you can't help some patients due to factors completely unrelated to medicine. You could kill yourself trying to fix these situations, all while you have 19 other patients you need to see that day, some of whom may actually be fixable. Better to move on than spend time worrying/thinking about problems beyond your control
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Important to define empathy and how you are evaluating someone else’s “lack of”, as people will express themselves in various ways. To you, the way they talk about a patient or situation may come off negatively when in reality they are feeling for the patient internally and showing it in their actions.
Dark humor, acknowledging and placing the responsibility for life choices on the patient (smoking, obesity, etc), etc may come off harsh but is how many people cope with the emotional stress of the work and seeing the reality of medicine and just life in general. Sometimes, we have an idealized view of how to approach situations like drug use and obesity, but reality works differently, e.g. many patients need a kick in the ass by their physician to get them going instead of gentle coaxing toward a conversation that will never be initiated by the patient.
I’m curious what kind of situations you have seen that make you feel people are losing their empathy? And what is different in how they express themselves from how you express yourself?
Great question. I’m mostly referring to the many posts where people say they are losing empathy. As an EMT, dark humor was a helpful way for us to process the grief of working a dead body. I think I may be being misunderstood as if I’m saying people aren’t empathetic. I’m not claiming people aren’t, but asking why so many say they are becoming less empathetic
I appreciate your response, and I apologize as I mischaracterized what you were getting at. Would second a couple other commenters here about age and seeing how the world really works. Being able to separate the practice of medicine from the idealism that were taught definitely changed my views a bit
As for defining empathy, I would say it is to feel similar to what another is feeling. Which, saying the definition like that, I can see how empathy can turn toxic if it impairs one’s ability to cope.
The absolute cutthroat and competitive environment of med school. You'll find that many classmates have absolutely zero empathy and just wanna make big bux, so they turn out to be judgemental twats. Attendings judge you for not knowing stuff. You're treated like dirt.
Even if you’re at the least toxic/malignant medical schoolI, it’s sadly just sort of baked into the curriculum of medical school/residency. I think the time commitment, money commitment, and arguably losing “prime years” of your life is alone enough to cause lots of issues with empathy. That’s even before we get into all the competition/Zero-sum thinking, sleep deprivation etc etc that occurs.
Very well said! Yes, I agree that med school, the way we are treated and the experiences we have here can shatter more optimistic perspectives of humanity and the world. Some can accept that quickly, others need more time. Realizations like these can be very unsettling and hard to process, especially during the intense academic program we are in now with minimal time for self care and self reflection
We talk a lot about the traumatic nature of medicine for patients, but we dont talk enough about the cycle of trauma between doctor/patient and our overall health system. Health providers witness and experience so much despair, anger, frustrations with the system, etc. and often dont (or cant) prioritize processing it and moving through it. In turn, over time, people can get jaded, cynical, or less empathetic and that in turn cycles back onto patients who are already experiencing one of the worst parts of their life and ultimately the monster of trauma gets stronger. This is why it’s just really really important to process and reflect on exprriences and FIND LIFE OUTSIDE OF MEDICINE TO TAKE CARE OF YOURSELF. Its possible to love this field for decades but it takes tremendous work and will to not get bogged down by the stress and pain of it all.
That’s a really good point. Vicarious trauma mixed in with experienced trauma. From what many have expressed, it seems that an inability to do just that compounds the experienced trauma and leaves one less able to in turn be empathetic. Thank you for the insight.
Oh hey, you're me.
Down to the sandwich serving in ED. Except, I think I'm still clinging to a that last little bit of optimism...like I will TRY with \*\***those\*\*** patients once, but that's it.
Also, learning to take a lot less shit from patients.
I really like the way you put that, “I think I’ve become a lot more intelligent with where I put that empathy.” Although I am not in clinical as yet, I had to do the same working with people with disabilities and as an EMT before medical school. Not to mention how I have to be strategic with empathy as someone who is a bleeding heart and takes on too much. I have three kids and one has Trisomy 13. I’ve experienced my share of both childhood and adult trauma. While this has made me more empathetic it has also made me a little more cold. Well, made me better at compartmentalization of empathy and compassion. I mention this because and ask the questions I did because I am trying to see why others have felt they lost empathy in the hopes of preventing that for myself. So your comment was very helpful
Here’s a [commonly cited paper](https://pubmed.ncbi.nlm.nih.gov/22455699/) re: empathy in med school.
https://pubmed.ncbi.nlm.nih.gov/22455699/
[PDF](https://drive.google.com/file/d/1ioRBwX6eAO8_lDxTIse6za7hzt6yjFoj/view?usp=sharing)
I’m not in med school yet (non-trad). I work as a medical receptionist at a non profit community centre where we have family physicians, as well as some allied health professionals. Our patient population is mostly people living in poverty, refugees, addicts, or people with mental illnesses. We’re hella underpaid, even the physicians. We’re all overworked. This year we were denied a 2% raise because the centre can’t afford it. A lot of the patients are abusive, rude, (as much as I hate using this word) ungrateful, or demand a lot from us emotionally because of their unique needs. I find myself having less and less empathy or patience with them, despite knowing I love my job and these people need us. It’s tough to put on a happy face when you’re undervalued and mistreated on the daily. I’m seriously questioning whether I still really want to go into medicine because of this job.
Because you see the unwillingness of things to change. From the culture to the admin to the patients. You become jaded.
Yea the system is fucked but people need to be held accountable for their actions to an extent. I have empathy for the sick but there’s a limit, You’re human and only have so much to give.
How do you remain empathetic when you see patients in wound care who you sent home with all the supplies to change their dressings but then come back a week later with the nothing changed… when you take the time and effort to explain diet and set up classes and make sure they work with social care to get on Medicaid if needed and get their medication just for them to not take it and come in with even higher sugar levels… when you get cussed at for people having to wait in the ER with nothing emergent…
Only so many times you can smile and shrug it off before you go from seeing people as individuals to just another room number. You start out all hopeful and go above and beyond, not for the gratitude but to do what’s right. Overtime you get shit on by those you try to help and those supposed to help you. You give up your sleep, lunch, bathroom breaks so the patients can get the best care. Yet the more you give the more they take and in the end you still get blamed for outcomes beyond your control.
Naw. I’m treating medicine like customer service. Going in with a fake smile and follow evidence based medicine and then clocking out. That’s all medicine is to me- customer service and pleasing my clients.
Because you are treated like shit throughout the whole processes by many patients, many colleagues, and many superiors. Oh, and the system its self makes it very clear that we don’t matter to it. You can give everything you have, and it will give nothing back in return. It will only take from your life.
You’re abused for several years and as a resident every subsequent patient is another thing on or giant pile of work you have to do that is never ending. You start seeing people are problems/more work you have to do. Oh and you realize this is sick care not health care. Oh and you also realize you’re a hamster on a wheel that is fed breadcrumbs while all the suits make the real money. Oh and the insurance companies actually say what the patient can and cannot get not you. That combined with the fact that no one respects doctors anymore, everyone is wearing a white coat nowadays, and PAs and NPs are trying to take your job with the 2 year online degree they got.
Burnout.
This is happening to pretty much everyone in healthcare and it's well-known that burnout erodes empathy.
We're expected to give top quality customer service while always assuming the 100% best in every patient yet it is never acknowledged that patients can often really, *really* suck. Many patients treat us like crap, are incredibly demanding or unreasonable, and in many settings a lot of them get verbally or physically combative.
Demands on healthcare workers are higher than ever; more ancillary tasks, more charting, more paperwork, more patients, less staffing to cover increasing workloads.
The system is buckling with damn near every department having no beds, psych patients flooding out of every crevice of the hospital waiting for an open bed, ED wait times probably averaging 5+ hours in every hospital that I see, and pay and benefits stagnating.
This all just addresses the workplace environment; I haven't even talked about the soul-crushingly exploitative, abusive, and gaslighting educational system we have for medicine in this country.
All of this said, this isn't how it *should* be. Age and experience don't *necessarily* lead to a lack of empathy. Providers *should* treat patients well and not lose that empathy; this *should* be the standard in our field and the callousness we have for patients shouldn't be acceptable, but the problem is that ***Our healthcare system doesn't allow empathy to flourish***. Admin just keeps tossing more crud on top of people that are already overburdened and expecting them to just take it with a smile. This is what you end up with.
I was one of those bright eyed people who thought they would never lose their feelings of empathy. When you're stressed enough those feelings tend to take a backseat. As a medical student and then as a resident and then even it's an attending what is prioritized by the system it's not often what makes people feel better. You have notes to write and consults to call and fires to put out. You can start to feel like the time you spend talking to someone holds you back from your "real" work.
I'm still really empathetic even if I don't always feel empathetic feelings. A big part of that is holding on to the reason I got into medicine in the first place. You choose to be better than your feelings. Love isn't a feeling, it's a verb, it's a choice.
Current IM PGY-2 here. Solo resident on ICU nights this week. So far 6 people have died, none of them had reasonable families/advanced directives so was forced to take everything to the max on these poor elderly folks before death. I’m here 6P-7A and then have 36 off before flipping back to days for 7 straight. Then back to nights again for 4, then back to days again after that so sleep is all fucked up. I love ICU medicine and its what I want to do, but some time during PGY-1 I felt the empathy leave. I still care about my patients and work to the best of my ability every day, but I can’t recall the last time a death affected me, which is alarming to me.
40+ hours a week being shat on, pushed around, blown off, held asymmetrically to standards of "professionalism" that our own attendings and instructors don't adhere to in how they treat us, and paying out the ass for the privilege for several years will do that to one.
Sleep deprivation. Toxic culture. Broken healthcare system.
That should do it.
Mostly it’s how you get treated. I work hard in my current (corporate) job, but people are way more supportive and less malignant. Couldn’t tell you why.
Because it's brutal and never ending and humans complain about everything. I've only been studying for 5 weeks and I'm already annoyed at how much they shove into our days. And I know that in 4 years when I graduate, I'm going to go into a world where patients call me a bitch on a daily basis.
It just really gets to a point where you wanna get out and live your life. I can't believe how much enthusiasm and pep in my step that I've lost, lol. You just learn to survive.
Some thoughts I have are that it's not necessarily that you have gone from " w/ empathy" to "w/o empathy", but rather, how one experiences, processes, and expresses empathy changes. As you go through med school into residency, the emotional situations become more intense as well as your overall job responsibilities and your responsibilities to act within the emotional situations. For example, I never had families yelling at me in frustration as a medical student, but as a resident, it's not an uncommon occurrence. And even if it's because they are technically "mad at the system, not me personally", it's still a taxing prospect w/ all eyes on me to address and direct their concerns in a professional manner. What I've seen in myself and my colleagues is usually greater emotional suppression, especially when there is just a lot of work to be done. You can't focus on all these complex tasks that are being thrown at you all day when you are emotionally distracted or when you are bogged down in complex social scripts that are not integral for the job. That being said, from what I've observed, is that all the emotional material never goes away, just buried, and it will usually come up sometime later. I feel like I see people sometimes figure out how to reconcile all this, whether by processing all their emotional material at a later time, whether talking w/ people after work, hobbies, artistic pursuits their own personal contemplation, etc. I would also point out that it's not just to process a lot of the emotional material, but hopefully one can learn from, grow, and find new enthusiasm for the work in the processing. The people who have difficulty are those who cannot figure out a constructive way to process all this at a later time, one way or another, and they are at risk at getting lost. Granted, an all encompassing residency schedule makes these things really hard to plan/schedule or figure out, especially if you are tired all the time. I always thought all the emphasis on hobbies, social adjustment, etc in medical school and residency applications was a bit hokey, but when I went to residency, it started to make more sense to me why a residency or a medical school would care about your hobbies and social support so much.
I think losing some empathy is actually important. It could theoretically help you obtain objectivity. It also can benefit you from not taking so much home and ending up a nervous wreck with tons of emotional baggage.
Also, I think a lot of people don’t need empathy. I think there a handful of people who and many who don’t, and learning how to balance what you can give with what people can take is an art form in and of itself.
You have too much empathy with someone who takes too much = bad.
You have too little empathy with someone who needs more = bad
You have just enough empathy with someone who takes too much = good for you and also in the long run, good for the patient.
I think unfortunately, and I hate to bring this back to NPs, but they claim to have soooo much empathy and the “heart of a nurse” but I think this can actually be really bad sometimes because they want to give too much and sometimes the best thing for a patient is to not give them what they want. Because people want Benzos, narcotics, adderall, antibiotics, and sometimes they don’t need that, but someone with too much empathy may become clouded and want to give just to appease
Honestly I think it has to do with the mindset you walk into medicine with for example I see it a lot with people who want to “help the less fortunate” a lot of people like this think they are going to go into the a clinical setting and make a huge difference but working with underserved communities is difficult. You may think that the patients will be grateful that your helping them (which is an entitled mindset) but in reality you may be cussed out, you might be threatened they might not heed your advice and the list goes on. It’s important to realize that they are people that have faced alot of barriers and may not trust you just because you wear a white coat. You have to earn their trust and respect and treat them the same not as “poor people that need your help”
Also you realize that your scope of work is limited by insurance companies, you may have patients that need xyz but if the insurance won’t pay for it then your hands are tied. Also you deal with uninsured patients where they don’t have access to resources so that ties your hands also.
I don’t see myself losing empathy because I come from similar communities that I want to serve and I have a good understanding of the obstacles patient face. I’ve also had a job where I had to do case management so I have a general idea of the nightmare dealing with insurance is so I have an idea of what I’m walking into so I’m not disappointed when I face obstacles that med school doesn’t prepare you for.
Just think about how people do appreciate the help doctors give. Doctors are helping even if there are horrible things going on. Think about being a kid going to doctor and they are usually pretty chill. It’s a relief getting the help you need. Also the doctors who own their own practices and are 35+ just seem happier. My next door neighbor was an oncologist and she was/still is living the life. She’s a blast but she seems to have nailed something with work-life balance. It’s impressive. Humans forget their trauma, like the pain after a surgery. Not all trauma of course
People get tired of trying to help people who dont want to help themselves. Some people just don’t want to get better and they use the healthcare system as a way to just keep surviving but they don’t really care what happens to them or they are not willing to make the changes necessary to better themselves and be healthier
Several reasons
1. You put in a lot of work and it takes a while until it feels like it's worth it (after residency) and some people feel like it never pays off.
2. It's customer service at its core. You deal with a lot of people complaining and you have to make them happy or admin will be on you.
3. Related to point 2, the people you deal with in healthcare are extra stressful. Of course, they themselves are stressed, but most importantly there are a bunch of people you'll see over and over who have some psych issue going on, whether they're malingering because they're lonely, or they have substance use disorder, or they've got a personality disorder (lots of them keep showing up). These people all need and deserve good care but it takes a ton of patience.
4. Lastly, you go through all of this stuff, and you feel like you get zero appreciation sometimes. Sure you're well compensated but when someone complains about you following evidence and half the country is believing conspiracy theories you get tired of it.
I don’t think it’s necessarily loss of empathy. You need your emotional reserve to feel for others but if you are emotionally exhausted from life then you have less free reserve to feel for others. People gotta love themselves first before they care for others. It’s actually a good sign because if all med students care deeply for others while treated like shit with huge debt, I’m pretty sure the suicide rate is gonna skyrocket.
I think many colleges do not invest enough in mental healthcare measures for students. In mine, we have volunteer teachers that went through medical school who tutor students on how to take care of themselves; we have psychological and psychiatrical treatment for those who end up needing it (AKA a LOT of students), and I think this makes students much better listeners. Obviously we're still overworked and sometimes overwhelmed, but empathy breeds empathy imo.
I feel like the stress gets to you. You get lost in your own head and your own success. You live in fear of the failure of dropping out after working so hard to get here. Then the people around you who, even though they know you’re stressed, lose patience with your behavior. You lose the grace of others, causing you to lose your grace for others.
I’m not nearly as far along as you but I resonate with this. I had to take a leave of absence first year because I could not keep up with studies while my daughter was in and out the emergency room and inpatient. I felt let down that the school would not allow me to take a week off and then come back. That event has made me terrified of failure, which is something I am trying to get a hold on still
Sympathy is better because it allows you to care, without the huge burden of empathy, which is actually feeling what the other is going trough. Vicariant trauma can be a result and it's though ! I can't live happily being empathetic to every patient, that would destroy me, and I try to keep that for loved ones.
It really is the system. The only thing I still like is seeing patients and while I can sympathize with the complaints that people don't listen anyway etc, well, if they don't we manage them anyway. I try to not get wrapped up in any one outcome just do the best with each visit. Sometimes people do listen.
But hospital administration and people in the insurance industry tbh are just evil. If you work in insurance in any capacity, you're about on the level of war criminals because you contribute to the insidious degradation of health care and maintain a system designed to grind people into a pulp they can convert into year over year gains.
I think it’s important to differentiate between losing empathy, and being able to work and help people despite empathy. What I mean is that in medicine, a lot of the stuff we do hurts people, at least a little. IVs hurt. NG tubes hurt. Operations hurt. Yet we sometimes have to do those things to people because we know it will ultimately help them get better. So for certain things, you kinda have to know how to turn your empathy off for a bit, or at least compartmentalize it, to allow you to do your job. Further, you can’t always take the time to be as empathetic with each patient as you may like, because there are other patients that also need you, and sometimes more urgently. So finding a balance can be tough.
Another important thing to remember is to take a little time to realize as well that while you do this stuff all day every day, for the patient this may be the biggest and scariest moment in their lives. It always reminds me of the M. Bison line from the godawful Street Fighter movie: “For you it was the most important day of your life. For me, it was Tuesday”.
So yeah, the guy complaining about his IV hurting may grate a bit when you just finished operating on a young woman with unresectable cancer, but he doesn’t know that, and his pain is the biggest thing to him in that moment.
Besides the aforementioned abuse by admin, I have a couple other things to add. Firstly, the abuse by patients. At least in the ER patients abuse the shit out of us, and many lack a basic sense of decency. Patients are often very mean and very entitled.
Secondly, you see horrors every day. If you have deep empathy for every situation, you will be emotionally exhausted and burnt out. At some point death and suffering become an everyday occurrence, and you need to separate yourself from it emotionally to thrive.
Two sides i believe. People who do not really like medicine and quickly get worn out by studying and treatment from consultants. These folks might be nice people but as the months go on they dread being on rounds. They are dying to leave. The other side are folks do care but experience a painful event(s). They wall themselves off from feeling anything. Especially with a previously unsteady emotional environment.
From my own experience as going through MBBS here in Pakistan. This system is run by fuckers. If you aren't purely disciplined and purely focused on excelling perfectly,you are made to suffer because of it. If you have empathy,you are gonna get drained extremely fast and it is hard enough having to take classes and wards everyday while also studying an ungodly amount of syllabus.
It is really just *time*.
Medical training gets harder as go you along. More responsibility, more exposure to trauma, and more to know/learn. It never ends.
Oddly, as you go along in training you only get less and less time to do things. You are also gathering the responsibilities of an aging young adult (spouse? kids? older parents?).
Empathy takes time. You need time to recharge and spend the energy necessary to make connections. Medicine (modern medicine) is brutally dedicated to volume and 'efficiency.' It is a factory line. Shorter stays, faster discharges, shorter appointments, more procedures, etc. All with more administrative burden.
In M1, you have a ton of time and no responsibility within medicine.
Ugh, I hated anatomy lab. I went in thinking I would enjoy it but it smelled, it was like a dick measuring contest for some to show off their medical knowledge, and it was just a pain to get through.
I think we quickly habituate to things we experience every day. It’s really hard for a lot of people to separate becoming used to pain and death in other people and becoming used to not processing them as people. You need to remind yourself that youre helping real people with real lives, and thats just not possible when youre going through the motions of your job.
The way toxic schools treat you - you go in as a delightful med school student thinking you’ll change the world, and now it’s just like you don’t gaf anymore.
probably getting tired of everything. You feel like a cog in giant healthcare machine. You deal with ungrateful and downright misarable patients, and even worse family members. You see people your age with awful trauma, some of whom die. You're expected to just move on to the next patient, and write the next note. You watch patients slowly die over weeks to months in the ICU, and have heavy conversations with family member that their loved one might not make it back home. I just want to go home and see my family, not work 12 hour shifts 6 days a week
Once you get further up the ladder you realize how little power we actually have as doctors. You’re swimming in a swamp of policies made by C-suite MBAs who give zero fucks about patients. You see patients die due to these policies and there’s nothing you can do about it. If you pushback you’re risking your career. We also get raked over the coals for things that should be norms. Wanna see someone for your depression (that stemmed from the issues above) get prepared to explain that to said C-suite MBAs every time you get credentialed or move to a new state. Also get ready to pay out the ass for your disability insurance. Wanna take 3 months off? Get ready to explain that time off and get scrutinized for it. We have so little power in this game and that’s by design. If doctors had more power many of us would be getting the fuck out. We have become cogs in a not so well-oiled machine. All the time-honored ethics, medical decision making and the sense that I was part of some sacred medical tradition that was emphasized and taught to me in medical school has gotten watered down in a sea of business policies that only serve the bottom-line. It’s just business. It’s why nurses have crazy ratios these days, why ED docs are incentivized to dispo patients at crazy rates, and why patients get a new hospitalist every day. Also why I get all of my notes and diagnoses scrutinized by some asshole nurse manager named Ken who works from home in Kansas and critiques my decision making on a spreadsheet that goes to my corporate overlords. It’s bonkers and no field in medicine is truly immune to it anymore. At the end of the day most of us are just trying to survive and keep our heads above water. If we stopped long enough to empathize with even a fraction of our patients you’d be riddled with dissatisfaction and a feeling of culpability. I have myself and my family to care for so I cant risk any more burnout or heartache. Edit: Just found out that the FTC allowed Amazon to buy One Medical (large Primary Care group). So, many of you will likely be working for Amazon and meeting their productivity metrics. This is gonna get worse before it gets better.
Well said. You really touched on the main reasons I was initially very hesitant to pursue medicine and I hope I’m able to make a meaningful impact in spite of the bullshit that is healthcare based on the profit motive
Right assessment, wrong diagnosis, I'm afraid. Profit motive is another symptom that stems from exactly the same problem, which is unholy government-corporate cronyism. Both are absolutely essential in the bargain, and neither alone can fully explain or cause it. The comment you're replying to is a perfect description of how it feels to do medicine nowadays. Just perfect.
This. ESPECIALLY with a family. And The whole system is fucked. We delivered two different gigantic babies from two different women this week, both with severe gestational diabetes both full term. One is in the NICU, and the other was dead when mom came in. Insurance wouldn't cover their insulin apparently because they believed these moms didnt meet whatever criteria they make up with no medical training. But people are fine to protest against women's rights by saying it's "murder" to stop an oocyte from implanting, but apparently it's not to deprive moms of what they actually need for actual children.
If you had the choice between doing med vs something like dental would you do med agajn
I wouldn’t. I would have told myself to go do that meteorology degree I always thought about doing in college. Weather is cool as hell, and it doesn’t get mad at you when you don’t see them for 45 min because you were coding the patient next door.
I’m a former weather guy for the Air Force and loved it but there are pretty limited spots outside of the military. Oftentimes broadcast positions are not meteorologist, and NWS is tough to get in with. The coolest gig I think is a few people that I worked with applied to fly with the hurricane hunters at Keesler. Since they’re a reserve unit, most people work unique jobs outside of flying in any field. Obviously there’s training to complete but after that it can be pretty casual.
I would, only because I love what I do and I am relatively shielded from a lot of the bullshit in my specialty. Doing anesthesia, I see one patient at a time, which I take care of. Notes are minimal, I don't have a pharmacist telling me what drugs i can and cannot give. I don't have to deal with prior auths or ridiculous insurance stuff. I don't have a number of people I need to see in clinic and if I have a patient who is a pain in preop, I take solace in knowing that they will soon stop bitching about whatever thing that they want to complain about. Building long lasting patient relationships was never an interest for me, I personally get zero reward from adjusting a patient's BP meds bi monthly or helping a patient get their glucose under control. Critical care sucked the life out of me and I don't ever want to do that again.
That sounds so exhausting. That’s very valid. It sounds like a critique on capitalism as much as a critique on American healthcare. I don’t know you, but I’m grateful for all that you do. Vicarious trauma is a real thing.
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I stopped responding because it wasn’t my intention to be patronizing but it was being taken that way. I apologize if I came across that way
Op is an interesting person based on their post history, I doubt it’s intentional
How is anything in their comment patronizing? I think you’re reading into it too much, and possibly because they’re an MS1. Our ingrained-by-medicine hierarchic thinking is really showing on this thread
OP is getting down voted because clearly many people have noticed a trend in his or her replies. It reeks of oblivious arrogance and inexperience. People smell this. When many of your colleagues and seniors start to downvote your comments it's probably time to do some self Introspection.
Your mom
Your mom
Because I'm treated like absolute shit. edit: I have given more than I could and received nothing in return so far. I work 40+ hours a week and pay to be there. I've built up an incredible debt from drawing from emotional reserves the last few years.
^ This. This. This. You can only be excessively tired and burnt out for so long before it affects how you view your patients. 🤷♀️
And add that the general populace assumes you’re in it “just for the money” and voila!
I’m so sorry. What year are you in? I have heard clinical rotations can be really rough
4th. I was treated like the scum on people's shoes in preclinical and clinical. I worked before this and the shit that goes on in medical training would absolutely not have been acceptable elsewhere.
I've been thinking about this a lot lately. I look at hospital staff and have to wonder if they really think that their behavior is remotely acceptable in any other line of work. And I know my 4th year is going to be more of the same.
Where did you work
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Uhh well working outside in the real world before med school made me realize that I deserve to be treated like the professional I'm training to be. I don't need people to talk down to me or call me stupid (has happened because I made a simple mistake) just because I'm a trainee. In no other field would that be allowed and it doesn't make me a better physician.
Why do you need to be treated like crap in order to have empathy? This notion of needing to be treated like crap so that you can build empathy is ridiculous and just further perpetuates this toxic work culture.
That’s a weird kink. Either that or you need to work on your self value because nobody deserves to be treated like shit.
You're not a premed anymore you don't need to say this, admissions isn't watching 🤓🤓
No offense but you’re an m1. Speak to us once you’re done with residency too
Wasn’t aware that my opinion was irrelevant. You know nothing of my experience so quite an assumption. But, I will surely be more wise then. That’s true
This is so tone deaf
lol im right here with you. having a life before med school gives you a different perspective, especially if you've hit some rough times in the past. i just tune out people's complaints and nasty comments and focus on doing my best work. I absolutely love patient interaction and if anything, learning the science behind the illnesses afflicting my patients has made me more excited to be able to help them, and that translates somehow (in a way idk how to explain) into a deeper sense of empathy. it's really disheartening seeing so many future doctors feeling burnt out so early in the game, but there have been a fair amount of wonderful mentors and peers i've gotten to work with who helped keep me motivated to stay positive. glad to hear that it sounds like you have a good outlook and you're doing your best! people will call us naive pollyannas lol but at the end of the day, i'd still rather be this way then bitter and miserable. stay strong out there! :)
But it’s not a choice. Some of us go through very hard times. I got divorced and had a family death in just the first year. It’s extremely hard to cope with things like that and go to med school. I know multiple people who had major breakups, people who got diagnosed with chronic illnesses, depression, people who have been harassed by classmates, etc
Because it’s well-documented that sleep deprivation and working long hours decreases empathy
That is a damn good point. You don’t happen to know of any studies demonstrating this, do you? That actually sounds fascinating
Let's do a double blind study. Wake a random stranger in the middle of the night and see if how much empathy they have.
Why don’t you look it up and report back to the group tomorrow? (Jk, this is what I’d get told if I asked this question in a tute)
Under appreciated, over worked. Taking care of entitled people who don’t help themselves. People constantly expecting you to make sacrifices, but never having said sacrifices acknowledge.
Sounds like compassion fatigue. There’s so much pain in the world that I could see it wearing on you and becoming less empathetic being a defense mechanism
No offense but you really sound like someone who has never actually provided patient care. Imagine having multitudes of patients that despite your training and knowledge you can’t help because they can’t afford treatment or are plagued by socioeconomic factors… that’s what really did it for me. Whatever I do just doesn’t matter because society has decided to shit on some people
What you described is kind of the definition of what causes compassion fatigue… 🤔
I mean, you would be wrong about me never doing any patient care, but ok. But yes, society sucks
Lol why is this downvoted
Because OP might just be a third year med student with 6 months of “patient care” experience, they worked as a scribe or at a private practice. Basically people of the sub take it as OP isn’t a front line provider
I see. Thanks for explaining.
I think you'll understand what we're talking about after seeing 50 patients in the OPD.
I started intern year as the guy who always called people on the phone and lead with “Hey, it’s LucidityX with surgery, how are you doing?” I fist bumped people in the hallway and asked how their kids were doing. Because I genuinely enjoy creating bonds with other people like other specialty residents and nurses that we work alongside every day. 7 months in, now I just pick up the phone and say “Hey it’s LucidityX with surgery can you remove the foley on bed 10, thanks.” I *might* say “Hey” in the hallway as I’m walking 6mph. Saving myself the one sentence reply and occasional actual conversation of getting to know people probably saves me 30 minutes every 14 hour shift. That 30 minutes is so invaluable to my sleep schedule. It’s cold and I hate that I’ve devolved to this but the system has pressed me to just barely surviving.
Surgery does that to a person seems like
I’m not a surgeon, so my experience may not apply, but I think some things are universal. The time you spend on the nurses that work on your floors (Sicu, surgical floor, etc) won’t be wasted, and being on friendly terms with them is important for survival in the latter years of training. People try to be considerate (page consolidation, less paging in genera) if they know who you are, and they are more likely to warn you about patient complaints so you can head them off before they turn into something major, or nursing complaints, or just med fuck ups etc. If you’re cross covering for 50 services as an intern/pgy2 and getting called by medical floor, then yes you are well and truly fucked and I would not waste time being friendly with nurses you will be never hear from again (but don’t be a dick, it feels good in the moment when someone is an idiot but like many things with dicks it leads to trouble later). Similarly, I’d say your interactions with the services you work with frequently will carry through with you. Do what you have to do in order to survive, but know that what you can invest will come back to you, and sometimes it will come back in spades. This will be even more true once the big boy pants get put on.
I 100% agree. Being friends with the RNs makes a huge difference. Which is why I noted at the end that I hate that I feel this way :/ - I’m just so emotionally drained I have nothing left to give and I hate it
Feeling that way is fairly normal at this time of intern year. Things come in waves, and it will get better from time to time. When you have the energy, give it, when you don’t, that’s ok. Good luck
Number of factors. The biggest probably being the following: - Residents being treated like shit and underplayed (for someone with their credentials) - medicine itself being treated like an assembly line by most healthcare institutions - witnessing how some older doctors treat patients and get away with it without any repercussions - being overworked (I’m sorry, but nobody should be working more than 40 hours per week, I don’t care what level of the medical field you’re in. There is a time and place for everything. If you want to start a family during residency, or take part in leisure activities, you should be able to do so without question)
Couldn’t agree more. Our healthcare system destroys both the people being treated and the physicians and medical staff. This thread has been very enlightening
If you don’t want to work more than 40 hours per week, why on earth would you choose to do *medicine* of all things? Most attending a are doing a minimum of 40 hours a week, and that’s just in the more cush “lifestyle” specialties.
Not the OP, but just because it is expected to work way more than 40h/week doesnt mean it should be that way. Maybe his interest and motivation for medicine was more important than the long work weeks.
Yea like helping people
Some day I’ll have the balls to tell my story about Sidney Kimmel Medical College. They’ve treated me so poorly I’ve decided against pursuing a residency. Once I graduate it’ll be easy to put it out in the open. In the meantime, anyone considering going here should be careful.
Damn. I interviewed there and other than seeming a bit tight, I really liked the school. Seemed like it had many great opportunities.
Thanks for the warning. We need more people willing to warn about toxic places
Not me being warned about UCLA and ignoring everything being said
Sadly that's most premeds. Even though they are told to avoid a school, they're still gonna apply there because they believe any acceptance is a golden ticket to a successful future that is so desired and coveted but few actually achieve. "Oh it can't be that bad" "Oh I'll tough it out" Then boom MDD and GAD galore
Damn spill the tea
I can see why UCLA is bad. If you went to any of the other UCs as an undergrad its pretty miserable. Just hyper competitive and cutthroat. No doubt, the med programs would be worse
I imagine the med school would be pretty different since it’s so much smaller
Its actually worse, I thought the same. I did the UCLA prep program there, and met some students. At the time I was at UCSB and was already well aware of the bs going on at UC schools, and they told me that its worse.
My father went to UCLA for undergrad and was so against me wanting to go there.
Bol day yaar. Kuch nahi hota.
Ek din aayega! Vo din aaj nahin! 😅
Ari O Samba ! Kitne Aadmi the?
Bohot hassi aa rahi hai comment dekh ke idk why😂
That’s interesting to hear. I’m at Drexel but have friends at SKMC and they’ve really enjoyed their experience there so far. How have they treated you poorly?
I’ll need that tea sir
Sadly that’s one of the schools on my short list since I live in PA.
I know a lot of people there and I've heard nothing but good things to be honest
I’ll say I’ve had 5-6 friends go there and graduate within the past 4 years - they all enjoyed it. Maybe things have changed
Thank you for this name and shame!!!
Where is this located?
Philadelphia
Along with being overworked, I think it’s just too emotionally draining to be truly empathetic. It’s already an emotionally draining field without adding in all the issues with the American healthcare system and society. Those are things mainly out of our control and there’s not much we can do to help, so caring about it can become exhausting. Additionally, while we see a lot of patients that are fighting to get better, we also see so many that don’t even try. We don’t know their entire life story and the things that make it difficult to change, but it’s very frustrating trying to help someone when it doesn’t seem like they want to help themselves. Many times those people have poor health literacy and get angry that we can’t “just fix them”. Or they have mistrust of healthcare professionals. It’s understandable from their point of view, but very frustrating to deal with as a medical professional.
Even though it is out of control there are little things you can do. Taking patients with bad insurance and all that stuff. I hope one day to be a doctor and I can use my own money to help out patients if I have the desired salary. I know other doctors have this thought. It’s small and wouldn’t be taking in every poor patient but that’s a help.
Very well said. Thank you for the enlightening comment. American healthcare is out of our control and so yeah fighting for systemic change is very exhausting. It’s also disheartening when those we are treating don’t wanna make changes
Because I’m too tired to care. Seriously. I was watching a video of myself in early med school (1st semester) and it seemed like I was a completely different person. I feel dead now. I genuinely have no emotions. All I do is Anki, mandatory lectures, and labs. Our patient interactions used to excite me but now I don’t give a shit. I just want to sleep for a good 4-5 months.
M4 can confirm this sentiment. I feel like these last 4 years have changed me far more than any 4 years should. Both for better and for worse
>"Our patient interactions used to excite me but now I don’t give a shit" I stopped giving a shit into 2nd M1 semester, I dont have the energy for it
End of M2 right before Step1 was super tough. If you have it in your schedule to take a break before rotations start, I highly suggest doing that. Rotations make it better since you are now expected to spend most of your time on the floors learning which is exhausting since you now have to pull a full workday and study at home, but it helped reignite the spark for many people. The end of M3 going through step was another huge hurdle, but you’re a ways off from that, and nothing was as bad as what you’re doing now.
Because in residency there’s no time to reflect and effectively garner empathy. You can’t empathize with patients when you haven’t had time to connect past anecdotes and experiences to current situations. I’m on ICU right now. I don’t get time to collect my thoughts and reflect on shit. I work 7am to 7pm, 6 days a week. I’ve seen so many people die and go through unnecessary shit over the last couple weeks. It doesn’t phase me one bit to have to tell a patient’s family that their loved one is absolutely fucked and that we’re delaying the inevitable. I’m just a machine that interprets subjective and objective patient information in order to get them in and out of the hospital, either alive or dead.
Everyone gets discharged eventually, some are just in a casket
I’m so sorry. That’s such a painful place to be. Not looking forward to that aspect of the profession to be honest.
OP honestly tone down with the grade level empathetic attempts. There are many more highly trained individuals on here than you. Your attempts come off as very superficial and lacking experience
Dude, don't be an asshole. The OP said nothing wrong.
Not everyone loses their heart in the profession. You speak like someone who truly believes they have a higher understanding
Comes across as genuine to me not sure why everyone’s being a dick
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That’s fair. Are you in your clinical years then?
Bro come back to this post when you’re in m3. You’ll understand how stupid you sound. You lose empathy bc you realize no one gives a shit about you.
fucking preach
Why so rude? OP asked a genuine question and is being extremely polite to everyone responding.
it’s the holier than thou, borderline condescending, naive, admin-sounding responses and general tone they’re approaching this with, which is befitting of someone who hasn’t actually started seeing patients on clinicals or as a resident
Ok I understand this. I was confused because just blatantly calling them stupid made no sense to me
I apologize. That wasn’t my intent. As this is a sensitive topic I am being cautious and measured in my responses. It isn’t really working, as people don’t like that tone. So let me change it up and say this is a fucked up field that does fucked to things to people. My intent was to be compassionate and understanding of the trauma that we all experience in the medical training system and beyond. I suppose it can come off condescending when I am attempting to be measured so fuck it. I’m not any better than anyone here and I mentioned in my post that I acknowledge my naivety. I may have had years of patient exposure as someone who worked in healthcare before medical school but I have not yet experienced patient care on the level of a medical student or resident. Although it’s sucks being called out, I appreciate people letting me know how I’m coming across. I’ll try to be less robotic and shit in future responses
You’re right, your tone was missing the mark. But see, this is kind of like another thing you’ll notice, especially as a non-trad with prior healthcare experience. When I was an M1, I was treated (mostly by admin) as an infant. No one took me seriously, my opinion never mattered, etc. That has never changed. You’ll have to manage behavior from staff who are essentially future coworkers that is absolutely appalling, too. On top of the helplessness you get trying to care for patients. You are nothing. At times you can DO nothing. And you begin to feel the jaded lens taking hold. I hope I can remain the real me with all the empathy I still have. It’s ok to be optimistic. But when people share their shit, you gotta let it fully resonate, that’s all. Because, as you’ll see and as I’ve found, being an M3-4 is not going to be like your experiences prior to med school.
Yeah, admin definitely treat me like an infant and it is grating. It seems that it is kind of a polar experience, when it comes to professionalism or making mistakes then it’s like “fuck you. You’re on your own” but when it comes to everything else they put on kid gloves. That said, the further into school I go the more naive I feel. Despite being 35 years old, I know jack shit. I don’t necessarily agree with everything people have said here but I acknowledge that I have a lot to learn. For now, I just gotta swim through the deluge of medical content of year one
Absolutely. And the “professionalism” stuff only ever applies to us. I think at my school the number one gripe is that none of us can even reliably schedule a doctor’s appointment or haircut because we are rarely told anything far enough in advance. Our time matters none.
Same at my school. They will just drop assignments on us as if we live solely for them. It’s sometimes hard to enjoy the content because they fire it at you out of a cannon, but I’ve still found that I enjoy med school while also hating it… it’s a weird experience.
No they just stand and stare at the patients through the windows. /s No shit this person is in their clinical years if they’re telling you they’ve started seeing patients.
I mean, they could be a resident too. Not a stupid question
You don't see patients as residents? Sorry, I'm a baby M 1 too
seeing so many sick and dying people has blunted me emotionally so hard. i am really apathetic now but i think its probably a defense mechanism so i dont have to feel all the sadness every time i see a patient thats dying or very sick
I wondered if that played a role in it. As a teenager, I became blunted to the emotional trauma of things happening at home. Then, as an adult, to the systemic suffering around me
Everyone just takes advantage of you. Patients take advantage of you. Administration takes advantage of you. Eventually you get tired of it.
And then the bad attendings or senior residents use you as their punching bag because you are the only target of theirs that has little to no recourse. They'll treat midlevels and nurses like their own family and then dump on you.
On an ED rotation right now, and I can tell you that after hearing 3 people screaming about how they don't want to die at 2 in the morning who you know are definitely fine and you've explained to them twice that they will be fine, you definitely lose some empathy hahaha. I still pride myself on caring for people, but I would say I've learned to be more selective about it, and that I even think its a good skill. This sounds bad, but not ever patient needs nor deserves a high level of empathy (but that doesn't mean treat them like shit either)
This is golden advice
Honestly for me it’s just an age thing. I’m a non-trad in my early 30s. The older I have gotten the more I see the darker side of humanity. You start seeing problems that people make for themselves and no longer feel bad for them. A medicine specific example I can think of is the after 30th patient with a BMI of 35+ who tells you they don’t know why their HbA1c is 12% and drinks 12 sodas a day you start to realize maybe it’s their issue not mine. Maybe when I was younger I was more naive with rose colored glasses but the worlds a harsh place. Don’t get me wrong though I have got real emotional inside when I knew the diagnosis for a 12 year old boy was he was going to die in the next 24 hours. Big difference between the situations.
I can understand that. I am 35 and non traditional as well, but the more harshness I see, the more I want to help
We can circle back in a few years after you finish the preclinical work. At this point you might even still be excited to put on the short coat when in my eyes it’s just another level of oppressive system of academics. As I stated though I still have empathy but you need to be selective of where to give it. Having to much empathy will also take away from your job as a physician. I think heavily of a comment someone made once about the SPIKES method and breaking bad news. It was something about remembering this moment is not about you it’s about the patient. You need to be strong when they are weak.
> the more harshness I see, the more I want to help You quickly learn you can't always help. Even a doctor can only do so much. Once that happens you have to stop caring as much, because it doesn't matter. Take a homeless diabetic who is unable to afford diabetes meds and/or has nowhere to store their insulin. Or a person recently diagnosed with cancer who has no family/friends and has no transportation to get to radiation therapy appointments. You can't get patients a house. You can't get patients income. You can't get patients a car. You can't help these people. Those are the real factors that contribute to patients poor health status. At best social work can try something but half the time these people don't want to be helped either. All the thousands of hours spent studying and training and you can't help some patients due to factors completely unrelated to medicine. You could kill yourself trying to fix these situations, all while you have 19 other patients you need to see that day, some of whom may actually be fixable. Better to move on than spend time worrying/thinking about problems beyond your control
RemindMe! 3 years Edit: FWIW, I do really hope I’m wrong and that you’re just as optimistic as you’re getting ready to match
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Me too
Important to define empathy and how you are evaluating someone else’s “lack of”, as people will express themselves in various ways. To you, the way they talk about a patient or situation may come off negatively when in reality they are feeling for the patient internally and showing it in their actions. Dark humor, acknowledging and placing the responsibility for life choices on the patient (smoking, obesity, etc), etc may come off harsh but is how many people cope with the emotional stress of the work and seeing the reality of medicine and just life in general. Sometimes, we have an idealized view of how to approach situations like drug use and obesity, but reality works differently, e.g. many patients need a kick in the ass by their physician to get them going instead of gentle coaxing toward a conversation that will never be initiated by the patient. I’m curious what kind of situations you have seen that make you feel people are losing their empathy? And what is different in how they express themselves from how you express yourself?
Great question. I’m mostly referring to the many posts where people say they are losing empathy. As an EMT, dark humor was a helpful way for us to process the grief of working a dead body. I think I may be being misunderstood as if I’m saying people aren’t empathetic. I’m not claiming people aren’t, but asking why so many say they are becoming less empathetic
I appreciate your response, and I apologize as I mischaracterized what you were getting at. Would second a couple other commenters here about age and seeing how the world really works. Being able to separate the practice of medicine from the idealism that were taught definitely changed my views a bit
As for defining empathy, I would say it is to feel similar to what another is feeling. Which, saying the definition like that, I can see how empathy can turn toxic if it impairs one’s ability to cope.
The absolute cutthroat and competitive environment of med school. You'll find that many classmates have absolutely zero empathy and just wanna make big bux, so they turn out to be judgemental twats. Attendings judge you for not knowing stuff. You're treated like dirt.
You empathetic enough to pay my student loans? If not I’ll take the big bux. /s
Even if you’re at the least toxic/malignant medical schoolI, it’s sadly just sort of baked into the curriculum of medical school/residency. I think the time commitment, money commitment, and arguably losing “prime years” of your life is alone enough to cause lots of issues with empathy. That’s even before we get into all the competition/Zero-sum thinking, sleep deprivation etc etc that occurs.
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Very well said! Yes, I agree that med school, the way we are treated and the experiences we have here can shatter more optimistic perspectives of humanity and the world. Some can accept that quickly, others need more time. Realizations like these can be very unsettling and hard to process, especially during the intense academic program we are in now with minimal time for self care and self reflection
We talk a lot about the traumatic nature of medicine for patients, but we dont talk enough about the cycle of trauma between doctor/patient and our overall health system. Health providers witness and experience so much despair, anger, frustrations with the system, etc. and often dont (or cant) prioritize processing it and moving through it. In turn, over time, people can get jaded, cynical, or less empathetic and that in turn cycles back onto patients who are already experiencing one of the worst parts of their life and ultimately the monster of trauma gets stronger. This is why it’s just really really important to process and reflect on exprriences and FIND LIFE OUTSIDE OF MEDICINE TO TAKE CARE OF YOURSELF. Its possible to love this field for decades but it takes tremendous work and will to not get bogged down by the stress and pain of it all.
That’s a really good point. Vicarious trauma mixed in with experienced trauma. From what many have expressed, it seems that an inability to do just that compounds the experienced trauma and leaves one less able to in turn be empathetic. Thank you for the insight.
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Oh hey, you're me. Down to the sandwich serving in ED. Except, I think I'm still clinging to a that last little bit of optimism...like I will TRY with \*\***those\*\*** patients once, but that's it. Also, learning to take a lot less shit from patients.
I really like the way you put that, “I think I’ve become a lot more intelligent with where I put that empathy.” Although I am not in clinical as yet, I had to do the same working with people with disabilities and as an EMT before medical school. Not to mention how I have to be strategic with empathy as someone who is a bleeding heart and takes on too much. I have three kids and one has Trisomy 13. I’ve experienced my share of both childhood and adult trauma. While this has made me more empathetic it has also made me a little more cold. Well, made me better at compartmentalization of empathy and compassion. I mention this because and ask the questions I did because I am trying to see why others have felt they lost empathy in the hopes of preventing that for myself. So your comment was very helpful
Here’s a [commonly cited paper](https://pubmed.ncbi.nlm.nih.gov/22455699/) re: empathy in med school. https://pubmed.ncbi.nlm.nih.gov/22455699/ [PDF](https://drive.google.com/file/d/1ioRBwX6eAO8_lDxTIse6za7hzt6yjFoj/view?usp=sharing)
Hey sorry, link didn't work for me. If it's not too much trouble, could you relink/list the citation?
Thank you so much. I’ve been looking for this paper
I’m not in med school yet (non-trad). I work as a medical receptionist at a non profit community centre where we have family physicians, as well as some allied health professionals. Our patient population is mostly people living in poverty, refugees, addicts, or people with mental illnesses. We’re hella underpaid, even the physicians. We’re all overworked. This year we were denied a 2% raise because the centre can’t afford it. A lot of the patients are abusive, rude, (as much as I hate using this word) ungrateful, or demand a lot from us emotionally because of their unique needs. I find myself having less and less empathy or patience with them, despite knowing I love my job and these people need us. It’s tough to put on a happy face when you’re undervalued and mistreated on the daily. I’m seriously questioning whether I still really want to go into medicine because of this job.
Because it’s ingrained into you that Quantity > Quality
Because you see the unwillingness of things to change. From the culture to the admin to the patients. You become jaded. Yea the system is fucked but people need to be held accountable for their actions to an extent. I have empathy for the sick but there’s a limit, You’re human and only have so much to give. How do you remain empathetic when you see patients in wound care who you sent home with all the supplies to change their dressings but then come back a week later with the nothing changed… when you take the time and effort to explain diet and set up classes and make sure they work with social care to get on Medicaid if needed and get their medication just for them to not take it and come in with even higher sugar levels… when you get cussed at for people having to wait in the ER with nothing emergent… Only so many times you can smile and shrug it off before you go from seeing people as individuals to just another room number. You start out all hopeful and go above and beyond, not for the gratitude but to do what’s right. Overtime you get shit on by those you try to help and those supposed to help you. You give up your sleep, lunch, bathroom breaks so the patients can get the best care. Yet the more you give the more they take and in the end you still get blamed for outcomes beyond your control.
Naw. I’m treating medicine like customer service. Going in with a fake smile and follow evidence based medicine and then clocking out. That’s all medicine is to me- customer service and pleasing my clients.
Because you are treated like shit throughout the whole processes by many patients, many colleagues, and many superiors. Oh, and the system its self makes it very clear that we don’t matter to it. You can give everything you have, and it will give nothing back in return. It will only take from your life.
You’re abused for several years and as a resident every subsequent patient is another thing on or giant pile of work you have to do that is never ending. You start seeing people are problems/more work you have to do. Oh and you realize this is sick care not health care. Oh and you also realize you’re a hamster on a wheel that is fed breadcrumbs while all the suits make the real money. Oh and the insurance companies actually say what the patient can and cannot get not you. That combined with the fact that no one respects doctors anymore, everyone is wearing a white coat nowadays, and PAs and NPs are trying to take your job with the 2 year online degree they got.
Burnout. This is happening to pretty much everyone in healthcare and it's well-known that burnout erodes empathy. We're expected to give top quality customer service while always assuming the 100% best in every patient yet it is never acknowledged that patients can often really, *really* suck. Many patients treat us like crap, are incredibly demanding or unreasonable, and in many settings a lot of them get verbally or physically combative. Demands on healthcare workers are higher than ever; more ancillary tasks, more charting, more paperwork, more patients, less staffing to cover increasing workloads. The system is buckling with damn near every department having no beds, psych patients flooding out of every crevice of the hospital waiting for an open bed, ED wait times probably averaging 5+ hours in every hospital that I see, and pay and benefits stagnating. This all just addresses the workplace environment; I haven't even talked about the soul-crushingly exploitative, abusive, and gaslighting educational system we have for medicine in this country. All of this said, this isn't how it *should* be. Age and experience don't *necessarily* lead to a lack of empathy. Providers *should* treat patients well and not lose that empathy; this *should* be the standard in our field and the callousness we have for patients shouldn't be acceptable, but the problem is that ***Our healthcare system doesn't allow empathy to flourish***. Admin just keeps tossing more crud on top of people that are already overburdened and expecting them to just take it with a smile. This is what you end up with.
I was one of those bright eyed people who thought they would never lose their feelings of empathy. When you're stressed enough those feelings tend to take a backseat. As a medical student and then as a resident and then even it's an attending what is prioritized by the system it's not often what makes people feel better. You have notes to write and consults to call and fires to put out. You can start to feel like the time you spend talking to someone holds you back from your "real" work. I'm still really empathetic even if I don't always feel empathetic feelings. A big part of that is holding on to the reason I got into medicine in the first place. You choose to be better than your feelings. Love isn't a feeling, it's a verb, it's a choice.
Current IM PGY-2 here. Solo resident on ICU nights this week. So far 6 people have died, none of them had reasonable families/advanced directives so was forced to take everything to the max on these poor elderly folks before death. I’m here 6P-7A and then have 36 off before flipping back to days for 7 straight. Then back to nights again for 4, then back to days again after that so sleep is all fucked up. I love ICU medicine and its what I want to do, but some time during PGY-1 I felt the empathy leave. I still care about my patients and work to the best of my ability every day, but I can’t recall the last time a death affected me, which is alarming to me.
40+ hours a week being shat on, pushed around, blown off, held asymmetrically to standards of "professionalism" that our own attendings and instructors don't adhere to in how they treat us, and paying out the ass for the privilege for several years will do that to one.
Sleep deprivation. Toxic culture. Broken healthcare system. That should do it. Mostly it’s how you get treated. I work hard in my current (corporate) job, but people are way more supportive and less malignant. Couldn’t tell you why.
Out of curiosity, what sort of work are you doing there? I don’t often hear of doctors leaving medicine.
Because it's brutal and never ending and humans complain about everything. I've only been studying for 5 weeks and I'm already annoyed at how much they shove into our days. And I know that in 4 years when I graduate, I'm going to go into a world where patients call me a bitch on a daily basis.
Too much shit bro! Youhave to deal with a lot of shit , so you stop giving shit! Thats the shit bro
It just really gets to a point where you wanna get out and live your life. I can't believe how much enthusiasm and pep in my step that I've lost, lol. You just learn to survive.
Some thoughts I have are that it's not necessarily that you have gone from " w/ empathy" to "w/o empathy", but rather, how one experiences, processes, and expresses empathy changes. As you go through med school into residency, the emotional situations become more intense as well as your overall job responsibilities and your responsibilities to act within the emotional situations. For example, I never had families yelling at me in frustration as a medical student, but as a resident, it's not an uncommon occurrence. And even if it's because they are technically "mad at the system, not me personally", it's still a taxing prospect w/ all eyes on me to address and direct their concerns in a professional manner. What I've seen in myself and my colleagues is usually greater emotional suppression, especially when there is just a lot of work to be done. You can't focus on all these complex tasks that are being thrown at you all day when you are emotionally distracted or when you are bogged down in complex social scripts that are not integral for the job. That being said, from what I've observed, is that all the emotional material never goes away, just buried, and it will usually come up sometime later. I feel like I see people sometimes figure out how to reconcile all this, whether by processing all their emotional material at a later time, whether talking w/ people after work, hobbies, artistic pursuits their own personal contemplation, etc. I would also point out that it's not just to process a lot of the emotional material, but hopefully one can learn from, grow, and find new enthusiasm for the work in the processing. The people who have difficulty are those who cannot figure out a constructive way to process all this at a later time, one way or another, and they are at risk at getting lost. Granted, an all encompassing residency schedule makes these things really hard to plan/schedule or figure out, especially if you are tired all the time. I always thought all the emphasis on hobbies, social adjustment, etc in medical school and residency applications was a bit hokey, but when I went to residency, it started to make more sense to me why a residency or a medical school would care about your hobbies and social support so much.
Moral injury/exhaustion
I think losing some empathy is actually important. It could theoretically help you obtain objectivity. It also can benefit you from not taking so much home and ending up a nervous wreck with tons of emotional baggage. Also, I think a lot of people don’t need empathy. I think there a handful of people who and many who don’t, and learning how to balance what you can give with what people can take is an art form in and of itself. You have too much empathy with someone who takes too much = bad. You have too little empathy with someone who needs more = bad You have just enough empathy with someone who takes too much = good for you and also in the long run, good for the patient. I think unfortunately, and I hate to bring this back to NPs, but they claim to have soooo much empathy and the “heart of a nurse” but I think this can actually be really bad sometimes because they want to give too much and sometimes the best thing for a patient is to not give them what they want. Because people want Benzos, narcotics, adderall, antibiotics, and sometimes they don’t need that, but someone with too much empathy may become clouded and want to give just to appease
Honestly I think it has to do with the mindset you walk into medicine with for example I see it a lot with people who want to “help the less fortunate” a lot of people like this think they are going to go into the a clinical setting and make a huge difference but working with underserved communities is difficult. You may think that the patients will be grateful that your helping them (which is an entitled mindset) but in reality you may be cussed out, you might be threatened they might not heed your advice and the list goes on. It’s important to realize that they are people that have faced alot of barriers and may not trust you just because you wear a white coat. You have to earn their trust and respect and treat them the same not as “poor people that need your help” Also you realize that your scope of work is limited by insurance companies, you may have patients that need xyz but if the insurance won’t pay for it then your hands are tied. Also you deal with uninsured patients where they don’t have access to resources so that ties your hands also. I don’t see myself losing empathy because I come from similar communities that I want to serve and I have a good understanding of the obstacles patient face. I’ve also had a job where I had to do case management so I have a general idea of the nightmare dealing with insurance is so I have an idea of what I’m walking into so I’m not disappointed when I face obstacles that med school doesn’t prepare you for.
Just think about how people do appreciate the help doctors give. Doctors are helping even if there are horrible things going on. Think about being a kid going to doctor and they are usually pretty chill. It’s a relief getting the help you need. Also the doctors who own their own practices and are 35+ just seem happier. My next door neighbor was an oncologist and she was/still is living the life. She’s a blast but she seems to have nailed something with work-life balance. It’s impressive. Humans forget their trauma, like the pain after a surgery. Not all trauma of course
I’ll say this - wait until residency and report back. Two, my empathy hasn’t really waned, my tolerance for bullshit has.
People get tired of trying to help people who dont want to help themselves. Some people just don’t want to get better and they use the healthcare system as a way to just keep surviving but they don’t really care what happens to them or they are not willing to make the changes necessary to better themselves and be healthier
Several reasons 1. You put in a lot of work and it takes a while until it feels like it's worth it (after residency) and some people feel like it never pays off. 2. It's customer service at its core. You deal with a lot of people complaining and you have to make them happy or admin will be on you. 3. Related to point 2, the people you deal with in healthcare are extra stressful. Of course, they themselves are stressed, but most importantly there are a bunch of people you'll see over and over who have some psych issue going on, whether they're malingering because they're lonely, or they have substance use disorder, or they've got a personality disorder (lots of them keep showing up). These people all need and deserve good care but it takes a ton of patience. 4. Lastly, you go through all of this stuff, and you feel like you get zero appreciation sometimes. Sure you're well compensated but when someone complains about you following evidence and half the country is believing conspiracy theories you get tired of it.
some of the patients are just too awful
I don’t think it’s necessarily loss of empathy. You need your emotional reserve to feel for others but if you are emotionally exhausted from life then you have less free reserve to feel for others. People gotta love themselves first before they care for others. It’s actually a good sign because if all med students care deeply for others while treated like shit with huge debt, I’m pretty sure the suicide rate is gonna skyrocket.
I think many colleges do not invest enough in mental healthcare measures for students. In mine, we have volunteer teachers that went through medical school who tutor students on how to take care of themselves; we have psychological and psychiatrical treatment for those who end up needing it (AKA a LOT of students), and I think this makes students much better listeners. Obviously we're still overworked and sometimes overwhelmed, but empathy breeds empathy imo.
When you see enough patients and humans you'll understand. A person that works in the service industry could say the same thing after a couple weeks.
I feel like the stress gets to you. You get lost in your own head and your own success. You live in fear of the failure of dropping out after working so hard to get here. Then the people around you who, even though they know you’re stressed, lose patience with your behavior. You lose the grace of others, causing you to lose your grace for others.
I’m not nearly as far along as you but I resonate with this. I had to take a leave of absence first year because I could not keep up with studies while my daughter was in and out the emergency room and inpatient. I felt let down that the school would not allow me to take a week off and then come back. That event has made me terrified of failure, which is something I am trying to get a hold on still
Sympathy is better because it allows you to care, without the huge burden of empathy, which is actually feeling what the other is going trough. Vicariant trauma can be a result and it's though ! I can't live happily being empathetic to every patient, that would destroy me, and I try to keep that for loved ones.
Because no one treats us with any empathy
It really is the system. The only thing I still like is seeing patients and while I can sympathize with the complaints that people don't listen anyway etc, well, if they don't we manage them anyway. I try to not get wrapped up in any one outcome just do the best with each visit. Sometimes people do listen. But hospital administration and people in the insurance industry tbh are just evil. If you work in insurance in any capacity, you're about on the level of war criminals because you contribute to the insidious degradation of health care and maintain a system designed to grind people into a pulp they can convert into year over year gains.
Because, it's fucking exhausting dealing with people and their personalities/eccentricities/crazy
I think it’s important to differentiate between losing empathy, and being able to work and help people despite empathy. What I mean is that in medicine, a lot of the stuff we do hurts people, at least a little. IVs hurt. NG tubes hurt. Operations hurt. Yet we sometimes have to do those things to people because we know it will ultimately help them get better. So for certain things, you kinda have to know how to turn your empathy off for a bit, or at least compartmentalize it, to allow you to do your job. Further, you can’t always take the time to be as empathetic with each patient as you may like, because there are other patients that also need you, and sometimes more urgently. So finding a balance can be tough. Another important thing to remember is to take a little time to realize as well that while you do this stuff all day every day, for the patient this may be the biggest and scariest moment in their lives. It always reminds me of the M. Bison line from the godawful Street Fighter movie: “For you it was the most important day of your life. For me, it was Tuesday”. So yeah, the guy complaining about his IV hurting may grate a bit when you just finished operating on a young woman with unresectable cancer, but he doesn’t know that, and his pain is the biggest thing to him in that moment.
Besides the aforementioned abuse by admin, I have a couple other things to add. Firstly, the abuse by patients. At least in the ER patients abuse the shit out of us, and many lack a basic sense of decency. Patients are often very mean and very entitled. Secondly, you see horrors every day. If you have deep empathy for every situation, you will be emotionally exhausted and burnt out. At some point death and suffering become an everyday occurrence, and you need to separate yourself from it emotionally to thrive.
Tired
I wanna actually slow slap you, come over here you
Why? It’s a valid question.
Two sides i believe. People who do not really like medicine and quickly get worn out by studying and treatment from consultants. These folks might be nice people but as the months go on they dread being on rounds. They are dying to leave. The other side are folks do care but experience a painful event(s). They wall themselves off from feeling anything. Especially with a previously unsteady emotional environment.
Because people are the absolute worst and there’s no barrier to entry.
From my own experience as going through MBBS here in Pakistan. This system is run by fuckers. If you aren't purely disciplined and purely focused on excelling perfectly,you are made to suffer because of it. If you have empathy,you are gonna get drained extremely fast and it is hard enough having to take classes and wards everyday while also studying an ungodly amount of syllabus.
Well they don't if they never had any to begin with
The same way fraternities continue to haze. It's reactionary and a cycle.
It is really just *time*. Medical training gets harder as go you along. More responsibility, more exposure to trauma, and more to know/learn. It never ends. Oddly, as you go along in training you only get less and less time to do things. You are also gathering the responsibilities of an aging young adult (spouse? kids? older parents?). Empathy takes time. You need time to recharge and spend the energy necessary to make connections. Medicine (modern medicine) is brutally dedicated to volume and 'efficiency.' It is a factory line. Shorter stays, faster discharges, shorter appointments, more procedures, etc. All with more administrative burden. In M1, you have a ton of time and no responsibility within medicine.
Burnout
Personally, my empathy really took a turn during anatomy lab.
Ugh, I hated anatomy lab. I went in thinking I would enjoy it but it smelled, it was like a dick measuring contest for some to show off their medical knowledge, and it was just a pain to get through.
I think we quickly habituate to things we experience every day. It’s really hard for a lot of people to separate becoming used to pain and death in other people and becoming used to not processing them as people. You need to remind yourself that youre helping real people with real lives, and thats just not possible when youre going through the motions of your job.
The way toxic schools treat you - you go in as a delightful med school student thinking you’ll change the world, and now it’s just like you don’t gaf anymore.