DC Medical Malpractice & Patient Safety Blog

That's the sellout price for a spine surgeon. Give or take a few million.

Like police officers, whose thin blue line separates them from “the other,” medical researchers and doctors are loath to diss their fellow professionals. But this week, the code of omerta was breached with a series of critical reports in The Spine Journal about industry-sponsored research in general and the use of a bone growth product in particular.

As noted in the New York Times, “It is extremely rare for researchers to publicly chastise colleagues, and editors of leading medical journals said they could not recall an instance in which a publication had dedicated an entire issue for such a singular purpose.”

At the center of attention is Infuse, a product manufactured by Medtronic that’s used in more than 100,000 spinal fusion surgeries in the U.S. each year to encourage growth of new bone so the spine fusion "takes." The Spine Journal articles claimed that researchers subsidized by Medtronic exaggerated the benefits of Infuse and minimized the risks.

All surgical procedures and all medical products carry some element of risk, large or small. Dumbfoundingly, some of Infuse’s defenders claimed it had no risk. None. Zip. Nil. Uh-huh, and I’m vacationing next month on Jupiter.

In a joint editorial, five doctors wrote, “It harms patients to have biased and corrupted research published. It harms patients to have unaccountable special interests permeate medical research.”

Objective research and the “do no harm” vow apparently have their price, and for some of the so-called “scientists” championing Infuse, it is $12 million to $16 million—the median amount collected by researchers from Medtronic. Median. That means half got more. Clearly, for Medtronic, corrupting science is a good investment: In the most recent fiscal year, Medtronic earned an estimated $900 million from Infuse.

Infuse was approved by the FDA in 2002 for one type of spinal fusion, and as required, Medtronic reported complications in its use that the agency considered sufficiently significant to require the company to list them on the product label. But, as the New York Times explained, “in reporting on such studies in 13 medical journal articles published during the last decade, researchers whose studies were paid for by Medtronic maintained that Infuse’s use was not tied to any complications.”

In addition to its approved use, Infuse is used for other spinal procedures. The Justice Department, however, has been conducting a criminal investigation to determine whether Medtronic illegally promoted such off-label uses, which the company denies.

At this point, Medtronic's credibility, and that of the people who speak for its scientific authority, is thin.

A couple of months ago we gave a shout-out to a physician who had written a commentary about Genentech's efforts to have the FDA bless the use of its drug Avastin for treatment of certain breast cancers. He had objected to the use of patient testimonials as compelling evidence to support such appeals because they're not science, they're marketing.

In what the company and its supporters probably consider honorable tenacity but thinking minds ascribe to naked greed and abuse of taxpayer resources, the FDA again this week is hearing the case for approving Avastin as a conditional treatment for certain breast cancers, never mind that studies have shown it to be neither life-prolonging nor markedly life-enhancing. In the face of life-threatening side effects, Genentech still champions the drug because it has helped some patients. Yes, Virginia, and some people make a living swallowing swords and eating fire, but such activity isn't, as they say in FDA-land, "generally recognized as safe."

Two editorials appearing this week in the New England Journal of Medicine speak in favor of science and respect for human life.

Genentech presented four arguments against the FDA’s proposed withdrawal of Avastin for breast cancer: one, the move has no precedent; two, the possibility of some patients benefiting justifies continued approval; three, individual patient choice should prevail; and four, ruling against Avastin will make future drug development confusing and discourage innovation. And, like the kid who throws the ball over the fence because he doesn't like the ump's call, Genentech also took a shot at the FDA committee considering the matter, calling it biased and requesting different judges.

We won’t dignify Genentech’s hissy fit, but, in order, here's why Genentech's appeal is folly.

One: Precedent for removing a drug’s indication for a specific disease is part and parcel of U.S. drug regulatory process.

Two: Just because some patients might benefit doesn’t mean there is enough benefit to outweigh the harm to many other patients taking this highly toxic drug. Such lazy extrapolation ignores the absence of Avastin data identifying the patient characteristics that are associated with the benefit. That's incomplete science, and it’s dangerous.

Three: Genentech’s position that “conflicting interpretations of data should be resolved in favor of retaining access and choice” is a direct contradiction of the FDA's mandate. As the NEJM commentary stated, "In a democratic republic, access and choice represent two among many values. The FDA must also protect scientific rigor, the integrity and legitimacy of federal regulations and guidance, and the public’s health. The agency’s reputation for using science to guide regulatory decisions in the public interest is its most critical institutional asset."

Four: FDA action to restrict a drug's use from some applications is common and practically perfunctory. Instead of chilling R&D, such a situation might effect more aggressive drug development--if Avastin offers little promise for patients with metastatic breast cancer, won't pharmaceutical companies be inspired to develop a better product? After all, that’s where the money is, and we all know what motivates Big Pharma.

One person, two scenarios: the first almost effortless, the second chock-full of hassles. And with those hassles comes the danger of a malpractice event and a preventable patient injury. Consider:

Our Patient -- we'll call her OP -- had an appointment for a chest X-ray in the morning, and an appointment for a blood draw in the afternoon. The radiologist was on time, the procedure took mere minutes and it required only a small co-pay. Can a medical visit get any better?

Yes! When OP asked for a copy of the image for her own records, the office manager offered to put it online via an IT service that manages their office records on the cloud--an Internet data storage system accessed by log-in, enabling patients and doctors to share information.

Now for Scenario No. 2: After Our Patient had the blood drawn at the doctor's office, she was told to wait three days before calling for the lab results. When she asked that copies of the whole blood panel be sent to her for her records, she was told there would a processing charge unless she wished to make an appointment to make her own copies at the office. There was no option for online file sharing.

Lots of patients at that point would say to heck with it and would skip getting the lab results, with possible negative consequences for their health if the results showed something abnormal and the test result slipped through the cracks at the office of the ordering doctor -- a frequent problem with offices deluged with paper test results.

Last autumn, we reported about a study by the Institute of Medicine (IOM) to identify best policies and practices for improving health-care safety and reducing malpractice when using electronic health records. Its focus is the prevention of health IT-related errors, rapid reporting of patient safety concerns and methods to promote safety-enhancing features of electronic health records. Although the study results and recommendations are several months away, electronic record-keeping remains front and center.

Despite a vigorous campaign by the federal government and some large health-care providers to move the nation’s patient records from the Jurassic Age of paper to the Electronic Age of digital communication, most physicians and clinics have been slow to embrace the transfer. Apart from radiology, which the Los Angeles Times notes leads the digital charge, there are two overriding reasons for the health-care establishments to lag other industries in digital record-keeping.

The concern for patient privacy resonates with many people, especially in light of what seem to be daily disclosures of hackers compromising the customer data base of a bank, a social media platform, a large retailer… Both health-care providers and patients rightfully wonder about privacy and security.

The second impediment to efficiently computerizing medical records reflects the labyrinthian nature of codifying a wide variety of medical specialties and medical office practices to be organized by a myriad of IT companies vying for the business. According to MarketWatch, “Critics say the architects of the plan left out a means of ensuring that the systems in the emerging patchwork of proprietary software will be able talk to each other. On top of that, the very act of digitizing millions of patient histories represents a technological leap for the legions of doctors who remain attached to paper record-keeping.”

Because health care represents one-sixth of federal spending, and because, according to federal estimates, 80% of doctors and hospitals had yet to embrace even rudimentary measures to computerize records, the federal economic stimulus in 2009 included incentives for doctors to digitize their records. It’s hardly been a resounding success, and one physician’s experience might indicate why: His practice purchased a system from a small vendor for $400,00 ($80,000 per doctor), but looks to recover only one-sixth of the cost from the feds. “There’s no uniform code by which the medical community is operating, and no widely used software standard like Microsoft’s Windows being used,” MarketWatch reported.

So it might be a while before patients and their caregivers can access all of their records with efficiency and security. If you are considering keeping and transferring your records in electronic form, here, according to the Los Angeles Times, is what you need to ask to ensure they’re secure:

• *Is the IT company managing the records legitimate? Find out from the practitioner or facility that recommended it whether they have a "business associate agreement" with the vendor. This is a contract required by the federal Health Insurance Portability and Accountability Act (HIPAA), which spells out when health-care providers may share protected health information with other people or companies. The details of how that information is secured are established in a business associate agreement. Such a contract signals that the company that stores your medical information is HIPAA-compliant and that your privacy is being protected.


• *Will your data will be stored in the United States? Will all information will be encrypted before being sent across the network? “Yes” is the only acceptable answer to both.


• *Is contact information available on the vendor’s website? If the company’s site does not include staff member names, a company address and telephone number, decline its services.


• *What happens if something goes wrong? If the company goes bankrupt or is acquired by another, what happens to your data and who owns it? If the contingency isn’t clear or treats your records like a tradable commodity, decline its services.

Article first published as The Too-Slow Evolution of Electronic Medical Records on Technorati.

A favorite whipping boy of the medical industrial complex is the alleged wave of lawsuits that need to be squashed for freedom to reign once more in America. Now, a new documentary airing on HBO exposes the truth behind so-called "tort reform."

The documentary is called "Hot Coffee" -- after the infamous case of spilled McDonald's coffee that turns out to have a lot more merit, and a far more serious injury, than the Chamber of Commerce would like the public to realize.

The documentary airs Monday, June 27th at 9 pm EDT on HBO. It's done by trial lawyer Susan Saladoff, former DC resident who now practices in Oregon. Check it out.

Here's a good preview piece in the New York Times.

DePuy's now notorious metal-on-metal artificial hip, known as the ASR, was marketed as the next great thing in orthopedics, but actually was a recycled old design that ignored warnings from industry insiders that the all-metal construction was subject to dangerous flaking of metal fragments inside the patient's body.

That's the conclusion of a new takeout on the artificial hip saga from the New York Times' Barry Meier, who has written extensively on the DePuy debacle and other defective products in the medical device world.

The article also discusses a disturbing loophole in FDA regulations that allowed products like the DePuy ASR onto the market with little testing, because the manufacturer could argue that they were close enough to an old design that they should be grandfathered into approval.

On one side you have what Justice Hugo Black evocatively called "organized money" -- the corporate interests dressed, in this case, in the garb of drug manufacturers: White coats with hundred dollar bills stuffed in the pockets.

On the other side: Regular folks: consumers, patients, and individual doctors.

Who wins in the U.S. Supreme Court? This week, organized money won: twice.

By 5-4 votes in both cases, the Supreme Court decided:

* Generic drug manufacturers are immune from lawsuits for defective and misleading labeling on their products even if patients are injured.

* Drug manufacturers have a constitutional right to collect data on individual doctors' prescription-writing habits, to help them market to those doctors more effectively.

The second decision will help "Big Pharma," brand name manufacturers who work hard to goose sales of their drugs while still under patent, before the generics bring in cut-rate look-alike products. So in a way, the court was balanced: One bone thrown to the brand name drug makers, and the other to the generics. But consumers were on the short end of both cases.

Why is the drug marketing case bad for consumers and for patient safety? Because the state of Vermont, whose law was overturned by the Supreme Court ruling on "free speech", was trying to give some breathing space for doctors to make decisions about what drugs are safest and most effective for their individual patients, without having the manufacturers' sales people in essence spying on the doctors by tallying up their weekly patterns of drugs prescribed. Read more on this drug marketing case from Merrill Goozner's blog.

The other decision is even more obviously bad for consumers. This ruling, based on a bizarre interpretation of the federal law that lets generics copy brand name drugs once the patent has expired, gives generics absolute immunity from lawsuits by injured consumers -- so the generic companies will have no incentive to follow the safety records of the drugs they profit from and put out corrected labels. Read more on this one from the American Association for Justice.

It’s the morning of your surgery, and you have been a paragon of preparation. Your advance lab work is complete, you’ve fasted for 12 hours, you arrived 10 minutes ahead of schedule and are poised to sign the final paperwork before being directed to pre-op. You present the advance health-care directive you prepared months ago to the intake clerk, and begin to fill in the consent form.

But wait. One provision says that the hospital has opted “not to honor” advance directives. Can it do that? If so, what’s the point of being such a responsible person in the first place?

Yes it can, and many medical institutions do under the laws of “conscientious objection.” But there are good reasons for filling out such a directive, and for medical facilities to have the flexibility to override them.

According to the Centers for Disease Control and Prevention, the most common types of advance directives are living wills and do-not-resuscitate orders. Overall, 28% of home health-care patients, 65% of nursing home residents and 88% of discharged hospice care patients had at least one advance directive on record.

Advance directives protect the wishes of patients unable to speak for themselves. Outside of the surgical theater, directives generally address conditions associated with the elderly and others such as persistent vegetative states that are not acute, but ongoing. During surgery, if something goes wrong, such as an adverse reaction to anesthesia or an unexpected organ failure, doctors need to respond quickly; their goal is to ensure the success of the surgery, and a completely binding advance directive can hamstring a reasonable effort to address a sudden problem. You don’t want someone able to correct a situation quickly and successfully to be prohibited from doing so by a document intended to address a more long-term issue.

But the time limits suspending a directive should be clear; medical providers, even if they aren’t bound by its terms during surgery, must be aware of them afterward. And if the surgeon or hospital refuses to honor your documented wishes during recovery, most states require them to make a reasonable effort to transfer you to providers who will.

Patients can protect their rights and enhance their surgical outcome by:

asking before surgery about the hospital’s policy on advance directives. If you don’t like it, look elsewhere for your procedure, but understand that most hospitals won’t comply with a directive during surgery;

understanding the time limits of the suspension—it should cease once you’re in recovery;

ensuring that you have an advocate with you who understands your wishes—a relative or friend who acts as your agent to make health-care decisions if you’re unable.

Chances are, you or a family member has been the beneficiary of a freebie from the doctor’s office, and we don’t mean a cherry lollipop when the kids got their tetanus booster. We’re talking drugs, often of the prescription variety, that a pharmaceutical representative has left after a marketing visit to the doctor’s office. "Samples," they're called.

We've covered the dangers and the hidden costs of "samples" for both doctor and patient previously in this blog, Today's topic is a little broader: the many tentacles of the pharmaceutical industry that reach into the doctor's office and that can affect the care you and your loved ones get. More specifically, there is a possible pay-for-play attitude that’s harder for doctors to resist as medical costs continue their upward thrust and doctors say they feel increasingly marginalized.

In “Doctor Compensation and Industry Influence,” writer Ed Silverman notes that “The ongoing controversy over financial ties between physicians and the pharmaceutical industry centers, of course, on concerns that medical practice may be unduly influenced,” and that doctors are indignant that people could believe their medical judgment would be influenced by swag. But many doctors are unhappy with their compensation, citing costly and lengthy education and training, stressful and protracted relations with insurance companies, rising malpractice insurance premiums and patients armed with an Internet medical degree and questions about diagnoses and treatment.

There’s a lot going on here, and although much of doctors’ dissatisfaction is righteous, it’s unfair for them to expect patients to:

be sympathetic about the costs of an education they chose to pursue;
suffer their ill will in the face of greedy or incompetent insurance companies; and
simply accept that mistakes will be made and that retaining legal counsel is disloyal and unfair.

And it’s just flat-out arrogant and dismissive for physicians to prefer patients who never ask questions, who aren’t invested in their own health care and whose default is to defer to the guy in the white coat because he’s over-educated and underpaid. That’s not good for the patient or, ultimately, the practice of medicine.

A recent survey by Medscape, “Do doctors earn enough?”, generated a robust response within the medical community, and not necessarily for the numbers report (orthopedic surgeons and radiologists earn the most--$350,000 median income—and pediatricians the least-- $148,000 median), but for the ancillary issues.

Responding to the survey in “Mo money mo problems,” physician Sean Pannick drew a line of clarity for parties on both sides of the worth issue: “Doctors should look at their income and ask themselves--and their patients--whether it fairly reflects the quality of their work. Patients, on the other hand, also need to be mindful of the financial component to the doctor-patient relationship. They may not know (or want to know) that money matters when it comes to doctors, who often profit more from a series of tests and procedures than a simple clinical assessment. Conversations in the consulting room already mask a number of hidden agendas, and the issue of renumeration (sic) is another one that lurks beneath the surface.”

Absent a truly malfeasant practitioner, the quality of care a patient receives from his or her doctor probably isn’t influenced markedly by occasional, reasonable attention from members of the medical industrial complex with something to sell. But it might be affected by the efficiency of ordering a test over the harder work of having a conversation.

It is your duty to yourself and your loved ones to get the best possible care, and that means asking questions. If you wonder if your doctor has gotten paid to represent a medical product or service, ask. If you have read something on the Internet that might relate to the problem you’re presenting in the exam room, broach the subject. If your doctor is too busy, distracted or feeling too undercompensated to engage, it’s time to go doctor shopping.

The contest between flesh and bone versus the spinning blade of a table saw is always a
rout. The 40,000 Americans who land in emergency rooms every year with such injuries
are testimony that table saws are the country's most dangerous commonly used power
tool. This spring, the issue of table-saw safety
has found a more receptive audience among federal regulators than have
several previous efforts at raising consciousness about a bloody battle no one ever wants
to wage.

Consider:

4,000 victims of table-saw accidents suffer amputations every year;
a table-saw accident occurs every nine minutes.

So why have these numbers failed to diminish significantly since the 2004 introduction of
a technology that shuts off a saw when it senses contact with skin? Because, apart from
the company that introduced SawStop, no other power tool manufacturer has embraced
the technology, and federal regulators have not required its use. Although understandably
reluctant to endorse a product, the feds finally are acknowledging the bone-headedness of
ignoring a clear solution to a vexing problem.

Invented by a physicist, a SawStop blade carries an electric signal that changes upon
contact with skin, thanks to the fact that the human body is conductive. The change
activates a brake, and the blade stops spinning instantly. In a recent interview with NPR,
Bob Adler, a commissioner at the Consumer Product Safety Commission (CPSC), said,
"What you have is somebody who has invented a dramatic technology that seems to
reduce virtually all the injuries associated with table saws."

The potential benefit of imposing such a safety measure has been compared to that of
safety belts, air bags, disabling refrigerator door locks and other landmark regulations
that have saved lives and limbs.

The power tool industry claims that SawStop would increase the price of table saws
beyond consumer tolerance, essentially doubling the cost for the least expensive models.
It says that the blade guards on most models proved awkward, that users routinely
removed them, but that they've been redesigned. Their improved effectiveness, other
manufacturers say, bypasses the need to mandate use of the more expensive and
complicated SawStop.

Recently, the National Consumers League sponsored an effort by injured woodworkers to
lobby lawmakers and regulators to make the safety brake mandatory on all table saws.
Some weeks later, at a public meeting on table-saw safety, Inez Tenenbaum, chairwoman
of the CPSC, said, "It's clear that we need a standard that will truly address and help
reduce the tragically high number of finger and hand injuries that are occurring on a daily
basis around the country."

The CPSC wants to encourage major tool companies and SawStop to reach a licensing
agreement to enable the industry to use the technology voluntarily.

The commission has just directed its staff to draft a new regulation package. It should be
ready for public comment by the end of September.

A study examining outcomes of heart and lung transplant surgery has concluded that patients fare essentially the same whether the transplants are performed during the day or at night. Two smaller previous studies – one on kidney transplants and the other on liver transplants – had indicated that patients tended to fare worse if the operations took place in the middle of the night.

The new study, published in the Journal of the American Medical Association, took into account all of the nearly 30,000 heart and lung transplants performed in the United States over 10 years. Researchers were surprised by the results, which indicated that, contrary to conventional wisdom, patient outcomes had little to do with the time of the operation or the fatigue of the surgeon. Rather, they seemed to hinge on the reliability of the surgical team.

Unlike surgeons in other specialties, cardiothoracic surgeons almost always work in the operating room with the same team of highly specialized anesthesiologists, nurses, physician assistants and technicians. The team’s familiarity with and constant repetition of the same complex steps — placing patients on bypass machines, performing certain intraoperative studies, even executing specific suture sequences — may be the key to ensuring consistent performance, whatever the time of day.

When performing a transplant, “the surgeon isn’t doing a complicated operation in the middle of the night with an anesthesiologist who usually staffs gynecology procedures and a nurse who works in the orthopedic operating rooms during the day,” says Dr. Ashish Shah, a co-author of the study and assistant professor of surgery at the Johns Hopkins University School of Medicine. “We need to think about doctors less like airline pilots and more like a part of a special forces military team. Those teams carry out complex tasks at a very high level and under less than ideal physiologic or environmental conditions.”

Source: The New York Times

You can read an abstract of the study here.

Physician groups and health insurers often blame excessive malpractice settlements for the high rates that doctors have to pay to obtain malpractice liability insurance. But a recent analysis indicates that regional differences may play an even more significant role in determining malpractice insurance rates.

According to a recent analysis by Excellus BlueCross BlueShield, a BC/BS carrier in upstate New York, medical malpractice premiums for physicians in different regions of the state can vary as much as five times the amount paid, and the difference can exceed $100,000 for some specialties. In particular, malpractice rates for upstate New York physicians are considerably less than those in downstate regions and are similar to the amounts paid by physicians in states that report the lowest premium rates in the country.

The analysis, entitled “The Facts About New York State Medical Malpractice Coverage Premiums," found that the standard malpractice premium for an internist in Buffalo, Syracuse, Binghamton and Utica ($9,874) is significantly lower than for an internist practicing on Long Island ($35,028). A general surgeon's premium rate in those same upstate areas is $32,663, contrasted with a Long Island general surgeon's rate of $115,872, while obstetricians/gynecologists in many upstate regions may pay $52,650, whereas their Long Island counterparts pay a standard rate of $186,772.

The data presented in the fact sheet for New York state physicians is based on current standard premium rates of the Medical Liability Mutual Insurance Co., which insures most physicians in the state.

Source: The Ithaca Journal

You can obtain a free copy of “The Facts About New York State Medical Malpractice Coverage Premiums” here.

It’s bad enough when a treatment goes so wrong a patient has to sue to get financial compensation for the physician’s malpractice, but what if the physician has no liability insurance and the judgment can’t be collected? For Georgia residents, this no longer poses a problem, because under a new law that may be the first of its kind in the U.S., physicians must disclose whether or not they are covered by medical liability insurance.

According to the law, which was signed by Georgia Governor Nathan Deal last month, physicians are required to inform the Georgia Composite Medical Board if they are insured. The board will make the information available on its website as part of a physician's public profile. In addition, doctors also must disclose whether they are covered by insurance when asked by patients. If the physician declines to inform his patients, the result could be disciplinary action by the board.

"The patient has a right to know if a physician carries malpractice insurance," says Rep. Ben Watson, MD, who sponsored the measure. "This is part of how a patient can judge a physician."

The Medical Association of Georgia, which represents physicians in Georgia, supported the bill. The vast majority of Georgia’s nearly 18,000 physicians have liability insurance.

The Georgia law may be the first of its kind to add "insurance coverage" to the list of public disclosures required of physicians. Last month, the Illinois Assembly passed a similar bill, but it has yet to be signed into law.

Source: American Medical News

Maryland hospitals reported significantly more serious patient care problems, including malpractice and preventable injuries, in 2010 than in the previous year. According to the state’s annual report on patient care and safety, there were 265 adverse events causing death or serious injury to patients reported in 2010, compared with 190 the year before.

However, health officials attributed the increase to better identification and reporting - particularly when it came to pressure ulcers (bedsores) - not to a real increase in problems.

Falls continue to be the No. 1 adverse event at hospitals, followed by pressure ulcers and delays in treatment. No hospitals were named in the report, but larger ones with more complex cases reported more problems, according to the Maryland’s Office of Health Care Quality, which has been collecting the information from hospitals for 6 years.

The director of the office, Nancy Grimm, praised Maryland hospitals’ continued efforts to improve patient safety. "Increased reporting by hospitals is an indication of engaged and proactive patient safety programs, which ultimately promotes positive patient safety outcomes,” she said. “The greater the reporting, the better results for patients."

Source: The Baltimore Sun

Every patient and every doctor know that delivering bad news is something that physicians sometimes have to do. But too many doctors don't realize that the way they communicate can cause terrible and needless emotional injury.

A flat, heartless delivery of bad news can make patients feel abandoned and devastated. A touch of compassion, on the other hand, may not extend a patient's life by a single day, but does make them feel that they are still part of the community of the living.

Patient advocates say that Compassion is one of the four C's that patients have a right to expect. (The others are: Competence, Communication and Convenience.)

William Branch, an internist and professor at Emory University School of Medicine in Atlanta, has conducted studies for two decades to determine if physicians can be taught to be more compassionate.

Dr. Branch maintains that “our healthcare system does not lack compassion,” and that compassion can be taught, though not in a single training session.

In research conducted at five medical schools in 2009, Branch studied two sets of faculty members on their compassion skills as evaluated by their medical students and residents. The students watched the faculty members interact with patients, and they scored those interactions plus the quality of their direct teaching of caring skills.

One faculty group underwent a two-year program that combined experiential learning of skills such as role modeling along with reflective exploration of values through writing narratives and other activities. The other group had no intervention. The study found that the compassion-training group rated significantly more compassionate with their patients.

However, just as it can be taught, compassion also can be lost. A 2008 study of 419 medical students showed that women had twice the empathy scores of men and that scores declined at the end of the third year, when students had begun regular exposure to patients during clinical rotations — exactly at the point where they needed more, not less, empathy. But this trend can be prevented; another study of 209 students at the Robert Wood Johnson Medical School found that empathy was maintained among third-year students who received specialized training.

Source: Washington Post

You can read Dr. Branch’s research paper in Academic Medicine here.