Whenever it meets with physicians in their environment, the QMA has observed that many of its members are committed to improving care and services on a daily basis. Great initiatives are taking shape everywhere. Some of them should even be implemented or adapted elsewhere, but for this to happen, we need to know that they exist!
If you have set up a project that deserves more visibility or if you know of members colleagues who have done so, feel free to contact QMA. We would be pleased to showcase your achievements.
Studying physician empathy
Drawn by the importance of social determinants for improving the health of populations, Charles-Antoine Barbeau-Meunier decided that he wanted to be in on the action and not just the reflective process. So he swapped communications and sociology for medicine. “I felt that I could make a bigger difference,” he explained. He is a student at the Sherbrooke Faculty of Medicine and Health Sciences who, after completing a master’s degree in sociology, is currently doing a double doctoral program in medicine and biomedical imaging.
Currently, Mr. Barbeau-Meunier is alternating his research on multiple sclerosis with his medical education. A separate curriculum that has given him a little more time than his medical studies and has enabled him to return to his first passion, or the focus of his master’s thesis on empathy. His hypothesis was that empathy could be a foundation of social action and therefore make it possible to mitigate certain crises such as climate change.
His more flexible schedule as a researcher has also allowed him to submit a paper on the erosion of empathy among the next generation of medical professionals at the Association francophone pour le savoir (ACFAS) convention on May 8, 2018. Having done a systematic review of the literature, he found that it is not so much the medical curriculum that leads to an erosion of empathy among medical students but certain disruptive elements, namely the predominance of a performance-focused context and a culture of self-neglect during one’s medical studies.
In reaching this conclusion, Mr. Barbeau-Meunier based his findings on the definition of empathy as stated by neuroscientist Jean Decety, for whom empathy has a cognitive dimension, as well as emotional and behavioural dimensions. “The medical curriculum is actually a very good context for developing empathy, whether it is the feeling in itself or the ability to use it. However, it is also an environment that inhibits this behaviour,” Mr. Barbeau-Meunier pointed out.
Research in this field is still lacking, but several studies presented at the ACFAS are pointing in this direction. The lack of sleep, stressful and rigid working conditions, and a large volume of patients to see within tight time constraints can lead to an erosion of empathy by preventing students (or clinicians later on) from expressing their empathy.
The five pillars of empathy
Several conditions are necessary for expressing empathy. Similar to the way he approached climate change in his master’s thesis, Mr. Barbeau-Meunier looked at how the medical context colours the ability of students to develop their empathy, as well as to use it.
To feel empathy, one must be able to connect with the other person. Through facial expressions and especially the eyes, it is possible to read the other person’s emotions and the transparency of their intentions. While this does not present a problem in health curriculums during which students have very frequent access to patients and exposure to all sorts of care contexts, we know that technology presents a variety of obstacles once they are in a hospital environment. For instance, it is difficult for patients to feel like they are being heard when physicians seems to be focusing all their attention on a computer.
It is also necessary to learn how to control one’s emotions, which is appearing more and more frequently in the literature, but is not always properly understood and expressed in the field. In the care context, suffering, vulnerability and death, among other things, can present a significant emotional burden or, at the very least, a chronic one. According to Mr. Barbeau-Meunier, this requires an effort of control, conscious or not, and the need to learn to recognize our emotions and to work with them.
But in the current medical culture, there is a taboo around the emotional dimension of care. There is a tendency to tell students to learn to ignore their emotions rather than to work with them. And that is where compassion fatigue gets the students just like practising physicians! “It’s not necessarily a bad thing to feel emotions, on the contrary, it is essential information to guide a clinician,” pointed out Mr. Barbeau-Meunier, who found that so much emphasis was put on the cognitive dimension of empathy that the emotional dimension, while very well recognized in the literature, was forgotten.
Once physicians are able to control their emotions, they can then turn their full attention to the other person. A strength of the curriculums according to Mr. Barbeau-Meunier. Students learn to develop good listening skills, to ask questions to get the information they need. However, there is a risk that students will no longer pay attention to themselves, since the target of their attention is the other person. They can then miss signals that convey needs or an appropriate response.
The social connection also plays an important role. People always have more empathy for those with whom they identify. But physicians are having more and more difficulty in identifying with their patients, because of increasingly diverse environments, but also because of the social status of physicians and the wage difference that can create discomfort with other health professionals or some patients.
Finally, it is necessary to consider the environment in which empathy is practised. While the medical environment can foster empathy, it can also sometimes promote putting other priorities first, for example by inciting a caregiver to see a patient as a bed to free up or a task to manage rather than as a suffering individual.
“My analysis allowed me to corroborate that we are developing a better capacity for empathy than before in medical studies, but that there are also essential elements that the context will drain and that will prevent empathy or make it more difficult to express,” explained Mr. Barbeau-Meunier.
So should we change the way empathy is taught? Of course, we can always reinforce the training and better equip future health professionals to be able to share their emotions with colleagues. But that will not change anything if we do nothing to evolve the system in which physicians practise. “You could have the most empathetic person, but if you don’t allow that person to express empathy, it will be useless,” concluded Mr. Barbeau-Meunier.