What if your doctor’s brain felt your pain – from being pricked with a needle all the way to surgery?
It might be tough for them to get anything done, huh?
Jean Decety, PhD, and his colleagues from the University of Chicago wanted to see whether physicians empathized with pain differently from the general population. They had a hunch that physicians’ brains would be better at regulating their emotional responses to pain, allowing them to stay focused on treatment.
Current models suggest that empathy to pain involves two stages: an automatic, emotional sharing component, followed by a cognitive evaluation. Decety and his team suspected that physicians would be better at modulating the emotional component.
To find out, they gathered 30 participants: 15 physicians and 15 people with no medical experience, who were matched to the physicians in age and level of education.
Next, they showed each subject 120 pictures of different body parts. In half the pictures, the body parts were touched by a Q-tip, and in the other half the body parts were touched with a needle.
While the participants were viewing the pictures, their brain activity was measured using EEG. Following the EEG, subjects were asked to rate the amount of pain intensity and unpleasantness they thought the models in the photographs experienced.
The researchers’ hunch proved true.
After viewing the images, control participants reported significantly higher projections of pain intensity and unpleasantness than the physicians did.
Also, the physicians’ EEG results showed less activation than the control in the regions of the brain responsible for empathy to pain.
This study suggests that physicians, whether due to their training or their professional experience, can regulate their emotions better than lay people when it comes to seeing people in physical pain. And better emotional regulation could reduce fear and alarm responses, and thus make problem solving easier.
This research has an important limitation: it uses a matched control, rather than true random assignment into control and treatment. Maybe the brains of people who become doctors simply are made of sterner stuff (though I doubt it).
Of course, you can’t randomly assign physician status, so it’s difficult to avoid this problem.
While most of our patients aren’t physicians, this study has serious implications for practice. If a few years of training can change the way our brains react to the pain of others, perhaps we can also change how our brains react to our own pain.
Imagine how helping patients regulate their fear responses could improve healing.
In fact, brain science has thousands of potential applications. To find out how you can use the latest breakthroughs in neuroscience to help clients heal, take a look at this.
If you’d like to read the full study, it was published in Vol. 50 of NeuroImage.
Have you ever helped a client with their brain’s emotional regulation? Please share your experience in the comments below.
I think only the ones that find themselves on the other side of the scapel rreally feel the empathy.
I want my surgeon to be focused on his skill and job and not too sure if i care of his empathy status as long as his excellent in his field.
Empathy comes from other brain centers and predominantly heart space. Feelings are housed in energy fields of heart space connection
Interesting thing: Empathy towards suffering patients (of others) which is prolonged… allows people or empowers them to get stuck in their predicament with no resolutions…but does not lead to a resolution or conclusion…wears us down and exhausts us as well as them.
The frequency of exposure to the image of a needle on skin
would be far greater for physicians than the general public.
It would seem that desensitization due to increased
exposure to the image might be a more appropriate
conclusion to draw.
Nurses are generally very empathic, yet might have a
similar outcome as the physicians regarding exposure
to this image. Might be an interesting follow up study.
Empathy has an entirely different context in that you are
present with the person, not just the image of a needle
touching the skin.
Warm Regards,
Aila
This thread fascinates me.
Thanks for the many insights.
This morning as I re-read it I also see it as an invitation to myself to be attentive to this.
What happens to my compassion when I’m scrutinizing and evaluating for suicidation or depression?
How do I avoid scanning for symptoms in a random conversation at a cocktail party?
In essence how do I move in and out of “subject” and “object” type dynamics without being too far in one or too far in the other?
I agree with the majority of colleagues posting here.
I worked over twenty years as an emergency physician, and I did adapt to it, not so much by becoming better at emotional regulation, as by dis-connecting.
Fortunately, we are complex beings, and I could be cool and hyper-focussed during a resuscitation and then drop out of that state and re-access compassion and connection. (That might be more suggestive of “emotional regulation”, the ability to dis-connect and then re-connect)
Over time, though, this constant flux did create more and more stress and internal dis-connection.
Now that I work as a psychotherapist (currently finishing up the certification level of sensorimotor psychotherapy) my compassion and sensitivity are very present again.
I think we need to be quite careful about the conclusions we jump to in a study like this … often adaptations to extreme circumstances look a lot neater from the outside than they really are … disconnection is rarely healthy in the long term.
I noticed that people who work in a slaughter house, for example, became, desensitized over time, to the trauma that was taking place all around them, and understandably so. I believe that, at least in my observation of doctors, that they also become desensitized to the circumstances that their patients are in. Obviously then, the emotionally associated context that those study physicians are viewing those pics in is much reduced. That is understandable and would enable them to do their “work” more proficiently. The EEG results would show a lower rate of emotional response, of course, but i do not think it is a result of any higher mental competence. In my humble opinion, that is.
I think the repetition of causing pain to patients would over time cause you to become more immune to it so you would feel less empathy. I don’t think everyone who wants to become a doctor is make of tougher stuff necessarily. They should test it on students in med school who haven’t had any practical experience yet.
I read this article with interest and it struck me that whilst it is a seemingly positive thing that Physicians show an ability to regulate their response to pain ( though I’d argue that this is not a conscious regulation but achieved through training to a point of uncoscious competence) it may also be testimony to the fact that their training may have trained the ’empathy’ out of them!
It has become a common complaint in the ‘health care’ industry in this country, that Doctors do not show that they ‘care’ enough. To the point that we have a growth ‘industry’ in Patient advocacy.
This seeming lack of ’empathy’ can be attributed to many factors including the corporatisation of the medical industry, the potential for litigation and the elevation of the Value of ‘productivity’ and ‘efficiency’in what was once a vital ‘calling’ not so much a profession. There is also the lack of time afforded to patients because Doctors are struggling to function in under resourced systems that are in crisis.
I found it so interesting that one of the most important findings that Dr Dan Siegel spoke of was the proof we now have that a doctor who takes time to show even a little empathy for their patient increases the likelihood and speed of recovery for their patients. This is in keeping with Larry Dossey’s thoughts on the impact of the non local mind.
I have experienced first hand the true care of wonderful physicians who have balanced the capacity to show empathy whilst also being extremely practical. On the flip side I’ve had the great misfortune of being treated by those who are so well trained in the practical that their ‘bed side manner’ and ability to relate to me as a warm blooded human being have become seriously disconnected.
Managing our responses and knowing how our responses impact the capacity for others to cope and respond well to our care is at the heart of care and healing. Recognising the personal communication style of our clients and delivering care in the way that works best for them must be the highest priority rather than assuming every patient would rather the practical comes before the emotional. I sincerely hope that the balance is restored.
It may seem like hubris for a performer to be offering commentary on a site for professional medical/therapeutic practitioners; I hope the training and viewpoint from the theater world might have something to offer. I found it interesting how much of the feedback here had to do with physicians possibly being numbed, desensitized, hardened, or possibly even pre-disposed to a lack of empathy. This was my knee-jerk response while actually reading the article (“What if these doctors aren’t managing their emotions, but are instead just robotic jerks?”) But I know that way of thinking does tremendous disservice to the majority of those who practice medicine, and while it’s reflective of much of my actual experience, it’s not reflective of reality.
Much of what is being discussed here seems to lie at two ends of a spectrum: being so callous and hardened by training and experience that it’s as if there were no pain for the patient, to the other end where the practitioner could say, like Clinton, “I (literally) feel your pain”. It’s the job of a performer to get their audience to open up and feel along with a character, without becoming lost in that character’s experience themselves. Over time I’ve noted colleagues of mine who have come to a sort of middle ground that I’ve observed among other Mindful persons of various professions, which is more like “I SEE your pain.” The practitioner is fully aware and present to the patient’s experience, but does not participate in it. I don’t know what part of the brain would be activated by that approach, but I’d love to see more study on the subject.
The suggestion of this study (as offered by whomever authored the article) – that physicians can regulate their emotions better than lay people when it comes to seeing people in physical pain – is not quite accurate. As Decety says in a video interview posted on the University of Chicago website, this study applies to physicians who are performing the procedure that causing the patient to experience pain. By its limited parameters, the study does not apply to the physician has not brought about a patient’s pain but who is merely listening to a patient describing the pain he or she is experiencing. As most of us are aware, under this latter circumstance most allopathic doctors demonstrate insensitivity and clinical indifference. My guess is that just as lawyers are unconsciously stripped of their sense of moral suasion in law school, so are doctors unconsciously stripped of their genetic predisposition for empathy in medical school. But even now, studies are showing that patients of doctors who openly express compassion for their physical suffering get well faster than patients of doctors who don’t. Hopefully, with what we now know about neuroplasticity, more and more doctors’ brains can be rewired to openly express care and concern for their patients.
As a surgeon I always help giving them plenty of confidence to asume the process they live. and I invite them to relax take benefit of the free time, and meditate on the message life could be sending them with the illness: what is there behind to learn, to change, to comprehend, to give up, to forgive.
They always appreciate the company it all mean during the hard period of doubt, of fear and of pain.
The experiment lacked a control population with which to compare the findings. It might be difficult to avoid other selection biases but it would be good to try. Thus it is vulnerable to the possibility that to some extent those who become physicians are self-selected partly on the basis of the variable being studied.
Diane B’s story of her self-selection out of the field confirms that this happens.
How can we grow in being able to experience and express compassion for others and tolerate the associated discomfort without numbing? A nice challenge to work on in the experimental lab of our own lives.
Matched rather than random sampling is only one of the research study on physician’s emotional response to pain.
The small sample size of 30 is also a significant limitation and precludes the generalization of the study’s findings.
What about the demographics of the participants in the study – what were the specialty areas/patient populations served by the physicians represented in the study?
Rebecca Voight, PhD, RN
I believe you are making a huge leap when you assume that the brains of people who become physicians are NOT simple “made of sterner stuf”. While going through a pre-med program at an Ivy League, I met many bright people who definitely had the academic capacity to become a physician, but felt like they couldn’t take the invasiveness of most modern medical procedures.
Although I had some leanings that way, I ultimately decided to pursue alternative medicine because I didn’t want to be trained primarily in pharmaceuticals and surgery as primary therapeutic options. I had to train myself using “energy medicine” techniques (visualizations, Donna Eden’s zip up, etc) so that I didn’t take on my patient’s suffering and carry it out of the treatment room with me.
I have found this characteristic of not knowing how to run one’s empathy to be a part of many cases of ADHD, chronic fatigue, depression, and just plain overwhelm, by helpers of all sorts.
Of sterner stuff? I don’t know if it is sterner, but definitely different. The brain of the premedical student had to be one willing to curtail its natural desires, study ungodly hours, compete against the most obsessive-compulsive greasy grinds the world had to offer – just to get into medical school. And that was just for openers.
First there had to be a suppression of empathy for self, then for others (diminished social connections). My experience was that this was easiest for those with little empathy to begin with. The rest of us had to battle with our feelings to bend to the rigors of the training.
As for brains, I suspect a shift along the autistic spectrum towards the “idiot savant” (sic) is most useful in such circumstances. Alice James’s statement is relevant here, “I suppose one has a greater sense of intellectual degradation after an interview with a doctor than from any human experience.”
Doctors sensitive to the feelings of patients were often reviled and shunned in teaching hospitals, in my experience, yet it was by through the development of and integration of emotional sensitivity that I was able to make the shift to the New Paradigm of Holism. Now the appropriate awareness of and utilization of emotion is my most powerful tool for healing and behavioral change. – Emmett Miller DrMiller.com
Having run groups for medical professionals for years – this makes complete sense to me.
The bigger questions that emerge from this for me are: what impact does this capacity to “turn off” emotional response have on the quality of life of both patient and provider?
How does an MD manage to “turn it back on” so that s/he can have intimate moments of vulnerability with her/his significant others? How does this capacity to shut down emotion limt the quality of communication between provider and patient or between two providers (isn’t feeling/emotion a big part of what we communicate?) How does this “shut down-ness” impact the competitive nature of research and possibly keep us from rich collaborative breakthroughs?
I recently cared for my spouse who died of leukemia. What I noticed as a patient advocate over the 18 months of hospitalizations was that when a doctor was able to make an emotional connection with us –even briefly– the felt experience after s/he left was clearly different than when they made no effort to exchange on that level. In the one case I felt a sense of hope after they left the room even if informationally the news was bad.
To me this is significant: if my experience is generallized it would suggest that by not connecting with patients emotionally (What Dan Siegel calls “attunement”) medical doctors are enhancing a sense of hopelessness, perhaps creating more anxiety even if they hope to obtain the opposite by delivering reassuring news.
The path I would be interested in exploring if I were to train MD’s again would be: How do I allow myself as an MD to be in an intimate relationship with you even though I know you are gong to die? How do I learn to tolerate the pain/fear of loss that I am pre-emptively feeling so that I can be more fully present with you right now?
Yes! Just get the patient to ‘dissociate’ their pain. e.g. That’s your pain OVER THERE what’s it like as you SEE IT OVER THERE NOW, and YOU are HERE sitting in this chair! Often a profound effect as the person realizes they can change their perception – Powerful!
Ted
I teach and use kinesiology (muscle testing) and have worked with many people who are ‘overly’ empathic. These people report they cannot got out in public, particularly to malls, because they pick-up everyone’s physical and/or emotional pains. I have had the same report from many healers who experience this while working with clients. Using muscle testing I have had a high percentage of successful results helping clients and students determine the type of boundary protection they need that will change this for them. For some it is a specific prayer, or specific imagery, or invocation, or maybe a crystal to wear or a whole list of possible interventions. This is something I can help people with long distance if you know someone in need. If this sounds too far-out I understand, I am happy to talk with healthy skeptics as I was one once. I am also willing and interested to do research to see if this can be demonstrated.
That is open minded and smart thinking. I would be happy to be part of that study. I
do not care what the modality is…it is what it is and if it works..It Works!!!
When people are in desperate states ie..depression/anxiety… They will try just about anything to get out of their pain. We can ask the patient to try a technique and see what outcome happens. Let the patient be their own judge.
I’m not sure I agree with the interpretation of the results of this study. I am studying Peter Levine’s Somatic Experiencing. Does the study differentiate between self-regulation and what Levine calls a state of “functional freeze”, where people can perform but are completely dissociated from their physical / emotional responses, where they feel nothing. That is not empathy, nor is it self-regulation. True self-regulation involves growing the internal capacity to be fully present to one’s internal/felt experience without going into overwhelm – it is not about “not feeling”. This article’s conclusions surprise me given the focus on somatic work at NICABM. I personally and professionally have experienced physicians to be fragmented, unattuned and lacking empathy or presence – not all of them, mind you, but so many… That would confirm the “functional freeze” hypothesis.
While scientific research has helped us a great deal, unfortunately it is sometimes driven by other motives (the financial gain and to publish), than curiosity and betterment of humankind.
This is an example. All we have to do is look at how we train and indoctrinate soldiers (in a much shorter period) to kill the enemy. They are not regulating their emotions they experience psychic numbing similar to some physicians. The soldier could not kill another human being, and the physician could not treat so many sick patients. I’m sure somewhere in their childhood development, this ability to accept this psychic numbing, also plays a part. It also shows the power of what stress can do to us.
The problem here is not about regulation of emotions and enjoying the full range of human emotions, it’s about how humans have the capacity to shut down their natural emotional responses or overreact, due to stressors in the environment.
My issue is the opposite. I found it difficult to not take on the suffering of the patients with whom I worked. Many of them confided to me things they did not share with anyone else. It is incredible the things people go through and carry on. In the end, despite my practicing all the self care I could – exercise, socializing, gardening, etc. I couldn’t do it anymore. My body was wearing their pain. Empathy is very important and drawing the line on how to protect yourself when you are going to be doing this type of work for years and years remains a challenge to ‘get it right’.
Yaelah pint in an important direction: physicians “modulating” their pain may be self protective for them and contra-indicated for patient recovery. Several studies have illuminated how greater physician presence improves patient outcomes. If patients use the same unconscious strategies to “modulate” their response to pain (i.e. distance themselves) it seems to go against all of our mindful practices that encourage turning toward pain, fear, discomfort and other negative emotions to learn to see them as part of the thought stream and reduce their capacity to attach themselves to our lives…..
Empathy to the patient is for and foremost respecting the patient, listening to what THEY have to say about their body and mind, as no one knows bettrer than them, whatever the doctor might think of him/herself. Empathy is about TOUCHING and LOOKING at the patient and not relying on computers, papers and books when making a diagnosis. Empathy is being able to provide the best treatment to the specific patient without constraits and pressure by the system (to shorten clinic time) and the drug companies (to push their products). Sometimes just a simple talk about change of diet and lifestyle can suffies. No one is asking the doctor to feel the patient’s pain. But how many doctors of today, if any, are following the real practical empathy needs mentioned above?
I agree entirely. I teach my patients to eat healthy non-processed food, then take 3 minutes to breathe and relax and think of the things they are grateful for ( a great tip from Judith Orloff) and then move for 15 minutes if possible to improve the circulation to their entire body and to repeat this module every 3 hours through the day. I take a 1 1/2 hour initial visit so the patient can tell me their story which helps them see themselves as well. Sharing the story builds empathy, too. I would like to alert this group to the problem of cadmium air pollution, a stress agent that lowers vitamin D and increases glucocorticoids, both have adverse effects on the brain.