Perspective: Does medical education promote professional alexithymia? A call for attending to the emotions of patients and self in medical training

Academic Medicine

Volumn 86, Issue 3, 2011, Pages 326-332

  Shapiro, Johanna ^a  

^a University of California   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

EID: 79952194695     PISSN: 10402446     EISSN: None     Source Type: Journal    
DOI: 10.1097/ACM.0b013e3182088833     Document Type: Review

References (94)

1. Roter DL, Frankel RM, Hall JA, Sluyter D. The expression of emotion through nonverbal behavior in medical visits. J Gen Intern Med. 2006;21(suppl 1):S28-S34.
2. Torppa MA, Makkonen E, Mårtenson C, Pitkälä KH. A qualitative analysis of student Balint groups in medical education: Contexts and triggers of case presentations and discussion themes. Patient Educ Couns. 2008; 72:5-11.
3. Shapiro J. The Inner World of Medical Students: Listening to Their Voices in Poetry. New York, NY: Radcliffe Medical Press; 2009.
4. Oatley K, Keltner D, Jenkins JM. Understanding Emotions. 2nd ed. Malden, Mass: Wiley-Blackwell; 2006.
5. Isen AM, Rosenzweig AS, Young MJ. The influence of positive affect on clinical problem solving. Med Decis Making. 1991;11: 221-227.
6. Meitar D, Karnieli-Miller O, Eidelman S. The impact of senior medical students' personal difficulties on their communication patterns in breaking bad news. Acad Med. 2009;84: 1582-1594. http://journals.lww.com/academic medicine/Fulltext/2009/11000/The-Impact-of-Senior-Medical-Students-Personal.40. aspx. Accessed November 23, 2010.
7. Hall JA, Roter DL, Blanch DC, Frankel RM. Nonverbal sensitivity in medical students: Implications for clinical interactions. J Gen Intern Med. 2009;24:1217-1222.
8. Wald HS, Reis SP, Monroe AD, Borkan JM. "The Loss of My Elderly Patient:" Interactive reflective writing to support medical students' rites of passage. Med Teach. 2010;32:e178-e184.
9. Hafferty FW. Beyond curriculum reform: Confronting medicine's hidden curriculum. Acad Med. 1998;73:403-407. http://journals.lww.com/academicmedicine/ Abstract/1998/04000/Beyond-curriculum-reform-confronting-medicine-s.13.aspx. Accessed November 23, 2010. (Pubitemid 28215048)
10. Merriam-Webster Dictionary. "Emotion." http://www.merriam- webster.com/dictionary/emotion. Accessed November 23, 2010.
11. Wells A. Emotional Disorders and Metacognition: Innovative Cognitive Therapy. Chichester, England: John Wiley & Sons; 2000.
12. Moore J. Conceptual Foundations of Radical Behaviorism. Cornwall-on-Hudson, NY: Sloan Educational Publishing; 2008.
13. Misch DA. Evaluating physicians' professionalism and humanism: The case for humanism "connoisseurs." Acad Med. 2002; 77:489-495. http://journals.lww.com/academic medicine/Fulltext/2002/06000/Evaluating- Physicians-Professionalism-and.4.aspx. Accessed November 23, 2010. (Pubitemid 34655273)
14. van Middendorp H, Lumley MA, Jacobs JW, Bijlsma JW, Geenen R. The effects of anger and sadness on clinical pain reports and experimentally-induced pain thresholds in women with and without fibromyalgia. Arthritis Care Res (Hoboken). 2010;62:1370-1376.
15. Kurlander JE, Kerr EA, Krein S, Heisler M, Piette JD. Cost-related nonadherence to medications among patients with diabetes and chronic pain: Factors beyond finances. Diabetes Care. 2009;32:2143-2148.
16. Gazmararian JA, Ziemer DC, Barnes C. Perception of barriers to self-care management among diabetic patients. Diabetes Educ. 2009;35:778-788.
17. Katon WJ, Rutter C, Simon G, et al. The association of comorbid depression with mortality in patients with type 2 diabetes. Diabetes Care. 2005;28:2668-2672. (Pubitemid 43951157)
18. de Groot M, Anderson R, Freedland KE, Clouse RE, Lustman PJ. Association of depression and diabetes complications: A meta-analysis. Psychosom Med. 2001;63:619-630. (Pubitemid 32695143)
19. van Melle JP, de Jonge P, Spijkerman TA, et al. Prognostic association of depression following myocardial infarction with mortality and cardiovascular events: A metaanalysis. Psychosom Med. 2004;66:814-822. (Pubitemid 39552863)
20. Watson M, Haviland JS, Greer S, Davidson J, Bliss JM. Influence of psychological response on survival in breast cancer: A populationbased cohort study. Lancet. 1999;354:1331-1336. (Pubitemid 29481628)
21. Moynihan C, Norman AR, Barbachano Y, et al. Prospective study of factors predicting adherence to medical advice in men with testicular cancer. J Clin Oncol. 2009;27:2144-2150.
22. Plomp HN, Ballast N. Trust and vulnerability in doctor-patient relations in occupational health. Occup Med (Lond). 2010;60:261-269.
23. Smith A, Juraskova I, Butow P, et al. Sharing vs. caring-The relative impact of sharing decisions versus managing emotions on patient outcomes. Patient Educ Couns. April 29, 2010 [Epub ahead of print].
24. Benbassat J, Baumal R. Teaching doctor-patient interviewing skills using an integrated learner and teacher-centered approach. Am J Med Sci. 2001;322:349-357. (Pubitemid 33139189)
25. Bower DJ, Young S, Larson G, et al. Characteristics of patient encounters that challenge medical students' provision of patient-centered care. Acad Med. 2009;84(10 suppl):S74-S78. http://journals.lww.com/academicmedicine/Fulltext/ 2009/10001/Characteristics-of-Patient-Encounters-That. 19.aspx. Accessed November 15, 2010.
26. Rhodes-Kropf J, Carmody SS, Seltzer D, et al. "This is just too awful; I just can't believe I experienced that ...": Medical students' reactions to their "most memorable" patient death. Acad Med. 2005;80:634-640. http://journals.lww.com/academicmedicine/Fulltext/2005/07000/- This-is-just-too-awful-I-just-can-t-believe-I.5.aspx. Accessed November 15, 2010. (Pubitemid 40961997)
27. Pitkälä KH, Mäntyranta T. Feelings related to first patient experiences in medical school. A qualitative study on students' personal portfolios. Patient Educ Counsel. 2004;54: 171-177. (Pubitemid 39044528)
28. Kasman DL, Fryer-Edwards K, Braddock CH III. Educating for professionalism: Emotional experiences on medical and pediatric inpatient wards. Acad Med. 2003;78:730-741. http://journals.lww.com/academicmedicine/Fulltext/ 2003/07000/Educating-for-Professionalism-Trainees-Emotional.17. aspx. Accessed November 15, 2010. (Pubitemid 36889900)
29. Beca IJP, Browne LF, Repetto LP, Ortiz PA, Salas AC. Medical student-patient relationship: The students' perspective [in Spanish]. Rev Med Chil. 2007;135:1503-1509.
30. Karnieli-Miller O, Vu TR, Holtman MC, Clyman SG, Inui TS. Medical students' professionalism narratives: A window on the informal and hidden curriculum. Acad Med. 2010;85:124-133. http://journals.lww.com/academicmedicine/ Fulltext/2010/01000/Medical-Students-Professionalism-Narratives-A.35.aspx. Accessed November 15, 2010.
31. Sung AD, Collins ME, Smith AK, et al. Crying: Experiences and attitudes of thirdyear medical students and interns. Teach Learn Med. 2009;21:180-187.
32. Hammer RR. An education that pierces what the knife cannot: A student perspective. Anat Sci Educ. 2010;3:151-153.
33. Rucker L, Shapiro J. Becoming a physician: Students' creative projects in a third-year IM clerkship. Acad Med. 2003;78:391-397. http://journals.lww.com/ academicmedicine/Fulltext/2003/04000/Becoming-a-Physician-Students-Creative- Projects.15.aspx. Accessed November 15, 2010. (Pubitemid 36443458)
34. Bombeke K, Symons L, Debaene L, De Winter B, Schol S, Van Royen P. Help, I'm losing patient-centredness! Experiences of medical students and their teachers. Med Educ. 2010;44:662-673.
35. Ahluwalia S, Murray E, Stevenson F, Kerr C, Burns J. 'A heartbeat moment': Qualitative study of GP views of patients bringing health information from the Internet to a consultation. Br J Gen Pract. 2010;60:88-94.
36. Hall JA, Stein TS, Roter DL, Rieser N. Inaccuracies in physicians' perceptions of their patients. Med Care. 1999;37:1164-1168.
37. Hall JA, Horgan TG, Stein TS, Roter DL. Liking in the physician-patient relationship. Patient Educ Couns. 2002;48:69-77. (Pubitemid 36151683)
38. Butow PN, Brown RF, Cogar S, Tattersall MH, Dunn SM. Oncologists' reactions to cancer patients' verbal cues. Psychooncology. 2002;11:47-58. (Pubitemid 34121086)
39. Levinson W, Gorawara-Bhat R, Lamb J. A study of patient clues and physician responses in primary care and surgical settings. JAMA. 2000;284:1021-1027. (Pubitemid 30659134)
40. Pollak KI, Arnold RM, Jeffreys AS, et al. Oncologist communication about emotion during visits with patients with advanced cancer. J Clin Oncol. 2007;25:5748-5752.
41. Kennifer SL, Alexander SC, Pollak KI, et al. Negative emotions in cancer care: Do oncologists' responses depend on severity and type of emotion? Patient Educ Couns. 2009; 76:51-56.
42. Anderson WG, Alexander SC, Rodriguez KL, et al. "What concerns me is ..." Expression of emotion by advanced cancer patients during outpatient visits. Support Care Cancer. 2008; 16:803-811. (Pubitemid 351809803)
43. Ford S, Fallowfield L, Lewis S. Doctor-patient interactions in oncology. Soc Sci Med. 1996; 42:1511-1519. (Pubitemid 26161402)
44. Maguire GP. Breaking bad news: Explaining cancer diagnosis and prognosis. Med J Aust. 1999;171:288-289. http://www.mja.com.au/public/issues/171-6-200999/ maguire/maguire.html. Accessed November 16, 2010. (Pubitemid 29445718)
45. Groopman J. How Doctors Think. 1st Mariner Books ed. Boston, Mass: Houghton-Mifflin; 2008.
46. Halpern J. From Detached Concern to Clinical Empathy: Humanizing Medical Practice. New York, NY: Oxford University Press; 2001.
47. Gerbert B. Perceived likeability and competence of simulated patients: Influence on physicians' management plans. Soc Sci Med. 1984;18:1053-1059.
48. Coulehan J, Williams PC. Vanquishing virtue: The impact of medical education. Acad Med. 2001;76:598-605. http://journals.lww.com/academicmedicine/ Fulltext/2001/06000/Vanquishing-Virtue-The-Impact-of-Medical.8.aspx. Accessed November 15, 2010. (Pubitemid 32549944)
49. Bub B. Focusing and the healing sequence: Reclaiming authentic emotions as an aid to communication and well-being in medicine. Explore (NY). 2007;3:413-416. (Pubitemid 47181276)
50. Coulehan J. Viewpoint: Today's professionalism: Engaging the mind but not the heart. Acad Med. 2005;80:892-898. http://journals.lww.com/academicmedicine/ Fulltext/2005/10000/Viewpoint-Today-s-Professionalism-Engaging-the.4.aspx. Accessed November 15, 2010. (Pubitemid 41376920)
51. Evans BJ, Stanley RO, Burrows GD. Measuring medical students' empathy skills. Br J Med Psychol. 1993;66:121-133. (Pubitemid 23206088)
52. Coulehan J. Compassionate solidarity: Suffering, poetry, and medicine. Perspect Biol Med. 2009;52:585-603.
53. Angoff NR. A piece of my mind: Crying in the curriculum. JAMA. 2001;286:1017-1018.
54. Jennings ML. Medical student burnout: Interdisciplinary exploration and analysis. J Med Humanit. 2009;30:253-269.
55. Joyce B. Facilitator's Manual: Practical Implementation of the Competencies. http://www.acgme.org/outcome/e-learn/FacManual-module2.pdf. Accessed November 16, 2010.
56. Association of American Medical Colleges. Assessment of Professionalism Project. https://www.aamc.org/download/77168/data/professionalism.pdf. Accessed November 23, 2010.
57. Larson EB, Yao X. Clinical empathy as emotional labor in the patient-physician relationship. JAMA. 2005;293:1100-1106. (Pubitemid 40300284)
58. Hojat M. Ten approaches for enhancing empathy in health and human services cultures. J Health Hum Serv Adm. 2009;31: 412-450.
59. Hojat M, Vergare MJ, Maxwell K, et al. The devil is in the third year: A longitudinal study of erosion of empathy in medical school. Acad Med. 2009;84:1182-1191. http://journals.lww.com/academicmedicine/Fulltext/2009/09000/ The-Devil-is-in-the-Third-Year-A-Longitudinal.12.aspx. Accessed November 23, 2010.
60. Winefield HR, Chur-Hansen A. Evaluating the outcome of communication skill teaching for entry-level medical students: Does knowledge of empathy increase? Med Educ. 2000;34:90-94. (Pubitemid 30069427)
61. Suchman AL, Markakis K, Beckman HB, Frankel RM. A model of empathic communication in the medical interview. JAMA. 1997;277:678-682. (Pubitemid 27097436)
62. Holm U, Aspegren K. Pedagogical methods and affect tolerance in medical students. Med Educ. 1999;33:14-18. (Pubitemid 29043180)
63. Kearney MK, Weininger RB, Vachon ML, Harrison RL, Mount BM. Self-care of physicians caring for patients at the end of life: "Being connected...a key to my survival." JAMA. 2009;301:1155-1164, E1.
64. Dobie S. Viewpoint: Reflections on a welltraveled path: Self-awareness, mindful practice, and relationship-centered care as foundations for medical education. Acad Med. 2007;82:422-427. http://journals.lww. com/academicmedicine/ Fulltext/2007/04000/Viewpoint-Reflections-on-a-Well-Traveled-Path-.19.aspx. Accessed November 23, 2010. (Pubitemid 46597456)
65. Engel JD, Zarconi J, Pethtel LL, Missimi SA. Narrative in Health Care: Healing Patients, Practitioners, Profession, and Community. Oxford, UK: Radcliffe Publishing; 2008.
66. Klyman CM, Browne M, Austad C, Spindler EJ, Spindler AC. A workshop model for educating medical practitioners about optimal treatment of difficult-to-manage patients: Utilization of transference-countertransference. J Am Acad Psychoanal Dyn Psychiatry. 2008;36:661-676.
67. Kushnir T, Kushnir J, Sarel A, Cohen AH. Exploring physician perceptions of the impact of emotions on behaviour during interactions with patients. Fam Pract. September 10, 2010 [Epub ahead of print].
68. Grewal D, Davidson HA. Emotional intelligence and graduate medical education. JAMA. 2008;300:1200-1202.
69. Todres M, Tsimtsiou Z, Stephenson A, Jones R. The emotional intelligence of medical students: An exploratory cross-sectional study. Med Teach. 2010;32:e42-e48.
70. Brannick MT, Wahi MM, Arce M, Johnson HA, Nazian S, Goldin SB. Comparison of trait and ability measures of emotional intelligence in medical students. Med Educ. 2009;43:1062-1068.
71. McQueen AC. Emotional intelligence in nursing work. J Adv Nurs. 2004;47:101-108. (Pubitemid 38859942)
72. Gross JJ. Emotion regulation: Affective, cognitive, and social consequences. Psychophysiology. 2002;39:281-291. (Pubitemid 34478045)
73. Chambers R, Gullone E, Allen NB. Mindful emotion regulation: An integrative review. Clin Psychol Rev. 2009;29:560-572.
74. Decety J, Meyer M. From emotion resonance to empathic understanding: A social developmental neuroscience account. Dev Psychopathol. 2008;20:1053-1080.
75. Eisenberg N, Fabes RA, Murphy B, et al. The relations of emotionality and regulation to dispositional and situational empathy-related responding. J Pers Soc Psychol. 1994;66:776-797.
76. Beach MC, Inui T; Relationship-Centered Care Research Network. Relationshipcentered care. A constructive reframing. J Gen Intern Med. 2006;21(suppl 1):S3-S8.
77. Decety J, Lamm C. Human empathy through the lens of social neuroscience. Scientific WorldJournal. 2006;6:1146-1163. (Pubitemid 44440807)
78. Wald HS, Davis SW, Reis SP, Monroe AD, Borkan JM. Reflecting on reflections: Enhancement of medical education curriculum with structured field notes and guided feedback. Acad Med. 2009;84:830-837. http://journals.lww.com/ academic medicine/Fulltext/2009/07000/Reflecting-on-Reflections-Enhancement-of- Medical.9.aspx. Accessed November 15, 2010.
79. Coulehan J. Tenderness and steadiness: Emotions in medical practice. Lit Med. 1995; 14:222-236.
80. Engel GL. The need for a new medical model: A challenge for biomedicine. Science. 1997; 196:129-136.
81. Astin JA, Shapiro SL, Eisenberg DM, Forys KL. Mind-body medicine: State of the science, implications for practice. J Am Board Fam Pract. 2003;16:131-147.
82. Sierpina V, Levine R, Astin J, Tan A. Use of mind-body therapies in psychiatry and family medicine faculty and residents: Attitudes, barriers, and gender differences. Explore (NY). 2007;3:129-135. (Pubitemid 46381451)
83. Epstein RM, Siegel DJ, Silberman J. Selfmonitoring in clinical practice: A challenge for medical educators. J Contin Educ Health Prof. 2008;28:5-13.
84. Epstein RM. Mindful practice. JAMA. 1999; 282:833-839. (Pubitemid 29408934)
85. Linehan MM. Acceptance and change: The central dialectic in psychotherapy. In: Hayes SC, Jacobson NS, Follette VM, Dougher MJ, eds. Acceptance and Change: Content and Context in Psychotherapy. Reno, Nev: Context Press; 1994:63-86.
86. Krasner MS, Epstein RM, Beckman H, et al. Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA. 2009;302:1284-1293.
87. Charon R. Narrative Medicine: Honoring the Stories of Illness. New York, NY: Oxford University Press; 2006.
88. King J, Down J. On taking stories seriously: Emotional and moral intelligences. Teach Bus Ethics. 2001;5:419-437.
89. Foster W, Freeman E. Poetry in general practice education: Perceptions of learners. Fam Pract. 2008;25:294-303.
90. Shapiro J, Rucker L, Boker J, Lie D. Point-ofview writing: A method for increasing medical students' empathy, identification and expression of emotion, and insight. Educ Health (Abingdon). 2006;19:96-105.
91. Wald HS, Reis SP. Beyond the margins: Reflective writing and development of reflective capacity in medical education. J Gen Intern Med. 2010;25:746-749.
92. Shapiro DH, Astin JJ. Control Therapy: An Integrated Approach to Psychotherapy, Health, and Healing. New York, NY: John Wiley & Sons; 1998.
93. Kabat-Zinn J. Bringing mindfulness to medicine: An interview with Jon Kabat-Zinn, PhD. Interview by Karolyn Gazella. Adv Mind Body Med. Summer 2005;21:22-27.
94. Shapiro J, Rucker L, Robitshek D. Teaching the art of doctoring: An innovative medical student elective. Med Teach. 2006;28:30-35.