Doctors repress their responses to their patients’ pain

A new study shows that experienced doctors learn to control the part of their brain that allows them to empathise with a patient’s pain, and switch on another area that allows them to control their emotions.






The controls showed increased brain activity in areas involved in processing pain, including the anterior insula, anterior cingulated cortex, somatosensory cortex and the periaqueductal gray (or PAG). The PAG in particular is thought to act like a control centre for our panic response, mobilising our limbs into action when we sense danger.

In the brains of the more detached experts, these areas failed to light up. Instead, they showed increased activity in parts of the brain involved in higher functions like self-awareness and emotional regulation, including the parahippocampal gyrus, the middle frontal gyrus, the medial prefrontal cortex and the inferior parietal lobule (compare Figure C and D in the image below).

Automatic pain circuits are repressed in experienced doctors who see pain in others

Even a needle in the mouth didn’t provoke an empathic pain response in the experts, while these were most likely to activate the somatosensory cortex in the controls.

The participants’ own answers to a questionnaire backed up the brain scans. When asked to rate the pain and unpleasantness shown in the needle videos, the controls gave an average score of 6.5 out of 10, while the acupuncturists felt the clips only warranted a 3 or 4 (figure B in image above).

Yawei and Decety ruled out the possibility that the doctors were just more emotionally numb than their controls, or more cavalier in the face of pain. In response to psychological questionnaires, the two groups showed no differences in their general levels of empathy or their sensitivity to pain.

Instead, the activation pattern in the experts’ brains suggests that their higher brain functions block the activation of the pain circuit. The parahippocampal gyrus is partially responsible for retrieving memories – its activation allowed the experts to use their previous years of experience to influence their current reactions. The temporoparietal junction is important in maintaining a distinction between oneself and others, and its activation could allow them to emotionally detach from their patients.

With experience, the acupuncturists know that their actions are painful for their patients and have learned to repress their own automatic responses to the sight of pain. That may sound cold, but it’s essential for operating a successful practice.

More on psychology and learning:

Experience tunes a part of the brain to the shapes of words

9/11 memories reveal how ‘flashbulb memories’ are made in the brain

Babies can tell apart different languages with visual cues alone

Reference: Cheng, Lin, Liu, Hay, Lim, Hung & Decety. 2007. Expertise modulates the perception of pain in others. Curr Biol 17: 1-6.

Image from Current Biology paper, Cell Press.

4 Responses

  1. Good read, I suppose an extreme form of this phenomenon would be seen in serial killers and the like or maybe there is nothing to suppress in those kind of people, I’m not an expert as is plainly evident.

  2. […] Young of Not Exactly Rocket Science touches on some interesting research in medical professionals empathy or sensitivity to pain. It attempts to explain how experienced doctors may be able to modulate their empathy, yet control […]

  3. well i’m not sure about that.

  4. Oh great, well thanks for laying our your opposing point of view so thoughtfully.

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