The Sympathy Pains of Doctors

Patients feel physicians, and the medical system in general, are unsympathetic as they tolerate hurtful procedures. As it turns out, research suggests they are more right than wrong.

Doctors and other medical professionals inflict pain—either directly or indirectly—to obtain a result that they anticipate will help them in their patient’s care. Patients let them. But, they don’t necessarily like it. In fact, often in this process, patients feel physicians, and the medical system in general, are unsympathetic as they tolerate hurtful procedures.

As it turns out, research suggests they are more right than wrong.

When onlookers see someone else in pain, the neural circuit that regulates pain is activated in the observer as well as in the person experiencing the discomfort. The response is automatic.

For example, when a child is ill, her mother often feels the symptoms. Even when an onlooker sees a stranger in pain, she or he may experience it, too. This empathetic response is processed through the limbic system, which controls our essential emotions. The areas involved are technically known as the anterior insula, periaqueducal gray and anterior cigulate cortex.

One researcher in the area, Jean Decety, PhD, director of the Brain Research Imaging Center at the University of Chicago, says this reaction in the observer may represent a panic response designed to be protective and avoid danger. Whatever the reason, this instinctive reaction to another’s pain can be modified.

Decety and his Taiwanese colleagues studied the response to others’ pain in controls who had not experienced acupuncture or been exposed to pain routinely. They were compared to physicians who, by their very training and experience in the medical field, were frequently in the presence of patients in pain. The physicians were called experts for the purposes of the study.

There were 14 subjects of similar age and backgrounds in each group. MRI was used to record changes in brain activity by detecting associated changes in blood flow response as the groups observed short videos.

In the images, humans were pricked with acupuncture needles in various regions of their bodies, plus touched with Q-tips. In response to this, the pain circuit was activated in the control group. However, it was not activated in the experts.

Instead, the physicians registered a response in the frontal lobes of the brain known for executive function and the right temporal parietal junction identified as important in incorporating information from the limbic system. The specific areas involved in the frontal lobe areas were the medial and superior prefrontal cortices. These are neural areas engaged in emotion regulation and cognitive control.

The authors say that this kind of toughening to others’ pain is protective to doctors and necessary for them to do their work. If this were not the case, then the stress of reacting to others’ discomfort regularly would lead to increased physician stress and burnout.

This desensitization is a mechanism that allows an originally caring person to become callous to others’ suffering. In this way, the observer of the suffering can more successfully protect himself when he is witness to the pain of others. He can better bear the unbearable.