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Do med students become less empathetic as they progress in training?

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Depends.  I definitely didn't but i did become more blunt as time goes on and knowing when to look out for myself more than others. Though i've also come to look out more for those earlier on in the process as well, more.

Being blunt, and perhaps standing up for yourself more and cutting out the riff-raff, doesn't mean you can't still be empathetic though.  I think the sooner medical students realize everything isn't rainbows and sunshine, and removing medicine from a pedestal, the easier the process is to actually tolerate and enjoy.  Same goes for understanding that you can't please everyone, especially not a unnecessarily cranky consultant at 2am who doesn't want to talk to the med student/resident, and that their frustrated expression isn't always your fault or your own inadequacies(thought certainly sometimes this IS true, but shouldn't be the default assumption)...and that there just so happens to be a none-zero number of socially stunted or inflated-egos in medicine in the real world after training.   

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It's difficult, but sometimes you have to fake it, especially in med school on a rotation that you might not be interested in. It gets better as you have more agency over what you're doing. It's important to be mindful however, and self-reflect on who you struggle to find empathy for, and why. I found early on that I struggled having empathy for people who didn't care about their own health, I acknowledged my own biases - smokers and morbidly obese have addictions and other socioeconomic factors that contribute, its not purely that they don't care - and it helped to discuss it with my colleagues. In the end it was one of the reasons I chose the field that I'm in, I have no difficulty having empathy for sick children (some of the parents on the other hand...).

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I think it's the occasional bad apple that ruins the bunch. Most patients are fine, but one bad patient encounter will foul your mood for rest of the day! It's hard to avoid as student and resident because you have no control over your schedule, and even as attending sometimes "bad apples" are dumped onto you. So I think it's very important to have something outside medicine to keep you "refreshed" so when you start the next day your mind is clear. Maybe go for jog or bike ride, play sports, play music, whatever can help you clear your mind. Don't let the bad experiences linger, move on, physicians are humans too and it's dangerous to let bad patients and experiences drag you into a hole.

I've seen people whose entire life is revolves around medicine, it's so embedded, engrossed, it's like medicine phagocytosed them! I always wonder how will they cope if one day they wake up and medicine has changed for them? For example didn't match into their desired residency, or got into medico-legal trouble, or got disabled and cannot practice anymore, or become burned out and depressed they cannot practice anymore. Would their life have any meaning left? Would their minds be able to move on? Would they be willing to pack up their box and direct their energy to excel in another field? 

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I did not personally find that to be the case. Over time it’s gotten easier to process and examine my own feelings about some of the awful stuff but I don’t view that as being less empathetic, but having a more mature empathy where I’m able to centre the patient’s experience even more.

I don’t participate in joking about patients or being insulting about patients as many people do, and I am very particular about treating my patients as people first and doing a lot of validating of their experiences. It’s my job, but it’s their life, and I really try to keep that in mind. I’m a bit fluffy bunny as a family med trainee, though, so maybe that’s my training coming out. :)

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