Department of General Practice and Community Medicine, University of Oslo, Oslo, Norway.
Med Teach. 2010;32(7):593-600. doi: 10.3109/01421590903544702.
Physicians' empathy is generally regarded as important and attempts are made to foster empathy. However, research indicates that the medical students' empathy is often stunted during medical education, and our understanding of how empathy is modulated during medical education is limited. This critical review explores some relatively-neglected challenges in the literature on empathy development in medical education. There is a lack of adequate attention to physicians' disciplinary matrix, the medico-scientific formation of physicians is often neglected, the dichotomy between the science and the humanities lives on and the 'soft' side is often presented as an appendix. This may contribute to sustain a double-blinded, dichotomized clinical gaze--a clinical gaze that tends to separate biomedical aspects from human experience and understanding and to neglect existential aspects of both the physician and the patient. Empathy training and the humanities should not be situated outside the hard core of medicine, but rather foster critical discussions of the limits and strengths of biomedical paradigms throughout medicine. In this way, the gap between biomedicine and the humanities could be bridged, and empathy training could contribute both in developing physicians' general clinical perception and judgement and in preventing the widespread stunting of empathy.
医生的同理心通常被认为很重要，人们也在努力培养同理心。然而，研究表明，医学生的同理心在医学教育过程中常常受到阻碍，我们对同理心如何在医学教育中调节的理解也很有限。本批判性评论探讨了医学教育中同理心发展文献中一些相对被忽视的挑战。人们对医生的学科矩阵关注不足，医生的医学科学形成往往被忽视，科学与人文之间的二分法仍然存在，“软”的一面往往被视为附录。这可能导致维持一种双重盲目、二分的临床视角——一种倾向于将生物医学方面与人类经验和理解分开，忽视医生和患者的存在方面的临床视角。同理心培训和人文学科不应置于医学的核心之外，而应促进对整个医学中生物医学范式的局限性和优势的批判性讨论。这样，就有可能弥合生物医学与人文学科之间的差距，同理心培训不仅有助于培养医生的一般临床感知和判断能力，还可以防止同理心的广泛阻碍。
