Do Doctors Lack Empathy?

Shortly after I finished Simon Baron-Cohen’s new book, The Science of Evil: On Empathy and the Origins of Cruelty, I spoke to one of my friends who had just had an extremely bad interaction with a doctor.  The friend had just received a frightening diagnosis and when she went to ask more questions, the doctor was blunt and emotionally-disengaged.  As I spoke to the friend, it occurred to me that, while there were some very important exceptions, I’d actually had a lot of similar experiences with doctors.  Might it be true that doctors have less empathy than other people?

Coincidentally, with the help of the gnomes of the World Wide Web, I found an interesting recent article by Omar Sultan Haque and Adam Waytz in Scientific American, which describes two experiments by Jean Decety and his collaborators at the University of Chicago that shed a bit of light on the answer:

In one experiment, physicians who practice acupuncture (as well as matched non-physician controls) underwent functional magnetic resonance imaging (fMRI) while watching videos of needles being inserted into another person’s hands, feet and areas around their mouth as well as videos of the same areas being touched by a cotton bud. Compared to controls, the physicians showed significantly less response in brain regions involved in empathy for pain. In addition, the physicians showed significantly greater activation of areas involved in executive control, self-regulation and thinking about the mental states of others.  The physicians appeared to show less empathy and more of a higher-level cognitive response.

This finding raised a further question. Perceiving pain in others typically involves two steps. First people engage in the emotional sharing of pain with another person, and then they make a cognitive appraisal of the emotion. Do physicians automatically feel empathy for the pain of others, but then quickly suppress it? Or is the cognitive suppression of empathy even deeper; has it become more automatic? Is it possible that the physicians no longer even experience the first step of empathy for pain that regular people show on their brain scans?

The investigators repeated the same experiment but rather than looking for changes in brain blood-flow by using fMRI, they assessed the brain’s event-related potentials (ERP). Results showed that when viewing the painful needle sticking, the physicians did not even show the early empathy response. The physicians had apparently become so good at empathy suppression that there was no early response to worry about.

Why might these effects exist? It could be that, compared to other professions, the people that gravitate to healthcare tend to be less empathic. This seems unlikely. Furthermore, studies of physicians show that they are often the most empathic and caring towards the beginning of medical school, and that they become steadily less empathetic with more clinical training. The more likely culprits are therefore the nature of medical training and the intrinsic demands of the profession.

Related Situationist posts:

• “Racial bias clouds ability to feel others’ pain,”
• Students’ Situations Leave Them Less Empathetic (Situationist)
• “The Interior Situation of Complex Human Feelings,”
• “The Neuro-Situation of Violence and Empathy,”
• “It’s Hard to Step into Someone Else’s Shoes,”
• “The Power of Suggestion“
• “The Situation of Objectification,” 
• The Situation of Psychopaths
• “The Situation of Morality and Empathy,”
• “The Situation of Caring,”
• “New Study Looks at the Roots of Empathy,”
• “Jennifer Eberhardt’s “Policing Racial Bias” – Video,”and
• “Hoyas, Hos, & Gangstas.”