Step 2 CS – Empathy

Step 2 CS – Empathy


By Law2Doc of SDN:

Agreed, although I found most of the SPs to be pretty good actors, hardly wooden. While one would hope that if you were facing a real patient with a real hardship, you would not have to fake empathy, I think it’s understandable for a lot of test-takers not to be able to get past the fact that they know the SP is a fake patient. I actually think you have an easier time getting all the points if you are able to put yourself into a mindset where you are buying into the fact that the SP is a real patient in front of you. But if you aren’t able to suspend disbelief, then just go through the motions. Say “I’m sorry to hear that — that must have been hard on you — do you need a tissue”. And then move on. No big deal; certainly nothing to find insulting.

They want to test how you would react to a real patient, with a real dilemma, and this is the best they have thought up to do that. so don’t be insulted, just act like you would if this was a real patient. That’s what they are testing and for a real patient, it is hoped that you won’t have to work to hard to conjure empathy for someone expressing a difficult. I think the people who drag their feet on the whole empathy issue, and whine about how unreasonable it is to try and force that are precisely the ones this part of the test is designed to address. If you don’t feel empathy, the board wants you to be able to fake it. Because this is a service industry, and patients expect a doctor who cares. So if you don’t learn to feel it, then learn to fake it, and you will pass the test.


by Law2Doc from SDN:

Nobody is trying to turn medicine into a service industry. It has been one for decades. The “teaching” of empathy is more to help folks who don’t fit the mold to better fit in to what medicine has already become quite some time ago, not trying to push it in that direction. It is actually hoped that folks who get recruited into med school have this kind of people skill. So there aren’t people trying to turn medicine into a service industry — it is one. Sorry. (Burger King isn’t a service industry, BTW, they sell goods. Similarly a car is a good and selling a car would not be an example of a service industry. Service industries sell services. Think consulting, law, and yes medicine.)

So sure, I agree that it’s a pain for some to suspend disbelief and “pretend” that an SP is a real patient. And not just for the empathy aspects, but all the other aspects of the encounter. But the empathy is something the profession requires due to it’s service industry bent, and so it’s something the NBME has seen fit to include in the test.


by Law2Doc in SDN:

Nope, not wrong — your interpretation is. Speaking as someone coming from the corporate service sector, a “service industry” is a term of art — I’m not concerned with a dictionary definition you happened to find although it does say medicine is a service industry — it’s actually a bad definition if it lumps wholesale/retail trade into services rather than goods. I’m using the phrase as it’s used throughout the business world (your encyclopedia entry notwithstanding).

It absolutely DOES mean a customer driven business. And yes, medicine is such a business, like law, consulting, etc. Burger King or a car dealership is NOT such a business — they certainly have service components to their business, but they are selling GOODS. There is a very big difference in the business world between selling goods and selling services, because of what the customer is seeking and expecting. If you are a seller of goods, you can often have lousy service but if the product is superior you will still do well. For example, many people think poorly of used car salesmen, but they stay in business if they give good deals on acceptable products. And fast food places usually hire the cheapest, least experienced individuals possible to cook and work the register, but people still flock to Burger King despite the lack of emphasis on service because they like the taste, the price, etc.

If your product that you are selling IS the services, however, rather than a car or a hamburger, this is not the same thing. People go to a doctor to be examined, advised, counseled. Basically you bring to bear your medical knowledge to service your customers. And so what they expect is very important in terms of whether they come away satisfied.

Again you might not like that medicine is a customer driven, service industry, but this ship has sailed long ago. This is precisely what medicine is. It’s a career about people, not products. Your bedside manner, your thoroughness, your patience, and yes, your empathy all will make a huge difference in your career progression in most specialties. And so the NBME considers this fair game for testing.

At any rate I think we’ve exhausted this debate. I agree that the test is hard because it requires you to pretend too much — on this we don’t disagree. But I don’t think empathy is a skillset a doctor ought to have, and I think if you don’t have it, you have to be able to still find a way to give the customer the kind of service they expect, even if it means you have to go through the motions. It’s true in every people field — you have to come off as genuinely interested in people and concerned about their problems. If that’s not natural to you, you have to find a way to do it un-naturally. So I don’t think it’s the flaw with CS to expect this.

I do think that CS ought to actually test that people can do a good physical exam as well as these niceties which I don’t think it really does. But that’s a very different issue than you raised


By DermPrincess in SDN:

If empathy is something you have to conjure, then maybe the field of medicine isn’t right for you. To patients, it is imperative that they feel a sense of empathy towards you, even if they just come in to get a wart removed. Trust me, this is ture, and people are hypersensitive about this… if they feel even slightly like you don’t feel empathy towards them, they will become suspicious that you are a money hungry individual who became a physician for the wrong reason. So, in my humble opinion, you have three choices…

1. Leave the medical field, or at least any occupations that force you to intereact with patients… maybe you could go into research.
2. Pray for real empathy
3. Get acting lessons









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