Empathy and Compassion Training in Medical Education: Is It Neuro-Discriminatory Gatekeeping?

Last year, I co-taught the course “Medicine and Literature” with Tetyana Dzyadevych, my colleague in Russian Literature. (She deserves credit for the idea, assignment design, and most of the syllabus—I only added conceptual readings.)

Here is the course description:

This course examines the literary representation of the physician and narratives of illness in Russia from the 1860s to the present. We read fiction and memoirs from writers who were also practicing physicians (Chekhov, Bulgakov, and Veresaev), as well as semi-fictional and fictional case histories (Tolstoy, Solzhenitsyn, and Palei). We examine how narratives help make sense of the human experience in times of physical and emotional crisis. We trace medical ideas through history and literature, and explore how medicine employs literary concepts. We will interrogate literary works in order to see how they have influenced cultural assumptions about disease, disability, and medical authority. Addressing some of the pressing issues of the present, the reading will challenge us to question our understanding and reconceptualize notions of normality/disability, health/disease, and life/death. Located at the intersection of literature and medicine, this course aims to enhance your narrative competency and communication skills, essential to the practice of both disciplines.

One goal we didn’t list in the course description, but which was central to our marketing of the course, was to encourage students (especially pre-med students) to develop empathy and compassion.

Over the past years, substantial resources have been devoted to empathy and compassion training for medical providers (to-be), because empathy and compassion are supposed to be critical components of effective health care (see this and this review).

One of our weekly readings made me question the usefulness, and even the social justice implications, of this idea. Here’s what happened.

We were discussing an excerpt on “Moral Character” from a classical textbook in biomedical ethics. In the chapter, “virtue ethics” is described as an approach to ethics centering “on the agent who performs actions” (p. 30), in this case the medical provider. “[M]oral virtue” is defined as “a dispositional trait of character that is morally valuable and reliably present” (p. 31) in this person. The “five focal virtues” in medicine and nursing are identified as “compassion, discernment, trustworthiness, integrity, and conscientiousness” (p. 33). Compassion is the top virtue a medical provider ought to possess.

One of our (pre-med) students strongly objected to the idea that they ought to develop and exhibit empathy and compassion to be a good physician. I am paraphrasing:

What difference do my emotions make to the patient if I do everything right—provide them with excellent medical care, have flawless bedside manners, and treat them respectfully at all times? I don’t feel empathy or compassion, but I know how to act so patients feel well-cared for. I find it unfair that the authors suggest I might be unable to be a good doctor because of a lack of emotions, even though patients can’t tell that from my actions.

The student had a point.

Since that day in October 2020, I’ve been thinking a lot about the student’s statement. It seems to me that requiring empathy and compassion in medical care is inherently neuro-discriminatory. Some people, especially neurodivergent people, experience and/or show empathy and compassion in a way that doesn’t align with common definitions of empathy and compassion (or a simplistic understanding of virtue ethics, for that matter). More importantly, by making empathy and compassion training mandatory components of medical education, we have diminished the already tiny space for neurodiversity in the medical profession.

Maybe it’s time to abandon empathy and compassion training and shift towards initiatives actively furthering equity, diversity, inclusion, and social justice in medical education, care, and research. I’m pretty sure that good bedside manners would follow from this, and it would certainly open the field to a wider variety of practitioners.

In short, I don’t care what my provider feels as long as they are competent, attentive, and respectful, but I care a lot about neurodiversity. How about you?

The neurodiversity symbol, a rainbow infinity sign, describes the diversity of human brains. Source: https://commons.wikimedia.org/wiki/File:Pastel_Neurodiversity_Symbol.png

2 thoughts on “Empathy and Compassion Training in Medical Education: Is It Neuro-Discriminatory Gatekeeping?

  1. But for health workers in most African countries, personal survival is the priority. How does a health worker prioritise compassion and empathy over his or her personal welfare? In fact, many people go into the medical profession with the hope that it will liberate them for poverty. Why are African trained health workers migrating to the US and Canada? The answer is obvious. We have a proliferation of ill-equipped private hospitals because of this reason. The truth is “equity, diversity, inclusion, and social justice in health practices in Africa can not be attained in the without first addressing the welfare package of its health workers. While your observation might work in America, it will only be profitable for intellectual debates in Africa.

    • Thank you very much for your comment, Joseph! It prompted me to consider what a privilege it is for physicians to be able to focus on empathy and compassion for their patients, as opposed to their own and their family’s safety and livelihood. That’s one side of the argument I hadn’t considered yet, despite being critical of demanding certain emotions from physicians for the reason I mentioned in my post. Again, thank you for drawing my attention to yet another perspective!

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