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October 4, 2007

BehindTheMedspeak: Why I don't feel your pain

Doctor_patient_relationship

Long story short: The apparent lack of empathy is acquired — not genetic.

Shankar Vedantam's October 1, 2007 Washington Post story about how physicians learn to not feel bad when they hurt you was interesting, and follows.

    Physicians Learn to Suppress Empathy Reaction, Study Shows

    Seeing another person subjected to an awful fate — eaten alive by a shark, say, or jumping from a burning building — it's difficult not to flinch. This automatic response of empathy is triggered by the activation of a brain circuit that includes regions known as the anterior insula, periaqueductal gray and anterior cingulate cortex.

    Scientists in Taiwan and Chicago recently asked a simple question: What happens to that response in the brains of physicians, who inflict pain on patients during medical procedures?

    Fourteen physicians and fourteen people who were not doctors recently had their brains scanned as they watched videos of acupuncture procedures. While the non-medical volunteers showed a strong activation of the brain regions involved in the empathy circuit, the physicians did not, according to a study to be published in next week's issue of Current Biology. It was led by Yawei Cheng of Taipei's National Yang-Ming University.

    The physicians, instead, showed activation in their prefrontal cortex, in brain areas related to thinking and control of emotions.

    "They have learned through their training and practice to keep a detached perspective; without such a mechanism, performing their practice could be overwhelming or distressing, and as a consequence impair their ability to be of assistance for their patients," said co-author Jean Decety, professor in psychology and psychiatry at the University of Chicago.

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Here is a link to a summary of the article in Current Biology cited above; the summary itself (by the authors) follows.

    Expertise Modulates the Perception of Pain in Others

    Perceiving the pain of others activates a large part of the pain matrix in the observer. Because this shared neural representation can lead to empathy or personal distress, regulatory mechanisms must operate in people who inflict painful procedures in their practice with patient populations in order to prevent their distress from impairing their ability to be of assistance. In this functional magnetic resonance imaging MRI study, physicians who practice acupuncture were compared to naive participants while observing animated visual stimuli depicting needles being inserted into different body parts, including the mouth region, hands, and feet. Results indicate that the anterior insula somatosensory cortex, periaqueducal gray, and anterior cingulate cortex were significantly activated in the control group, but not in the expert group, who instead showed activation of the medial and superior prefrontal cortices and the temporoparietal junction, involved in emotion regulation and theory of mind.

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Constant readers may recall a March 7, 2007 post in which I wrote, "... a raw, honest and unflinching report about how little us doctors care about you — and why, if you're to get the very best results possible, that apparently inhuman, cold attitude is not an option but, rather, a necessity.

"Long story short: If your neurosurgeon is psychologically devastated when a patient dies on the table and then finds her- or himself unable to sleep that night, well, that's all very warm and caring — but what if you're the first case on the schedule the next morning?"

I was inundated by email about my poor attitude following that post.

Maybe this one will help you understand why my seeming indifference can save your life.

On another note, maybe the fact that I can't stand movie scenes where someone gets gored or beaten up or even shoots up, and that I avoid horror movies like the plague, means that I'm not really a doctor after all.

Could've fooled me.

October 4, 2007 at 04:01 PM | Permalink


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Comments

confounder: people less inclined to show empathy go into medicine

Posted by: mack | Oct 4, 2007 11:22:25 PM

After reading your book, "Baby", I realized alot about this. A doctor has to absolutley be detached.

Posted by: doesn't matter | Oct 4, 2007 10:24:47 PM

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