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Wednesday, March 02, 2005

Retired Doc's Suggestions for Medical Curriculum-Part 3, Method acting?

I cannot take credit for this suggestion.E.B. Larson and X. Yao suggested this in the March 2, 2005 issue of JAMA. Method Acting type techniques were suggested to increase empathy in the doctor-patient relationship.I was not fortunate enough to have formal method acting training in med school.Several months ago a patient who I had attended for several years was found to have a large right upper lobe mass. Calling her into the office, to discuss the finding and the options etc was an emotionally draining exercise.I did not have to imagine and practice ahead of the meeting what it would be like to have cancer to feel for that person.(This rehearsal is part of the acting technique according to the authors.) Several years ago, a thoracic surgeon called me in tears to tell me that he was unable to resect a sarcoma that had invaded the kidney and vena cava in a 38 year old man who had two young children.The authors say " teaching acting to physicians also enriches their reservoir of human experience {and} ironically, can help them achieve detachment when they become too engaged in a patent's experience" I guess that means that if the surgeon and I had acting training we could have appeared to really care but not actually "get involved".This article really left me mind-boggled;I would be interested in what other physicians think of this. By the way, I don't really suggest that method acting be added quite yet to med school curriculum. Let us wait on the evidence. I believe there is something in a human's hard wiring or genes or something that makes people( at least those without autism) have empathy. I recall reading that even very young children can distinguish between a real smile and a fake one. The ability of our ancestors to detect emotions in others is part of the survival package that was passed down through the centuries. My recollection of myself and peers as house officers in a large county hospital reveals young people dealing with incredible amounts of human pain and misery and we did develop a shell of callousness and cynicism to survive it all but most of us overgrew that.


Maurice Bernstein, M.D. said...

I haven't received my copy of JAMA yet to read the article but I fully agree with your views. I teach first and second year medical students "Introduction to Clinical Medicine" and when I tell this to someone and they ask "Do you teach them bedside manner?" I tell the person "No.. teaching bedside manner is teaching them acting and I don't do that."
I teach them how to listen and try to understand what the patient means and how they feel and how to attempt to using the student's own compassion to help to try to connect with the patient. There is nothing theatrical about that. ..Maurice.

Anonymous said...

I recently started working as an Analyst in the U.S. Intelligence Community and I came across this blog while doing research on categories of biases in human analytical thinking. One of the acknowedged biases within the Intelligence Community (at least academically) is that "Lack of Empathy" is a potential bias and an impedement in analytical thinking. Lack of empathy in your job (even if you don't like to admit it) results in a lower quality of service to your patients just like lack of empathy towards my subjects results in a lower quality of intelligence product. For some reason empathy has taken on this pathetic conotation. We think of it as something that requires us to break down and cry. Empathy is to some extent what you are teaching your students. But as a professor you should know that cognitive understanding usually requires some kind of reinforcement or exercises. Method acting is one of a thousand exercises you could do to teach empathy. Perhaps you have a better one. But simply telling your future doctors about it is not enough. I can empathize with how difficult and time demanding being a med student is. I can empathize with going through 100 hour work weeks for 10 years straight. That doesn't mean I've actually done it and it doesn't mean I'm going to break down and cry now.

If you find it difficult finding empathy for a patient, try finding empathy for a terrorist organization. Not an easy task. Maybe I should look into one of those method acting classes.