Altruism in Medicine: Nurturing Empathy and Overcoming Challenges

The Hippocratic Oath is an integral part of a medical professional’s life. As medical students, we recite upon enrollment and upon graduation. It defines it as the promotion of another’s self-interest at risk to cost to oneself. It is defined as when a physician, “adheres to (the) best interest of the patient; and puts the best interest of the patient above self-interest and the interest of other parties (Jauregui 2016). It is not about offering presents to loved ones because we care about them.

Nor is it volunteering at a homeless shelter during free time to help fluff our resume.

It is not solely providing care to a patient during normal business hours or spending a few minutes extra on the telephone getting a patients’ medication approved. Altruism is defined as the sacrifice of self in devotion to others. It is cancelling vacation time to see more patients. It is spending time away from their own family to answer calls and pages when they would otherwise be allowed to rest and relax.

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Just as Dr. Helen van Horne was, staying from 5AM-11PM, had relentlessly devoted herself to treating patients and teaching others tirelessly above the needs of her own. Physicians and patients define altruism a differently as patients come from different cultures and experiences.

Through the eyes of a physician, altruism is defined by a few of the following: that the patient’s welfare come before the need for balance in their life. The patients’ welfare should come above their financial interest.

(3) The patients’ welfare should come above their need for sleep. In an emergency, putting the welfare of others over their own safety. Through the eyes of a patient, however, altruism is the complete devotion to the welfare of others at the expense and disregard of oneself. Patients may not be necessarily be thinking about their physician’s financial interest when they are getting care.

However, another complexity is that everyone’s definition of altruism falls on a scale. I once thought that altruism was unselfish acts of kindness. I took this definition one step further and included self-sacrifice. However, these are the expressions of altruism, rather than the driving force. Upon much contemplation, my personal opinion of the motivation behind altruism is empathy. Empathy is defined as identifying with another person and sharing the sorrows and joys of life. It can only be learned when a person puts themselves aside in order to engage in the best interest of others. We must remember “many patients endured far worse in their past” and that should be a reminder to always be empathetic to bring the altruism out.

I feel that a new physician develops altruism by encompassing the motivation behind it, heartfelt empathy. It is through their experiences of struggle and persevering through difficulties in life, should they put themselves aside for others. Everyone I feel has altruism in them, they just have find some way to bring it out. It can’t be taught. The 40 MCAT, 3.9 GPA pre-med may look good on paper but fail miserably at developing into an altruistic and compassionate physician. They need to figure out what do they consider their most important values to be. Through experiences, they need to reflect about whether any of these values have changed or if they were as important as they once were.

One can help bring out altruism by seeing the need and kindness of others surrounding them. For example I will speak about a personal experience. As someone who was emancipated from my parents at age 18 due to parental abandonment, I have lived in my car, showered at my college and worked full time. From this experience I had understood what it meant to be alone and feeling abandoned. As a future physician, from this life experience and struggle I’ve gone through, I will never judge a patient and will put myself aside in order to engage in their best interest. In medical school, our faculty can be role models and can provide an environment for altruistic activities, hence, attempting to bring it out of us.

In Being Mortal, Atul Gawande states that life is meaningful for people because of the story it tells through moments. If one were to measure each moment by how happy or sad they were in each second, it would be less meaningful (Gawande 2015). To me this statement is so powerful. It is the very essence of altruism because if we do something and expect something in return, it is less meaningful. Over the course of medical school education there are both challenges and enhances to altruism. First, the challenges. Just as in one of the stories about Dr. Helen van Horne in A Life in Medicine, she asks herself, “what do I have to show for years?” (Coles 2002). We all ask ourselves at one point in time if it’s worth it. The worry of failing an clinical exam, performing poorly on a board exam, being away from family, not having a social life.

These are a tiny glimpse of what I am assuming, myself included, during my medical school education. These experiences can definitely hinder altruism. However, if one rises up from the sadness, anxiety, hopelessness of these experiences, one can learn important values that would aid in developing altruism. Enhances to altruism include having an appropriate environment in which to display it. In the classroom, where many are competitive and worried about their futures, may not be the right area. But in the hospital, with actual patients, in 3rd and 4th year of medical school, is an excellent opportunity to put patients ahead of ourselves and not expecting anything in return. I feel that our curriculum does promote altruism excellently.

Our courses such as patient centered medicine and APM really hones in on what it means to be altruistic and provide patient centered care. Included in these courses are activities designed to help us self-reflect and really understand what it means to be self-less. In addition, our longitudinal integrated clerkship program is significant in that we are able to following the patient going through the health care system day by day. A glimpse of life in their shoes. I absolutely love that our medical school has an LIC program. Lastly, our family volunteering activity has had a big impact on me as well in terms of my values.

A quote I often love by Martin Buber, “I believe that the key to creating society that is nourishing, empowering and healing for everyone lies in how we relate to one another” (Scott 2017). One of the first things that come up to mind from this quote, from my most recent community week experience with my volunteer family, was how my patient, Linda, never let her illness define her. At one her first doctors’ appointments, the receptionist loudly called out to the attending physician, “lower body paralysis in waiting room.” I could only imagine how Linda felt, not as a human being, but an object.

Linda did not feel important and therefore decided it was in her best interest to seek another physician’s office that values her as a person, not an illness. No one should ever be labeled anything but a human being. This is not altruism. It is stories like this, that I listened coming from individuals that help shape and define my values. It gets molded, if you will. An addition experience, from our curriculum, was during our community week experiences with a health provider. Not only did he just treat patients, he engaged in different task such as: asking about how their family members were doing, what sports they were interested in, etc. That is the type of doctor I want to be. Engaged, actually genuinely interested in the life of another human being.

I definitely feel that healthcare policy changes will impact this domain of our professional lives. If a healthcare professional is supposed to meet a certain threshold by seeing many patients, how can he really get to know them if time is an issue. It is difficult to really be selfless and devote yourself to others when policy dictates how many patients we see. Unfortunately, given the primary care physician shortage, the solution will be very complex. The medical system needs a transformation of the attitude toward health care delivery. If reform is possible and addresses the issues that attending physicians, residents, and students face due to the current clinical environment, things might change and both patient and healthcare professional will have a meaningful relationship as it should be, without time-constraints (Dyrbye 2010).

One of the very important reason for going into medicine is because I think it will allow me to be happy. I enjoy seeing the light in a person's eyes after you've done something for them that few could. It doesn't have to be saving their life, but being able to provide a service that can help a person even in the slightest bit is appealing to me. I also enjoy the intellectual challenge that comes along with medical school, residency, and in future practice. I am competitive with myself, so pushing myself to my limit is something I love. The most important reason for going into medicine is the desire to put others before yourself. Being altruistic should be something that all physicians strive for.

I am interested in figuring out the specific determinants that make medical students less altruistic and less likely to serve the medically underserved. As students, we are molded by experiences we are faced with during clinical rotations. Also, I feel that there is more hand holding by attending physician toward residents and subsequently to medical students. It is hard for us at time, medical students, to convince ourselves that we are actually contributing to the care of patients. This is likely why there may be an increase in burnout and losing altruism.