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Medical students should watch films that inspire compassion

BMJ 2005; 330 doi: (Published 20 January 2005) Cite this as: BMJ 2005;330:166
  1. Roger Dobson
  1. Abergavenny

    Watching films that inspire compassion may make medical students more sympathetic to patients, more altruistic, and more understanding, a report in Families, Systems, and Health has claimed (2004;22;445-52). This “Don Quixote effect”—in which imagination overcomes reality—could be introduced into the medical curriculum to help medical students develop more compassion, kindness, and caring, by showing medical films such as Philadelphia, Wit, Terms of Endearment, and Leaving Las Vegas.

    Johanna Shapiro and Lloyd Rucker claim that doctors experience different emotions when faced with the same scenario in a film compared with in a clinical setting. “It is unfortunate that the very qualities of empathy and altruism that patients long for in their physicians may be more readily manifested in the darkness of the movie theatre than under the bright lights of the exam room,” say the authors.

    Although doctors and medical students can be moved to tears when they watch Philadelphia, a real patient dying under similar circumstances can make doctors feel fearful, annoyed, or resentful. This is because in the cinema there is no responsibility: “What appears in film evokes feelings of joy, sorrow, or anger, and the learner has the luxury of experiencing emotions for which he or she bears no accountability in the real world.”

    The authors say that such experiences can be harnessed to help with the development of more sensitive behaviours and attitudes in clinical care. This, they say, is the Don Quixote effect, which they define as when “a temporary emotional assumption of idealism leads to a positive interpretation of what would ordinarily be viewed as unpleasant, repellent, aggravating, or overwhelming.” The effect is best illustrated by the character Sancho Panza, who becomes more compassionate after occasionally mixing in the unreal world of Quixote.

    “We believe that going to the movies can be an effective way to trigger the Don Quixote effect in physician learners,” say the authors. Carefully chosen movies or short clips could be introduced into the medical curriculum in several ways: “Movie clips might become standard fare for orientation to various clinical clerkships or experiences.” Or students could watch The Fisher King in preparation for the emergency department or Wit as part of their oncology or gynaecology training. Philadelphia would be suitable for the internal medicine rotation, while Terms of Endearment may help those aspiring to specialise in breast cancer. Leaving Las Vegas could be fitted into the training curriculum for substance misuse.

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