Perspective: Does Medical Education Promote Professional Alexithymia? A Call for Attending to the Emotions of Patients and Self in Medical Training

Abstract

Emotions--one's own and others'--play a large role in the lives of medical students. Students must deal with their emotional reactions to intellectual and physical stress, the demanding clinical situations to which they are witness, as well as patients' and patients' family members' often intense feelings. Yet, currently few components in formal medical training--in either direct curricular instruction or physician role modeling--focus on the emotional lives of students. In this article, the author examines patients', medical students', and physician role models' emotions in the clinical context, highlighting challenges in all three of these arenas. Next, the author asserts that the preponderance of medical education continues to address the emotional realm through ignoring, detaching from, and distancing from emotions. Finally, she presents not only possible theoretical and conceptual models for developing ways of understanding, attending to, and ultimately "working with" emotions in medical education but also examples of innovative curricular efforts to incorporate emotional awareness into medical student training. The author concludes with the hope that medical educators will consider making a concerted effort to acknowledge emotions and their importance in medicine and medical training.

Narrativas de estudantes de Medicina e Enfermagem: currículo oculto e desumanização em saúde

“…Certamente, tais tópicos despertam emoções e sentimentos, que parecem ser ignorados ou colocados à margem ao longo da graduação 29 .…”

Unpacking affective learning: a longitudinal, qualitative study exploring how junior doctors learn to be compassionate through practice

“…Their emotional distress The findings from this study closely align with developments in medical education which recognise the primacy of emotion as intimately tied to the development of a doctor's identity (Dornan, 2014) (Girard et al, 1991) (Halpern, 2007) (Marcum, 2008) (Monrouxe andRees, 2012) (O'Callaghan, 2013) (Riess et al, 2012) (Satterfield and Hughes, 2007) (Shapiro, 2008) (Shapiro, 2011).…”

“…When deconstructed through the lens of the bioscientific medical model, empathy is redefined with an emphasis on the measurable, cognitive and behavioural elements; distancing itself from the affective emotional aspects linked to sympathy which is perceived as destructive for both the patient and the physician (Hojat et al, 2011). This focus on the cognitive and behavioural aspects of learning to care appears to contribute to the discomfort the medicinal culture continues to have in framing and responding to emotion in the clinical setting, reinforcing the deeply embedded constructs of emotional detachment and resulting in thoughts and behaviours which emphasise the distancing of one's emotions (Shapiro, 2011). …”

“…Yet, Halpern (2003, p. 670) contends 'patients want genuine empathy and care and doctors want to provide it'. Recent research suggests emotional connection may provide protection from compassion fatigue and burnout whereas suppression of emotion or emotional detachment may actually be a contributing factor (Shapiro, 2011). Empathy, according to Marcum (2008, p. 266) has become 'a rallying point for some medical professionals to reshape the emotionally detached clinical gaze and to reconnect the patient and the physician, especially at the emotional level'.…”

“…Compounding these factors is an environment where they are being assessed for competence within a culture which frames emotion as 'a corruption of reason to be transcended' … an illegitimate form of knowledge… (McNaughton, 2013, p. 72) and where the type of competence most valued is that of the unemotional type (Dornan, 2014) (Shapiro, 2011).…”