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Sunday, June 12, 2011

Consciousness, Empathy, Self and Wisom - 2

Empathy is an essential requirement for any physician. Also note that empathy and altruism are characteristics of a “wise physician”. At a time when patients think that physicians value technology more and do not truly understand their suffering, it is important to re-establish the value of empathy in patient-physician relationship. (DeWitt Stetten, a brilliant physician- scientist said that his ophthalmologists were interested in “vision”, not in his blindness). Patients are more likely to comply with treatment regimes when they feel that their physician is empathic. They are more likely to feel comforted and supported by an empathic physician.

However, empathy is a double edged sword. Too much empathy may cause earlier burn-out among physicians. In an interesting study from the Thomas Jefferson University School of Medicine, 400 medical students were studied for their level of empathy during the entire four year period of medical school. The researchers used a well-tested questionnaire to study empathy and noted that medical students show decline in their level of empathy during the third year of medical school. It is also interesting to note that women in general show more empathy. In a separate study senior physicians were noted to learn and modulate their level of empathy so they do not burn out.

We also know that it is possible to learn empathy. Meditation studies on Buddhist monks have shown that areas of brain which are active when one experiences compassion is more active in an experienced monk practicing compassion-meditation than in a novice. In other words, it is possible to improve the neural correlates of empathy and hopefully empathy. If we can teach skills in developing appropriate empathic connection with their patients, it may help prevent emotional stress and burn-out among our young physicians. It may also enhance professionalism and patient-physician relationship.

Is it possible to study the neural circuitry involved in what we call wisdom? Some may say that it is a quality that cannot be studied and quantified. But, it is possible to list qualities that are present in someone whom we call “wise”. Indeed all cultures have an idea of what wisdom consists of.

In an article summarizing neurophysiology of wisdom, Meeks and Jeste show that many of the elements which are listed as component of wisdom are common in different cultures. They are “rational decision making based on general knowledge of life, pro-social behavior including empathy, compassion and altruism, emotional stability, insight and self-reflection, decisiveness in face of uncertainty and tolerance of divergent values systems”. Interestingly, neuro-imaging studies show that prefrontal cortex and the limbic striatum are the two regions of the brain connected with several of these mental functions, when studied separately.

The limbic system is involved with emotions. Prefrontal cortex is essential for what are called the executive functions of the brain. Executive functions control and regulate other behaviors and include the ability to form concepts, think in abstract, adapt to new situations and change behaviors as needed and plan future actions based on observation, experience and insight. Wisdom involves balancing one’s emotional and rational aspects. Therefore it is not surprising that when you define wisdom by its component parts, it is possible to find out what its neuroanatomy is.

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