Cynicism and other attitudes towards patients in an emergency department in a middle eastern tertiary care center

Abstract

BackgroundA caring, compassionate practitioner of the medical arts is the idealized version of what makes a good doctor. If asked to think of a painting of a doctor we most likely conjure an image of a physician sitting at a patient’s bedside checking the pulse with a concerned look on his face. The reality is however that cynicism, among other negative attitudes, is becoming more prominent among physicians and medical staff. The causes and extent of cynicism likely vary among medical departments and different cultures. In this study, we aimed to assess attitudes of medical students and physicians in an Emergency Department (ED) in Lebanon that accommodates both local patients and is also known to attract patients from around the Middle East.MethodsA total of 30 students, residents and attending physicians at the American University of Beirut Medical Center were invited to participate. All participants underwent semi-structured interviews that were recorded, transcribed and then analyzed for common themes.ResultsMore negative emotions were expressed among participants than positive ones. Negative emotions were more frequently expressed among medical students, interns and residents than attending physicians. Cynicism in the ED was commonly reported however, maintenance of professionalism and adequate patient care were underscored. While empathy was recurrently found among participants, a trend towards a decrease in empathy with career progression was noted among attending physicians. Further, negative feelings towards patient families were prominent. Participants tended to categorize patients based on willingness to cooperate, gender, age, case acuity, ethnic origins and social status.ConclusionsCynicism emerged as a prominent theme among medical students and staff in our study. However, participants were also empathetic. These attitudes were generally attributed to the peculiar stressors associated with the Lebanese culture, low acuity cases and “VIP” patients. It is crucial to explore methods in order to decrease cynicism and improve patient care. Also, the implications of these attitudes on patient care remain to be discovered.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-016-0539-y) contains supplementary material, which is available to authorized users.

Predictors of Physician Compassion, Empathy, and Related Constructs: a Systematic Review

“…Finally, a small number of predominantly qualitative studies showed spirituality 89 , 136 , meaning 136 , and religiosity 137 to predict greater ECRC, although there was no effect of religion 39 . The evidence regarding factors such as living situation 39 , 42 , 72 , 82 , upbringing 98 , 113 , 131 , siblings 64 , 76 , having children 39 , 41 , 49 , 64 , 77 , 111 – 113 , 138 , 139 , the number of children 72 , 82 , 84 , 140 , and marital status 43 , 47 , 49 , 50 , 63 , 64 , 72 , 76 , 77 , 83 , 84 , 86 was conflicted and, hence, inconclusive.…”

The relationship between gender and coping mechanisms with burnout events in first-year medical students

“…This occurs because medical students will try to survive the demands in a medical education environment and therefore persevere with their situation. In addition, lack of experience in health services can result in medical students using cynicism as a way of controlling their environment [41].…”

Ações para a Retomada do Ensino da Humanização nas Escolas de Medicina

“…Entre os atributos do humanismo, o mais citado foi a empatia [16][17][18][19] . Os atributos inerentes ao humanismo médico variam entre culturas, sendo mais frequentes na cultura ocidental aqueles relacionados a competência clínica, comunicação, ética, humanismo, excelência, responsabilidade e altruísmo.…”

“…Alguns estudos sugerem que a empatia do estudante de Medicina decresce com o avanço dos anos de estudo, afetando a humanização da assistência 17 , porém outros não revelaram tal declínio 18,19 .…”

“…Outro fator considerado estressante foi a presença de vários familiares que acompanhavam os pacientes e que foram considerados intrusivos, questionadores, agressivos, desrespeitosos e exigentes. Os aspectos positivos e reveladores de empatia mais elevada foram direcionados a crianças e idosos 17 .…”