Empathy in Clinical Practice: How Individual Dispositions,Gender, and Experience Moderate Empathic Concern,Burnout, and Emotional Distress in Physicians

To better understand clinical empathy and what factors can undermine its experience and outcome in care-giving settings, a large-scale study was conducted with 7,584 board certified practicing physicians. Online validated instruments assessing different aspects of empathy, distress, burnout, altruistic behavior, emotional awareness, and well-being were used. Compassion satisfaction was strongly associated with empathic concern, perspective taking and altruism, while compassion fatigue (burnout and secondary traumatic stress) was more closely related to personal distress and alexithymia. Gender had a highly selective effect on empathic concern, with women displaying higher values, which led to a wide array of negative and devalued feelings. Years of experience did not influence dispositional measures per se after controlling for the effect of age and gender. Participants who experienced compassion fatigue with little to no compassion satisfaction showed the highest scores on personal distress and alexithymia as well as the strongest indicators of compassion fatigue. Physicians who have difficulty regulating their negative arousal and describing and identifying emotions seem to be more prone to emotional exhaustion, detachment, and a low sense of accomplishment. On the contrary, the ability to engage in self-other awareness and regulate one’s emotions and the tendency to help others, seem to contribute to the sense of compassion that comes from assisting patients in clinical practice.     

Thinking about Cats or Dogs Provides Relief from Social Rejection

Past research shows that anthropomorphizing animals and nonhuman objects is correlated with unmet social needs (e.g., loneliness), and momentary feelings of social rejection can be soothed by thinking about a pet or by having a dog nearby. The current work tested whether thinking of names for cats and dogs improves wellbeing after social rejection, as well as whether this phenomenon occurs because of a unique quality of animals or because of anthropomorphism more generally. In three studies, participants relived a past experience of social rejection, social acceptance, or a physical injury (a control condition), after which they reported their current wellbeing. Next, participants named either cats or dogs (studies 1, 2, 3), people (study 2), or plastic toys (study 3) before reporting their current wellbeing for a second time. Across all three studies, naming cats or dogs reduced feelings of social rejection. Naming anthropomorphic plastic toys, however, produced a similar effect. To test the role of anthropomorphism in this phenomenon, study 3 also measured participants’ chronic tendency to anthropomorphize and included a condition in which participants only viewed animals or toys. Rejected participants who simply viewed photos of cats or dogs (without naming them) experienced improved wellbeing if they were already dispositionally inclined to engage in anthropomorphism. Collectively, these results suggest that briefly thinking about cats or dogs is an effective strategy for improving feelings of social rejection and that general processes involving anthropomorphism can produce this ameliorative effect.     

Rejection of unfair offers can be driven by negative emotions, evidence from modified ultimatum games with anonymity

The rejection of unfair offers can be affected by both negative emotions (e.g. anger and moral disgust) and deliberate cognitive processing of behavioral consequences (e.g. concerns of maintaining social fairness and protecting personal reputation). However, whether negative emotions are sufficient to motivate this behavior is still controversial. With modified ultimatum games, a recent study (Yamagishi T, et al. (2009) Proc Natl Acad Sci USA 106:11520-11523) found that people reject unfair offers even when this behavior increases inequity, and even when they could not communicate to the proposers. Yamagishi suggested that rejection of unfair offers could occur without people's concerning of maintaining social fairness, and could be driven by negative emotions. However, as anonymity was not sufficiently guaranteed in Yamagishi's study, the rejection rates in their experiments may have been influenced by people's concerns of protecting personal reputation (reputational concerns) in addition to negative emotions; thus, it was unclear whether the rejection was driven by negative emotions, or by reputational concerns, or both. In the present study, with specific methods to ensure anonymity, the effect of reputational concerns was successfully ruled out. We found that in a private situation in which rejection could not be driven by reputational concerns, the rejection rates of unfair offers were significantly larger than zero, and in public situations in which rejection rates could be influenced by both negative emotions and reputational concerns, rejection rates were significantly higher than that in the private situation. These results, together with Yamagishi's findings, provided more complete evidence suggesting (a) that the rejection of unfair offers can be driven by negative emotions and (b) that deliberate cognitive processing of the consequences of the behavior can increase the rejection rate, which may benefit social cooperation.     

"I'm worth more than that": trait positivity predicts increased rejection of unfair financial offers

Humans react strongly to unfairness, sometimes rejecting inequitable proposals even if this sacrifices personal financial gain. Here we explored whether emotional dispositions--trait tendencies to experience positive or negative feelings--shape the rejection of unfair financial offers. Participants played an Ultimatum Game, where the division of a sum of money is proposed and the player can accept or reject this offer. Individuals high in trait positivity and low in trait negativity rejected more unfair offers. These relationships could not be explained by existing accounts which argue that rejection behaviour results from a failure to regulate negative emotions, or serves to arbitrate social relationships and identity. Instead, the relationship between dispositional affect and rejection behaviour may be underpinned by perceived self worth, with those of a positive disposition believing that they are "worth more than that" and those of a negative disposition resigning themselves to "taking the crumbs from under the table".     

The Jamaican body's role in emotional experience and sense perception: Feelings, hearts, minds, and nerves

When Jamaicans speak offeelings, they literally mean feelings: physical sensations. Emotions, which emerge through social interaction, comprise an unmarked subset of feelings. They can affect themind in ways that are actualized in behavior. Emotions affect other parts of the body as well, in ways that follow from an equilibrium model of health. Non-emotional feelings index bodily disequilibrium rather than causing it. An example of such is seen innerves: a chronic feeling-complaint that comes about when the nerves, associated with perception and sensation, are weakened, and which entails visual dimness, jumpiness, and joint trouble. Although exacerbated by certain social situations, and often used in social commentary and manipulations, nerves is experienced and treated as a physical rather than a socially-based disorder. By studying the bodily dimension of nerves and other feelings we may gain insight into the ways in which the body serves as a source of culture (e.g., nerves culture) as well as into how culture influences bodily experience. We may broaden our understanding of the complex interplay between the bodily and mental dimensions of people's lives.     

Rapid increase of host defence against brood parasites in a recently parasitized area: the case of village weavers in Hispaniola

Passerine hosts of brood parasitic birds usually vary in their ability to discriminate and reject alien eggs. Two main hypotheses have been suggested to explain the persistence of acceptor individuals in species that are exploited by brood parasites. The evolutionary lag hypothesis postulates that some hosts have not yet evolved the ability to discriminate against alien eggs. Once the ability to recognize the parasitic egg has appeared by mutation, it spreads because of the selective advantage of rejection. Parasites are then selected to produce more mimetic eggs, in order to escape host discrimination, which eventually ends up in an arms race between the parasite and the host. The evolutionary equilibrium hypothesis is based on the assumption that rejection behaviour is costly in the absence of parasitism, because of recognition errors. Acceptor hosts can persist when parasitism rate fluctuates or is consistently low. Indirect evidence for costs of rejection in the absence of parasitism has been provided by Cruz and Wiley, who reported low rejection rate for a population of village weavers (Ploceus cucullatus) introduced from Africa to Hispaniola (West Indies) more than a century ago. In Africa the species is parasitized by Chrysococcyx cuckoos and shows high levels of egg discrimination. Since no brood parasite was present in Hispaniola, Cruz and Wiley suggested that rejection was selected against in the absence of parasitism due to recognition costs. Introduction of village weavers in Hispaniola, therefore, provided a unique opportunity to test the decline of an adaptation. During the past century the shiny cowbird (Molothrus bonariensis) has expanded its range-invading most of the West Indies from South America. It was first observed in Hispaniola in 1972, and it started to exploit village weavers as a host. Given that shiny cowbirds substantially reduce the reproductive success of weavers, we should expect higher rejection rates nowadays compared to those reported by Cruz and Wiley 16 years ago. In agreement with this prediction, we found a high rejection rate of cowbird model eggs (89.3%, 95% CI = 81.1 to 97.5%), moderate levels of rejection of non-mimetic weaver model eggs (67.5%, 95% CI = 52.5 to 82.5%) and rather low levels of rejection of mimetic weaver model eggs (25%, 95% CI = 4 to 46%). The rejection rate of artificial cowbird eggs has therefore increased from 13.8% (95% CI = 5 to 22.6%) to 89.3% in 16 years. To check whether this rapid increase in host resistance is compatible with a genetic microevolutionary change, we built a population dynamics model where, as an upper bound, resistance is inherited by the progeny with a probability of one. This simple model shows that observed changes of rejection rate are compatible with a genetic microevolutionary shift only under the most favourable scenario for rejecters to spread. Relaxing one or several of these assumptions (e.g. high parasitism rate, absence of rejection costs) considerably lengthens the period needed for rejecters to spread. We suggest that both genetic and learning processes might be involved in the observed changes.     

Continuing psychological care

This article draws together thoughts derived from an experienced clinical psychologist's practice, with parents of ill and premature infants in the context of a psychological service for children and parents in a paediatric and maternity teaching hospital. Parents were those referred by attendant neonatologists in intensive neonatal care who observed acute distress. Referral was usually some weeks after birth and help continued until after discharge, in some instances after the death of the infant. The particular approach adopted was that of offering parents a therapeutic contact which, allowed them talk over these thoughts and feelings for which they had little other skilled listening environment. Parents chose the opportunity of a safe, calm and confidential contact to explore deep feelings and draw on their own strengths and an understanding of their own vulnerabilities. The novel insights derived and the clinical material presented were used to develop an understanding of the issues a support service should address. Key aims are described and should be incorporated to restore and enhance personal strengths and the mother child relationship hence contributing to positive outcome in infant development. Reference is made to the importance of understanding how women achieve soothed states and restoration of empowerment when birth presents extra challenge.     

The contribution of NKT cells,NK cells,and other gamma-chain-dependent non-T non-B cells to IL-12-mediated rejection of tumors

IL-12 is a potent cytokine that impairs the growth of several tumors in vivo in natural as well as in therapeutic conditions. Although IL-12 can enhance a number of immunological antitumor mechanisms, including those mediated by NK cells and CTL, recent reports have suggested that the mouse CD1d-restricted V alpha 14-J alpha 18 NKT cell was the essential cell type recruited in most, if not all tumor rejection models, including the B16 melanoma. In this study, we have examined and compared the role of NKT cells, T cells, NK cells, and other non-T non-B cells in the rejection of B16 melanoma cells after exogenous administration of IL-12. Surprisingly, our results failed to confirm a necessary role for NKT cells in this model. Instead, we found that NK cells mediated the rejection of liver metastases, whereas other gamma c-dependent non-T non-B cells, possibly lymphoid dendritic cells, were required for rejection of skin tumors. These findings challenge the view that NKT cells are systematically required for IL-12-mediated rejection of tumors, and instead reveal that a variety of effector pathways can be recruited depending on the tumor microenvironment.     

Cosmetic rhinoplasty

Rhinoplasty is safe, relatively painless and, if patients are carefully selected, quite successful. Psychological and personal benefits amply justify the procedure. Frequent indications are feelings of social rejection or ridicule and racial discrimination. Psychoneurotic patients with severe complexes, however, are poor subjects for rhinoplasty and should not be operated upon. It is doubtful that rhinoplasty grossly changes the physiologic integrity of the nose. Psychological trauma to the patient during hospitalization is to be avoided, sedation properly gauged for each patient, and complete block anesthesia used to preserve the cough reflex. The operation is brief and a small splint is worn for a few days. Complications are rare.     

COSMETIC RHINOPLASTY

Rhinoplasty is safe, relatively painless and, if patients are carefully selected, quite successful. Psychological and personal benefits amply justify the procedure.Frequent indications are feelings of social rejection or ridicule and racial discrimination. Psychoneurotic patients with severe complexes, however, are poor subjects for rhinoplasty and should not be operated upon. It is doubtful that rhinoplasty grossly changes the physiologic integrity of the nose.Psychological trauma to the patient during hospitalization is to be avoided, sedation properly gauged for each patient, and complete block anesthesia used to preserve the cough reflex. The operation is brief and a small splint is worn for a few days. Complications are rare.     

Resting-State fMRI Functional Connectivity Is Associated with Sleepiness,Imagery, and Discontinuity of Mind

Resting-state functional magnetic resonance imaging (rs-fMRI) is widely used to investigate the functional architecture of the healthy human brain and how it is affected by learning, lifelong development, brain disorders or pharmacological intervention. Non-sensory experiences are prevalent during rest and must arise from ongoing brain activity, yet little is known about this relationship. Here, we used two runs of rs-fMRI both immediately followed by the Amsterdam Resting-State Questionnaire (ARSQ) to investigate the relationship between functional connectivity within ten large-scale functional brain networks and ten dimensions of thoughts and feelings experienced during the scan in 106 healthy participants. We identified 11 positive associations between brain-network functional connectivity and ARSQ dimensions. ‘Sleepiness’ exhibited significant associations with functional connectivity within Visual, Sensorimotor and Default Mode networks. Similar associations were observed for ‘Visual Thought’ and ‘Discontinuity of Mind’, which may relate to variation in imagery and thought control mediated by arousal fluctuations. Our findings show that self-reports of thoughts and feelings experienced during a rs-fMRI scan help understand the functional significance of variations in functional connectivity, which should be of special relevance to clinical studies.     

Trypanosoma musculi and Trichinella spirails: Concomitant infections and selection for resistance genotypes in mice

Trypanosoma musculi infections were given to mice of different strains before, at the same time, and after an infection with 400 Trichinella spiralis. Examined parameters of the host response to T. spiralis were worm rejection, antifecundity responses, development of immunological memory, and muscle larvae burden. After dual infection, each mouse strain showed characteristic effects on resistance to T. spiralis. This was due to a dynamic interaction between the genes controlling rejection of T. spiralis and those influencing T. musculi growth. C3H mice develop high trypanosome parasitemias. This impairs worm expulsion and the development of memory to T. spiralis when Trypanosoma infections take place on the same day or 7 days before. The C57B1/6 mouse develops low parasitemias and T. musculi infections on the same day, or 7 days before T. spiralis, delaying worm rejection only slightly despite the overall weak capacity of B6 mice to expel worms. NFR-strain mice are strong responders to T. spiralis and also develop low parasitemias. Trypanosome infections on the same day, or after T. spiralis, produce a delay in worm rejection; the former is comparable to C3H mice. However, NFR mice alone showed enhanced rejection of worm when T. musculi infections preceded T. spiralis by 7 days. An unusual feature of C3H mice was that T. musculi infections 7 days before T. spiralis increased antifecundity responses at the same time that worm expulsion was inhibited. Trypanosome infections can therefore modulate distinct antihelminth immune responses in different directions simultaneously. The different outcomes of dual infections compared with single infections provides another selective mechanism by which genetic polymorphisms can be established and maintained in the vertebrate host.     

The change of life,the sorrow of life: Menopause,bad blood and cancer among Italian-Australian working class women

This paper explores the discourse of menopause, health and illness among 20 middle aged Italo-Australian working class women living in Melbourne. Using the methods of interpretative anthropology and the perspectives of critical feminist theory, I argue that women's discourse about health and illness is one way in which they express feelings of loss over the fertility of their youth, ambivalences about their lives in Australia, and grief over a life left behind in Italy. These losses are experienced physically and expressed metaphorically through conditions of bad blood and nerves and are perceived to contribute to their vulnerability to a range of diseases including cancer. For these women, the change of life is experienced as the end of life and their fear of cancer is representative of their fears of social and physical death. Cancer is also seen to be a disease more common in Australia and is used as a metaphor for expressing anxieties relating to feelings of placelessness, of being disconnected from one's roots, and anxieties about becoming old and dying far from “home.”     

Rapid decline of host defences in response to reduced cuckoo parasitism: behavioural flexibility of reed warblers in a changing world

On Wicken Fen and nearby watercourses eastern England, parasitism by cuckoos, Cuculus canorus, declined from 26% and 16% of reed warbler (Acrocephalus scirpaceus) nests in 1985 and 1986, respectively, to 2 to 6% of nests in 1995 to 1997, owing to a decline in cuckoos. Experiments with model eggs showed that over this 12-year period there was a marked decline in host rejection of non-mimetic eggs, from rejection at 75% of reed warbler nests in 1985 to 1986 to 25%, nests in 1997. Calculations suggest that this decline in host defences is too rapid to reflect only genetic change, and is more likely to be the outcome of adaptive phenotypic flexibility. Two other results show flexibility in host responses. First, there was a seasonal decline in rejection, which accompanied the seasonal decline in parasitism. Second, although rejection did not vary with proximity to a naturally parasitized nest within the 3.4km² of Wicken Fen and its surrounds, there was no rejection at a small unparasitized population 11km away. Flexible host defences will be advantageous when there are costs of rejection as well as short-term temporal changes and small-scale geographical variation in parasitism rate. Other recent studies reporting changes in host defences may also reflect phenotypic flexibility rather than evolutionary change.     

Evidence That Personal Genome Testing Enhances Student Learning in a Course on Genomics and Personalized Medicine

An emerging debate in academic medical centers is not about the need for providing trainees with fundamental education on genomics, but rather the most effective educational models that should be deployed. At Stanford School of Medicine, a novel hands-on genomics course was developed in 2010 that provided students the option to undergo personal genome testing as part of the course curriculum. We hypothesized that use of personal genome testing in the classroom would enhance the learning experience of students. No data currently exist on how such methods impact student learning; thus, we surveyed students before and after the course to determine its impact. We analyzed responses using paired statistics from the 31 medical and graduate students who completed both pre-course and post-course surveys. Participants were stratified by those who did (N = 23) or did not (N = 8) undergo personal genome testing. In reflecting on the experience, 83% of students who underwent testing stated that they were pleased with their decision compared to 12.5% of students who decided against testing (P = 0.00058). Seventy percent of those who underwent personal genome testing self-reported a better understanding of human genetics on the basis of having undergone testing. Further, students who underwent personal genome testing demonstrated an average 31% increase in pre- to post-course scores on knowledge questions (P = 3.5×10⁻⁶); this was significantly higher (P = 0.003) than students who did not undergo testing, who showed a non-significant improvement. Undergoing personal genome testing and using personal genotype data in the classroom enhanced students'' self-reported and assessed knowledge of genomics, and did not appear to cause significant anxiety. At least for self-selected students, the incorporation of personal genome testing can be an effective educational tool to teach important concepts of clinical genomic testing.     

Genetic variation in a freshwater prawn species,Palaemon paucidens,in South Korea

The biogeography of freshwater biota in the Korean Peninsula has been affected by recent geological processes and anthropogenic activity. The freshwater prawn, Palaemon paucidens, can serve as a non-fish model organism suitable for assessing these factors, as it is found in all river systems in the Korean Peninsula and may have been introduced by humans in some regions. In this study, we investigated the geographical distribution of genetic variation and the genetic structure of P. paucidens populations using mitochondrial DNA sequences and genotypes identified from four microsatellite loci. Our results showed that populations from westward-flowing river systems that drain into the Yellow Sea have more genetic diversity than those from southward-flowing river systems, and that the highest genetic variance revealed by analysis of molecular variance (AMOVA) using both genetic markers was observed in river systems grouped as HAN + GEUM, NAKDONG + JEJU, YOUNGSAN, and SEOMJIN. These results suggest that HAN and GEUM, in which freshwater prawn populations have higher levels of genetic diversity, were the most recently isolated river systems from Asian continental systems. Therefore, populations from HAN and GEUM experienced less severe bottlenecks than those from YOUNGSAN and SEOMJIN.     

Unsubstantiated opinion: Exercising privacy rights in medical science

Privacy laws are intended to preserve human well-being and improve medical outcomes. We used the Sportstats website, a repository of competitive athletic data, to test how easily these laws can be circumvented. We designed a haphazard, unrepresentative case-series analysis and applied unscientific methods based on an Internet connection and idle time. We found it both feasible and titillating to breach anonymity, stockpile personal information and generate misquotations. We extended our methods to snoop on celebrities, link to outside databases and uncover refusal to participate. Throughout our study, we evaded capture and public humiliation despite violating these 6 privacy fundamentals. We suggest that the legitimate principle of safeguarding personal privacy is undermined by the natural human tendency toward showing off.We are shocked! Shocked! Shocked! We are shocked at the amount of sensitive personal information being released on thousands of Canadians, including some of our country''s most prominent citizens. The widespread dispersal of and the easy access to health data offends our sensibilities as medical scientists who are respectful of Canadian privacy laws. We prefer to jump through innumerable bureaucratic hoops to obtain data for research, and we believe that our rivals in other scientific fields ought to do the same.We uphold traditional values. We reminisce about the golden age when conducting a chart review was the standard for measuring quality of care. Ethics submissions were like sustained foreplay, and privacy impact assessments provided another thrill verging on “joy of the forbidden.” The 3-week turnarounds gave us time to savour and appreciate every passing minute. And joy! Even more delays occurred when health records departments could not find the relevant charts.Woe unto those who visit the Sportstats website (www.sportstats.ca).¹ This site reveals personal data obtained from timers affixed to athletes competing in sporting events across North America. This database is thorough and is searchable for many past years. In fact, we recommend using these data if you need personal information about your neighbour, nemesis or boss. In this article, we offer pointers on 6 violations of privacy for those mavericks who flaunt the scientific establishment (not us!).     

Rejection of artificial cuckoo (Cuculus canorus) eggs in relation to variation in egg appearance among reed warblers (Acrocephalus scirpaceus)

Passerines that are exposed to brood parasitism can evolve reduced intraclutch variation in egg appearance to facilitate recognition and rejection of the parasitic egg. This has been shown to be true for European passerine species that are assumed to have participated in an evolutionary arms race with the cuckoo (Cuculus canorus). However, few investigations have been carried out with the aim of finding out whether there is a relationship between these two traits within a species. In this study, we compare the level of intraclutch variation in egg appearance and the rejection of an unlike parasitic egg within a population of reed warblers (Acrocephalus scirpaceus) in the south-eastern part of the Czech Republic. We parasitized reed warbler nests with an artificial non-mimetic cuckoo egg, and then monitored the reaction of the hosts. In 27 out of 48 nests (56.3%) the parasitic egg was rejected. The rejecter pairs had a statistically significantly lower intraclutch variation in egg appearance than the acceptor pairs. We discuss possible explanations for the observed relationship between rejection of unlike eggs and intraclutch variation in egg appearance within this population of reed warblers. The results are consistent with the evolutionary arms race hypothesis, but the intermediate rejection rate found in this population could also be maintained by an equilibrium between acceptors and rejecters due to rejection costs.     

Insulin for Type 2 Diabetes Mellitus: Separating the Myths from the Facts

Background: Reluctance to use insulin is a well-established problem among patients with type 2 diabetes mellitus (DM). Many of the concerns that prompt patients to resist insulin are rooted in myths that arose because of the medical profession's difficult history with this medication.Objectives: The goals of this article were to articulate those myths, describe their impact on patient and clinician reasoning, and explain how clinicians can reassure patients and help them make a more informed choice about insulin therapy.Methods: Materials used for this article were identified through a search of PubMed for the years 1993 to 2007. English-language articles were selected using the search terms diabetes mellitus, psychological insulin barriers, and clinical inertia.Results: There are patient- and physician-specific barriers to insulin initiation that providers must be aware of to successfully counsel patients. Physician issues include worries regarding the effect insulin initiation in patients will have on practice resources (eg, impact patient crises have during initial stages of insulin therapy, concern there is inadequate time or personnel to teach insulin therapy); fear that patients will become angry, alienated, or leave the practice; and concern about the potential for patient hypoglycemia and weight gain. Patient-centered issues focus on the fear of weight gain, social embarrassment/stigma, hypoglycemia, lifestyle changes/restrictions, painful injections, and feelings of failure and guilt that treatment has progressed to needing insulin. Clinicians can alleviate many patient concerns by becoming aware of the personal and social dimensions of insulin therapy. Numerous strategies are available for the clinician to use for successful implementation of insulin therapy in patients with type 2 DM.Conclusion: By investigating the new, simpler, more straightforward algorithms for initiating insulin and using them in patient care, it will be possible to help patients make an informed decision when the time comes to start insulin therapy.