Empathy or Efficiency?

11 07 2012

I’m not big on using this blog as a forum for the woe-is-me personal rants, but I have a short one today.

We got the scores of the end-of-life OSCE’s back today.  I was very close to failing.  Why?  Because the entire score was comprised of the number of specific objectives that we successfully met during the 15-minute time frame.  Each scenario had 11-13 objectives, allowing just over a minute to complete each; 3 of those objectives were “say good-bye and shake their hands,” so when I ran out of time in all 3 encounters, I robbed myself of 9 percentage points.  Sure, we were given extensive feedback on our mannerisms, empathy, respect for patients’ families, establishing rapport, et cetera, but these qualities didn’t count toward our final grade in the slightest.  In the end, my efforts to establish rapport and diffuse tension and be empathetic—in all of which I earned very high scores— essentially didn’t count.  I could have memorized the 35 specific objectives—some were so particular (eg. ‘ask the family members’ permission to discuss the prognosis with them) that this would have been a feat in itself—then gone into the room, been a complete a-hole, blown through the questions, ignored the fake family members’ sobbing, and scored 100% on my OSCE.  Sure, the comments would have been terrible, but as long as the objectives were completed, it would not have affected my final evaluations in the slightest.

This is ironic because end-of-life care is the most sensitive subject that can be broached in an OSCE, but it is the only OSCE in which no value is placed on empathy.

Sound like stereotypical surgery to anyone else?

I’m really just absolutely thrilled that the good people running my surgery clerkship are, in my opinion, completely emphasizing the wrong aspects of patient care.  Maybe my thoughts are running this direction because I’ve already had a bad week, maybe it’s being tired and feeling emotionally drained, maybe I’m completely losing the forest for the trees and lack understanding because I have no experience in the profession.

It’s true that the bulk of giving bad news—especially unexpected bad news—falls on the shoulders of surgeons.  I’ve seen a decent amount of very bad news just in the last week and a half being on the trauma service.  Perhaps they have to harden themselves to protect their own emotions.  Perhaps they have been doing the job so long they are drained of it.  Perhaps the sheer volume of hopeless cases and deaths they have dealt with has turned the patient into “just another dead guy.”  It’s very likely that I am having such a hard time seeing why empathy is not valued here because I haven’t seen as much tragedy as the attending physicians who have been doing this job for 30 or 40 years.

The weight of the scoring on this OSCE is starkly contrasted against what we have learned in other courses throughout medical school.  We spend a lot of time as a medical school talking about the importance of humanism in medicine.  When things like this OSCE happen, it’s easy to get confused.

The bottom line for today—other than the ‘I need to wait until the evals are back before I give feedback to the person who devised the exercise’ bit— is that maybe I do need to work more on having a more goal-directed, efficient patient conversation.   But I really don’t like the idea of giving up empathy in the name of efficiency, especially in the end-of-life issues.

Hopefully, when I’m practicing in the real world and it truly matters, I won’t have to.




2 responses

11 07 2012

I think what’s ironic is that the surgeons I’ve worked with have been FAR more empathetic than the internal medicine people I’ve worked with. In particular at delivering bad news. Maybe this is my institution only, but honestly I’ve been really impressed with them, and very UNimpressed with the medicine people.

As to this OSCE, hey you passed. That’s what’s important. And in the end you’ll get to be the kind of dr YOU want to be. Real human interactions aren’t measured by check boxes.

11 07 2012

do what you have to do to pass, and when you are practicing on your own treat your patients they way you like to be treated and youll make a great doc.

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