Open Access Open Access  Restricted Access Subscription Access

The feeling physician: educating the emotions in medical training

Johanna Shapiro


In this paper, I first address what medical students learn about appropriate (or tolerated) professional attitudes and emotions in the clinical context and how  the performance of emotional positions that create distance between doctor and patient and the defining of patients as other is encouraged through the informal and hidden curricula. Next, I examine what we know about medical students’ emotions. I then identify particular problematic emotional attitudes that can emerge in medical students toward patients, especially vulnerable patients who are marginalized or stigmatized in the healthcare system. To better understand this phenomenon, I discuss how such emotions emerge in response to both intrapsychic and systemic pressures. The paper then examines alternative models of healthcare that prioritize connection and solidarity with patients, considers how concepts such as emotional intelligence and emotional regulation may be pertinent in the training of future physicians and notes the relevance of such models and concepts to curricular innovation.


Compassion, emotions, empathy, medical education, person-centered medicine

Full Text:



Hafferty, F.W. (1988). Beyond Curriculum Reform: confronting medicine's hidden curriculum. Academic Medicine 73, 403-407.

Rabow, M.W., Remen, R.N., Parmelee, D.X. & Inui, T.S. (2010). Professional Formation: extending medicine’s lineage of service into the next century. Academic Medicine 85, 310-317.

Coulehan, J. (2005). Viewpoint: Today’s Professionalism: engaging the mind but not the heart. Academic Medicine 80, 892–898.

Feudtner, C., Christakis, D. & Christakis, N.A. (1994). Do Clinical Clerks Suffer Ethical Erosion? Students’ perceptions of their clinical environment and personal development. Academic Medicine 69, 670-679.

Branch, W.T. Jr., Kern ,D., Haidet, P., Weissmann, P., Gracey, C.F., Mitchell, G. & Inui, T. (2001). The Patient-Physician Relationship: teaching the human dimensions of care in clinical settings. Journal of the American Medical Association 286, 1067-1074.

Cassell, J. (2004). Stories, Moral Judgments, and Medical Care in an Intensive Care Unit. Qualitative Health Research 14, 663-674.

Hojat, M., Vergare , M.J., Maxwell, K., Brainard, G., Herrine, S.K., Isenberg ,G.A., Veloski, J. & Gonnella, J.S. (2009). The Devil is in the Third Year: a longitudinal study of erosion of empathy in medical school. Academic Medicine 84, 1182–1191

Smith, A.C. & Kleinman, S. (1989). Managing Emotions in Medical School: students’ contacts with the living and the dead. Social Psychology Quarterly 52, 56-69.

Groopman, J. (2008). How Doctors Think. 1st Mariner Books ed. Boston, Mass: Houghton-Mifflin.

Halpern, J. (2001). From Detached Concern to Clinical Empathy: Humanizing Medical Practice. New York, NY: Oxford University Press.

Shapiro, J. (2011). Perspective: Does Medical Education Promote Professional Alexithymia? A Call for Attending to the Emotions of Patients and Self in Medical Training. Academic Medicine. 86, 326-332.

Gerbert, B. (1984). Perceived Likeability and Competence of Simulated Patients: influence on physicians’ management plans. Social Science & Medicine 18, 1053–1059.

Hill, T.E. (2010). How Clinicians Make (or Avoid) Moral Judgments of Patients: implications of the evidence for relationships and research. Philosophy, Ethics, and Humanities in Medicine 5, 1-14.

Coulehan, J. & Williams, P.C. (2001). Vanquishing Virtue: the impact of medical education. Academic Medicine 76, 598–605.

Coulehan, J. (2009). Compassionate Solidarity: suffering, poetry, and medicine. Perspectives in Biology and Medicine 52, 585–603.

Evans, B.J., Stanley, R.O. & Burrows, G.D. (1993). Measuring Medical Students’ Empathy Skills. British Journal of Medicine and Psychology 66, 121–133.

Bub, B. (2007). Focusing and the Healing Sequence: reclaiming authentic emotions as an aid to communication and Well-being in medicine. Explore (NY) 3, 413–416.

Foster, W. & Freeman, E. (2008). Poetry in General Practice Education: perceptions of learners. Family Practice 25, 294-303.

Jennings, M.L. (2009). Medical Student Burnout: interdisciplinary exploration and analysis. Journal of Medical Humanities 30, 253–269.

Wear, D., Aultman, J.M., Varley, J.D. & Zarconi, J. (2006). Making Fun of Patients: medical students’ perceptions and use of derogatory and cynical humor in clinical settings. Academic Medicine 81, 454-462.

Henderson, S. (2005). Disregarding the Suffering of Others: narrative, comedy, and torture. Literature and Medicine 24, 181-208.

Rhodes-Kropf, J., Carmody, S.S., Seltzer, D., Redinbaugh, E., Gadmer, N., Block , S.D. & Arnold, R.M. (2005). “This Is Just Too Awful: I Just Can’t Believe I Experienced That …”: medical students’ reactions to their “most memorable” patient death. Academic Medicine 80, 634–640.

Jameton, A. (1994). Nursing Practice: The Ethical Issues. New York, NY: Prentice Hall.

Holt, T.E. (2004). Narrative Medicine and Negative Capability. Literature and Medicine 23, 318-333.

Engel, J.D., Zarconi, J., Pethtel, L.L. & Missimi, S.A. (2008). Narrative in Health Care: Healing Patients, Practitioners, Profession, and Community. Oxford: Radcliffe Publishing.

Pitkala, K.H. & Mantyranta, T. (2004). Feelings Related to First Patient Experiences in Medical School: a qualitative study on students’ personal portfolios. Patient Education and Counseling 54, 171–177.

Kasman, D.L., Fryer-Edwards, K. & Braddock III, C.H. (2003). Educating for Professionalism: emotional experiences on medical and pediatric inpatient wards. Academic Medicine 78, 730-741.

Smith, R.C., Dwamena, F.C. & Fortin, A.H. 6th. (2005). Teaching Personal Awareness. Journal of General Internal Medicine 20, 201-207.

Karkabi, K. & Castel, O.C. (2011). Teaching Reflective Competence in Medical Education Using Paintings.Medical Humanities 37, 58-59.

Torppa, M.A., Makkonen, E., Mårtenson, C. & Pitkälä, K.H. (2008). A Qualitative Analysis of Student Balint Groups in Medical Education: contexts and triggers of case presentations and discussion themes.Patient Education and Counseling 72, 5-11.

Jacobi, J.V., Watson, S.D. & Restuccia, R. (2011). Implementing Health Reform at the State Level: access and care for vulnerable populations. Journal of Law, Medicine and Ethics 39 (Supplement 1) 69-72.

Holloway, K.F.C. (2011). “Vulnerable” Populations - medicine, race, and presumptions of identity. Virtual Mentor 13, 124-127.

Shapiro, J. (2011). The Least of These: reading poetry to encourage reflection on the care of vulnerable patients. Journal of General Internal Medicine. 26,1381-1382.

Gilman, S. (2008). Fat: A Cultural History of Obesity. MA: Polity Press.

Armendinger, B. (2009). (Un)touchability: disclosure and the ethics of loss. Journal of Medical Humanities 30, 173-182.

Brophy, S. (2007). “Compassionate Leave”?: HIV/AIDS and collective responsibility in Ingrid de Kok’s Terrestrial Things. Literature and Medicine 26, 312-341.

Ahern, S.P., Doyle, T.K. Marquis, F., Lesk, C. & Skrobik, Y. (2012). Critically Ill Patients and End-of-Life Decision-Making: the senior medical resident experience. Advances in Health Sciences Education, Theory and Practice 17, 121-136.

Kristeva, J. (1982). Powers of Horror: An Essay on Abjection. New York: Columbia University Press.

Shapiro, J., Astin, J., Robitshek, D. &, Shapiro, D. (2011). Coping with loss of control in the practice of medicine. Families, Systems & Health. 29, 15-28.

McDonald, D.M. (2010). Not Silent, Invisible: literature's chance encounters with deaf heroes and heroines. American Annals of the Deaf 154, 463-470.

Chrisman, W.L. (2011). A Reflection on Inspiration: a recuperative call for emotion in disability studies. Journal of Literary & Cultural Disability Studies 5, 173-184.

Sonnenberg, A. (2005). Personal View: Victim Blaming as Management Strategy for the Gastroenterologist - a game theoretical approach. Alimentary Pharmacology & Therapeutics. 21, 1179-1184.

Rossiter, K. (2012). Bearing response-ability: theater, ethics and medical education. Journal of Medical Humanities 33, 1-14.

Clifton-Soderstrom, M. (2003). Levinas and the Patient as Other: the ethical foundation of medicine. Journal of Medicine and Philosophy. 28, 447-460.

Shapiro, J. (1994). No Pity: People with Disabilities Forging a New Civil Rights Movement. New York: Three Rivers Press.

Irvine, C. (2010). The Ethics of Self-Care. In: Faculty Health and Academic Medicine: Physicians, Scientists, and the Pressure of Success. (eds. T.R. Cole, T.S. Goodrich & E.R.Gritz ) pp. 127-146. New York: Humana.

Aull, F. & Lewis, B. (2004). Medical Intellectuals: resisting medical orientalism. Journal of Medical Humanities 25, 87-108.

Sy, T., Côté, S. & Saavedra, R. (2005). The contagious leader: impact of the leader's mood on the mood of group members, group affective tone, and group processes. Journal of Applied Psychology 90, 295-305.

Sung, A.D., Collins, M.E., Smith, A.K., Sanders, A.M., Quinn, M.A., Block, S.D. & Arnold , R.M. (2009). Crying: experiences and attitudes of third year medical students and interns. Teaching and Learning Medicine 21, 180 –187.

Shapiro, J. (2009). The Inner World of Medical Students: Listening to Their Voices in Poetry. New York, NY: Radcliffe Medical Press.

Beach, M.C., Thomas Inui, T.S., & The Relationship-Centered Care Research Network. (2006). Relationship-centered Care: a constructive reframing. Journal of General Internal Medicine 21 (Supplement 1) S3–S8.

Halpern, J. (2003). What Is Clinical Empathy? Journal of General Internal Medicine 18, 670-674.

Brody, H. (1997). Who gets to tell the story? Narrative in postmodern bioethics. In: Stories and their Limits: Narrative Approaches to Bioethics. (ed. H.L. Nelson), pp. 18-30. New York: Routledge.

Poirier, S. (2009). Doctors in the Making: Memoirs and Medical Education. Iowa City, IA: University of Iowa Press.

Charon, R. (2006). Narrative Medicine: Honoring the Stories of Illness. New York: Oxford Press.

Charon, R. (2001). Narrative Medicine: a model for empathy, reflection, profession, and trust. Journal of the American Medical Association 286, 1897-1902.

Shildrick, M. (2000). Becoming Vulnerable: contagious encounters and the ethics of risk. Journal of Medical Humanities 21, 215-227.

Spivak, G.C. (1990). The Post-Modern Condition: the end of politics?” In: The Postcolonial Critic: Interviews, Strategies, Dialogues. (eds. S. Harasym & G.C. Spivak), pp. 17-35.. London: Routledge.

Garden, R. (2009). Expanding Clinical Empathy: an activist perspective. Journal of General Internal Medicine 24, 122-125.

Todres, M., Tsimtsiou, Z., Stephenson, A. & Jones, R. (2010). The Emotional Intelligence of Medical Students: an exploratory cross-sectional study. Medical Teacher 32, e42–e48.

Duffy, F.D. (2006). Complexity and Healing Relationships. Journal of General Internal Medicine 21 (Supplement 1) S45-46.

Grewal, D. & Davidson, H.A. (2008). Emotional Intelligence and Graduate Medical Education. Journal of the American Medical Association 300, 1200-1202.

McQueen, A.C.H. (2004) Emotional Intelligence in Nursing Work. Journal of Advanced Nursing 47, 101–108.

Arora, S., Ashrafian, H., Davis, R., Athanasiou, T., Darzi, A. & Sevdalis, N. (2010). Emotional Intelligence in Medicine: a systematic review through the context of the ACGME competencies. Medical Education 44, 749-764.

Gross, J.J. (2002). Emotion Regulation: affective, cognitive, and social consequences. Psychophysiology. 39, 281–291.

Eisenberg, N., Fabes, R.A., Murphy, B., Karbon, M., Maszk, P., Smith, M., O'Boyle, C. & Suh, K. (1994). The Relations of Emotionality and Regulation to Dispositional and Situational Empathy-Related Responding. Journal of Personality and Social Psychology 66, 776–797.

Decety, J. & Meyer, M. (2008). From Emotion Resonance to Empathic Understanding: a social developmental neuroscience account. Developmental Psychopathology 20, 1053–1080.

Chambers, R., Gullone, E. & Allen, N.B. (2009). Mindful Emotion Regulation: an Integrative review. Clinical Psychology Review 29, 560-572.

Burks, D.J. & Kobus, A.M. (2012). The Legacy of Altruism in Health Care: the promotion of empathy, prosociality and humanism. Medical Education 46, 317-325.,

Meitar, D., Karnieli-Miller, O. & Eidelman, S. (2009). The Impact of Senior Medical Students’ Personal Difficulties on Their Communication Patterns in Breaking Bad News. Academic Medicine 84, 1582-1594.

Scheuer, C. (2011). Bodily Compositions: the disability Poetics of Karen Fiser and Laurie Clements Lambeth. Journal of Literary & Cultural Disability Studies 5, 155-172.

Browning, D.M., Meyer, E.C., Truog, R.D. & Solomon, MZ. (2007) Difficult Conversations in Healthcare: cultivating relational learning to address the hidden curriculum. Academic Medicine 82, 905-913.



  • There are currently no refbacks.