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We welcome back internal medicine physician Vijay Rajput. Two years ago, he shared his insights on the KevinMD article, “Top 10 things new interns should do.” Today, he returns to discuss updates on those recommendations, with a new emphasis on empathy, compassion, and introducing the power of kindness in medical education and clinical practice.
Vijay Rajput is an internal medicine physician.
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back Vijay Rajput. He’s an internal medicine physician. He last came on a podcast talking about his article, “Top 10 Things New Interns Should Do.” We invite him back today to give an update on that article. Vijay, welcome back to the show.
Vijay Rajput: Kevin, good morning, and thank you for having me. I really appreciate the opportunity to update or add some new information related to articles being published on your website as a blog.
Kevin Pho: All right. So, we last spoke two years ago. Any changes since then in terms of your tips and advice on what new interns and residents should do to succeed?
Vijay Rajput: Yeah, so in the last few years, I’ve been pondering this issue of empathy and compassion. Let me dive back over the last 25 years, at least in medical education and clinical health care. We’ve been telling physicians, students, and residents to show more empathy. Then we moved to compassion. But I would like to introduce the concept of kindness.
If you give me a few minutes, I’ll make it clear to our audience the difference between sympathy, empathy, compassion, and kindness. So, I’ll take a few minutes. Sympathy is when you superficially show pity for someone, right? I might just say, “Oh, sorry,” without actually having that feeling or even a cognitive response in my brain. A lot of times, when students or others take a history, they’ll hear a patient say, “Oh, my parents died,” and they’ll say, “Oh, sorry to hear that.” That “sorry” has no meaning to me. The only time we should say “sorry” in health care is if we made a mistake. A true apology should always include a genuine “sorry,” but that’s the only context for it.
Empathy is a conscious understanding—having an emotional response to someone who’s going through something. It’s a cognitive and emotional response. But it stops there. We use the phrase “walking in someone else’s shoes,” right? That’s empathy. We’ve been teaching empathy and assessing students on empathy. We even say, “Oh, they come in with great empathy as first-years, but by fourth-year, they lose it.” We’ve been saying that.
Compassion is empathy plus an action to alleviate someone’s suffering. That’s compassion in a very simple way—you have to have a desire or at least an attempt to alleviate suffering. Now, kindness—that’s an interesting one. We use the word kindness all the time, but it’s any benevolent act or gesture where you want to respond with help. The other person doesn’t have to be distressed or suffering for you to show kindness.
The first thing about kindness is that you don’t need any emotional attachment to the person you’re being kind to, and the person doesn’t have to be in a vulnerable situation. We have a lot of people in health care and education, and we can show each other kindness. So, that’s where I’d like to shift our education and health care focus a bit—toward kindness.
I can give you some examples, right? If you’re an intern or a student on your first day, and you’re in a patient’s room, and the patient is ringing the bell for a urinal bottle or can’t open a milk carton to pour on their cereal, you help them out. That’s kindness. They’re not necessarily in distress, but you’re showing kindness. There are so many opportunities we miss, and we don’t teach students, residents, or faculty about them. This has become my mission—to talk more about kindness.
Kevin Pho: So, are you finding that, in general, new residents and students you see lack kindness, or do you think it’s relatively innate? You gave the example of a patient ringing the bell, and you help them with a urinal or whatever they need. Does that need to be taught?
Vijay Rajput: You know, Kevin, that’s a good question. I used to think, “Yeah, we don’t need to teach that.” They should have learned it or should know. But the answer is no; I think we do need to teach it.
In a health care and medical student environment, we give them a fixed job description, right? They’re taught competencies, like breaking bad news or interpersonal communication. But I’ve never seen kindness listed there. I’ve seen empathy, and now, compassion. So, yes, we haven’t been teaching kindness. Most residents, especially my enthusiastic ones, will say, “Dr. Rajput, that’s not my job description. The medical assistants are supposed to do that.” And I say, “That’s not true.”
Small gestures can elevate engagement and well-being at all levels. I truly believe that if you’re more kind, you’re more likely to be engaged, people will reciprocate, and well-being will improve.
Kevin Pho: So how do you go about teaching kindness to your students? Do you lecture them, or do you do it through actions they can model after you? How do you go about teaching kindness?
Vijay Rajput: You said it right, Kevin—role modeling is the best way. I could give a lecture, and I’ve even written a paper on the need for kindness in medical education. But role modeling is crucial. If we don’t have role models at the bedside, they’re less likely to embrace kindness. So, yes, we need to teach, advise, and guide them on what kindness is. But at the end of the day, more role models are needed at every professional level—nursing, surgeons, and physicians.
For example, every time I’m on a service, I’ll find a patient who has a birthday. Out of my 15 patients, one or two are bound to have a birthday. I’ll give my residents or students $20 and say, “Hey, tomorrow, let’s bring a cake from the cafeteria or outside and go to the patient’s bedside.” Even if it’s a diabetic patient, we bring the cake and celebrate the birthday. It’s a simple gesture. I’ve even given money to patients for a bus ride. My residents might say, “Dr. Rajput, how do you know they won’t use that money for drugs?” And I say, “I can’t worry about that. I have to trust my patient.”
These small gestures of kindness are essential. We can show kindness at any level, and I think it would benefit everyone in health care.
Kevin Pho: Tell me a story about how gestures of kindness have impacted patients. How has it made a difference in a patient’s life?
Vijay Rajput: Kevin, in my career, every time I’ve shown kindness, patients have trusted me more. It’s the best way to build trust. I believe in going the extra mile for the person in front of me, even when it’s not part of the job description. This is a real problem in our health care system. People think, “Oh, this is my job description. If I deviate, I might get in trouble.” But my answer is no. The extra mile helps everyone and connects with what I call “practical wisdom”—deviating from the norm to help the person in front of you.
Kevin Pho: Let’s talk about role models. You and your fellow attendings sometimes have difficulty modeling kindness with all the stress, bureaucracy, and obstacles in health care. How do you have the presence to demonstrate kindness, especially on bad days?
Vijay Rajput: Absolutely, Kevin. There are two things you have to do at the end of the day. If you behaved poorly and realize it didn’t go well with a patient or nurse, two things need to happen. First, you need to apologize to the person affected, acknowledging that incident. Second, those observing you need a debrief. You need to have the courage to say, “What do you think happened?” and own up to it.
For instance, in a recent Zoom interview, one of my faculty asked a question that, in any context, could be seen as microaggression. The interviewee sensed it but didn’t respond. I had to set up another meeting, debrief my faculty, and tell others what happened. The debrief needs to happen that day—otherwise, people will forget.
Kevin Pho: You mentioned earlier that empathy can be taught. How does your program or the academic medical community teach empathy to new students and residents?
Vijay Rajput: Teaching empathy is about nature and nurture. I believe you need a basic substrate. I can’t give someone a script and say, “You’re an empathetic physician now.” But if they have the basics, it can be built upon. This can happen in every format—through standardized patients, peer learning, and reflection discussions. Debriefing and reflection are crucial for learning empathy and compassion. Reading alone isn’t enough.
Kevin Pho: We last spoke two years ago on this podcast about tips for new interns. How have new interns been over the last few years? Have you noticed any trends?
Vijay Rajput: A national discussion now is about burnout and well-being, especially among early-career physicians. I think the challenge is engagement and providing psychological safety. Residents need to manage three M’s early on: micromanagement, microaggression, and microincivility.
Some supervising physicians micromanage, claiming it’s for “patient safety.” Microaggression and microincivility are subtler but need addressing. We need to prepare residents for these challenges. It’s not realistic to think we’ll eradicate micromanagement, microaggression, or microincivility. But we need to help our learners handle these behaviors, and we should teach our younger physicians how to avoid displaying them. These three behaviors are often in the eye of the beholder, so perception varies between individuals.
Kevin Pho: Do you have any sessions that help new interns manage those three M’s?
Vijay Rajput: It’s still early, but I’ve been developing workshops at the national level for educators to address this in faculty development. Microaggression has been researched for the past decade, and Christine Pora wrote a book on incivility in health care and other organizations. But it hasn’t fully entered medical education yet. I hope that, over the next few years, more research and faculty development will integrate these concepts to better prepare our learners.
Kevin Pho: You mentioned burnout, especially in early-career physicians. What does your program or other medical educators do to help mitigate early burnout?
Vijay Rajput: Kevin, I believe everyone encourages meditation, yoga, exercise, and healthy eating. But I think the only real way to prevent burnout is through meaningful engagement with patients and finding joy in patient care. If they don’t find joy in what they’re doing, it won’t matter how much support we provide. That joy is critical, even though, as we know, there are stressful days and challenging patients. Finding joy in patient care can mitigate or prevent burnout.
Kevin Pho: We’re talking to Vijay Rajput, an internal medicine physician, about updates on his KevinMD article, “Top 10 Things New Interns Should Do.” Vijay, we’ll end with some of your take-home messages for the KevinMD audience.
Vijay Rajput: My take-home message is that, along with empathy and compassion, we need to incorporate kindness into education and clinical care. There are many opportunities to show kindness. I’d also stress the importance of managing the three M’s: micromanagement, microaggression, and microincivility. Preparing our young learners to handle these issues—and teaching faculty and clinicians to minimize these behaviors—will help prevent burnout, enhance well-being, and ultimately benefit our patients.
Kevin Pho: Vijay, thank you so much for coming on the show again and sharing your time, insight, and perspective.
Vijay Rajput: Kevin, thank you for having me, and have a good day.
