Cynicism Pervades Modern Medical Schools

A generation gap, or do med students become less empathetic, more cynical with formal education?

June 10, 2009 -- There is nothing like a corrupt philosophy to bring down a winning organization, such as the education of future physicians. Today many medical students discover the personal philosophy that inspired them to enter medical school is eroding, if not gone completely, following their exposure to medical education.

A small group of OHSU medical students and I regularly share breakfast and spirited discussion. We identify ourselves as “The New Curiosity Shop,” since we’ve found there is nothing we cannot convert into a lively question.

Naturally the students share their working philosophy, which in my judgment sounds like hard-knuckle cynicism. Apparently academic medicine has changed from the days of my class of ’47. Then students were intent on setting a post-WWII world to rights.
Our philosophy centered on making a good living while remembering a lesson or two from Hippocrates by way of Plato, on helping the patient toward health, a kind of impractical optimism. Today students I talk with are as interested in my dated philosophy of medical care as they are in the life and times of Dr. Marcus Welby.
My breakfast companions are equipped to sharply examine the world of medical education and they do. My impression of unseemly prevalence of cynicism received an immediate preemptive challenge. Not that the prevalence was denied. No, instead, the students boasted of it, proclaiming, “Being cynical is good.”
With ready dispatch developed by knocking off “pop” quizzes, these scholars cited Diogenes and his third-century BC Greek friends as original cynics, leaving a small environmental footprint.
My companions’ concept of cynicism offered me no sense of closure. Consequently I went to the Oxford English Dictionary where I learned a “cynic is a surly misanthrope, a person disposed to rail and find fault in the goodness and sincerity of human beings.” That definition comfortably matched a site on my cortex.
Next my companions offered to poll the local medical student body on their working philosophy. A month later the returns revealed that 27.9 percent of the freshmen, 34.6 percent of the sophomores, 46.8 percent of the juniors and 41.8 percent of the senior medical class declared themselves as cynics.
An immediate conclusion is that our medical faculty is effectively training a cadre of cynical doctors. This may not be intentional but simply students emulating their teachers’ example.
The poll generated additional questions, such as how long have medical students in Oregon been shifting their personal view of the world toward cynicism. And how long has this shift been going on in U.S. medical schools? A reliable answer would entail the difficult task of polling students in 147 medical schools. Even so, murmurings in the medical press indicate something is altering medical students’ attitudes nationwide.
A faculty member at Albany Medical College did an email poll of all 637 medical students and first year residents. He asked for factors affecting their ability to empathize with patients. The response of 293 students was reported, “As a cohort, their level of empathy decreased from year one to year four.”
A report from the University of Arkansas Medical School asked, “Is There Hardening of the Heart During Medical School?” The research team reported progressive diminishment of student empathy for patients from first to third year students.
This indicates a smell of a plague of cynicism in the sensibilities of future physicians. Perhaps we could find the answer by starting at the top with the president of the Association of American Medical Colleges, Dr. Darrell G. Kirch, and ask him if this is a common place matter in present day medical education nationwide.
Should Dr. Kirch’s reply indicate that medical education is presently free from the cynicism virus, we can all relax. However, if such is not true we might then ask to have the AAMC undertake a scholarly study of our essential academic philosophy of medical practice. 
As second best, I suggest we gather in Portland’s most public place, Pioneer Square, and until the security policy club us into submission, shout at the top of our lungs: “Fire. Fire. Our doctors’ sense of caring is on fire. Medical students are the first to go. They are burning up, down and sideways.”
With assistance from Dr. Alex Foster, ’09, Evelyn Ford, Class of 2011 and Mathew Iles-Shi, Class of 2012
Dr. Crawshaw is a retired psychiatrist with an active interest in civic medicine.
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Dr. Crawshaw's view of our profession's widespread cynicism is not merely that of one retired physician who graduated just after WWII. I saw this, and heard other medical students on the way through this sorry transition talk about it, as a senior in medical school in 1973. It is emphatically not "good to be cynical" whether you are a physician, journalist, or any of a number of professions that are important to society's functioning. We have a lot of work to do, and more of us need to be doing it, to improve this aspect of our profession's health.