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J Pain Symptom Manage. 2018 Nov;56(5):719-726.e1. doi: 10.1016/j.jpainsymman.2018.08.008. Epub 2018 Aug 23.

Third-Year Medical Students' Reactions to Surgical Patients in Pain: Doubt, Distress, and Depersonalization.

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Department of Surgery, Stanford University, Stanford, California, USA.
Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA.
Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA.
Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA; Department of Medical History and Bioethics, University of Wisconsin, Madison, Wisconsin, USA. Electronic address:



Medical students have limited instruction about how to manage the interpersonal relationships required to care for patients in pain.


The objective of this study was to characterize the experiences of medical students as they encounter pain, suffering, and the emotional experiences of doctoring.


We used qualitative analysis to explore the content of 341 essays written by third-year medical students who described their experiences with surgical patients in pain. We used an inductive process to develop a coding taxonomy and then characterized the content of these essays related to empathy, patient-clinician interaction, and descriptions of clinical norms.


Students found it difficult to reconcile patient suffering with the therapeutic objective of treatment. They feared an empathic response to pain might compromise the fortitude and efficiency required to be a doctor and they pursued strategies to distance themselves from these feelings. Students described tension around prescription of pain medications and worried about the side effects of medications used to treat pain. Students felt disillusioned when operations caused suffering without therapeutic benefit or were associated with unexpected complications. Although patients had expressed a desire for intervention, students worried that the burdens of treatment and long-term consequences were beyond patient imagination.


These observations about patient-doctor relationships suggest that there is a larger problem among clinicians relating to patient distress and personal processing of the emotional nature of patient care. Efforts to address this problem will require explicit instruction in skills to develop a personal strategy for managing the emotionally challenging aspects of clinical work.


Pain; curriculum; ethics; patient-doctor relationship; surgery

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