Last week, during a Disclosure Workshop, a resident who had apologized profusely as he struggled to put down his constantly beeping phone pursed his lips and shook his head as I talked about “being empathetic.” “Seriously?” he sighed. “I’m overworked and exhausted enough. I don’t have TIME nor ENERGY to exert all that feeling!” He wasn’t being glib. It was clear this young man was already beginning to trade “joy in work” for the fast track to burnout. Furthermore, he had a point. It takes energy to be truly empathetic.
Nonetheless, providers do have energy limits. I looked at this tired young man and was struck by his truth. I had a sudden, horrible thought. I’ve been teaching “empathy” and “compassion” for years. Have I been pushing the emphasis on caring too hard? Am I, along with all the rest of us advocates of patient-centered care, creating an unmanageable burden and unwittingly increasing the likelihood of provider burnout?
On a quest to see whether my desire for us to demonstrate empathy was instead causing harm, I dug into the literature. I was pleased to find that empathy may well be a protective factor against burnout. Helping others can benefit well-being. On the other hand, the article went on to describe empathy as containing self-regulatory and self-protective elements. Interesting. I tend to agree with Merriam-Webster, which defines empathy as “the action of understanding, being aware of, being sensitive to, and vicariously experiencing the feelings, thoughts, and experience of another….” It seems that it would be difficult to experience another’s feelings while maintaining self-regulation. Continuing to explore, I learned that empathy in families has been shown to increase parental joy but has possible negative consequences for health, increasing the tendency for inflammation. That’s not good.
I began wondering whether what we are truly advocating is something else. Perhaps it’s not the actions and emotion that we think of as empathy. Could we instead be talking about “compassion,” defined as a “sympathetic consciousness of others’ distress together with a desire to alleviate it?” And here I don’t mean the protective understanding at an arm’s length attributed to physicians of the 50s through 90s. I’m talking about true compassion including genuine sorrow and consciousness of the distress. It also includes a genuine desire to alleviate the suffering.
Where do we go with this? We are exhausting our providers. Burnout is real. Between 2011 and 2014, there was a 9% increase in burnout, bringing the level to a whopping 54% of providers who had at least one symptom associated with burnout. We have no reason to believe that the tide has changed. If anything, everything we hear implies that it has gotten worse.
By the time I finished researching, I didn’t feel much better.
What if patients really do not need us to feel THEIR pain, but sense and acknowledge the confusion, helplessness, and fear brought on by undesirable health changes? In my experience, patients do not need us to be the all-knowing, invincible providers. They also don’t need to feel like they need to take care of us! But they do need to know that we are touched to the heart by what is going on with them. That we are their partners on this journey of life and health. And that their pain genuinely matters to us.
Maybe what matters are not the words “empathy” or “compassion,” but that we are clearer on what we teach our providers about how to “be with” someone in their pain.
I’m going to change how I teach empathy/compassion/humanity.
Because everyone will interpret the words empathy and compassion differently, I’m going to focus on being “present,” something I’ve learned from years as a counselor and risk manager.
I have experienced many sad situations, often spending time in a room with someone just listening as he/she cried, ranted, and expressed helplessness. Sometimes they were patients. Sometimes they were nurses. Sometimes they were physicians. But in the end, they all agreed that whether or not I could “DO” anything to change the situation, the situation was changed because they felt heard.
We must change the perspective to shift the burden from feeling the patient’s pain to feeling our own realization that we are partners on this journey together. As providers we are fortunate to have the opportunity to be with humans when they are most vulnerable. We do this work because we care. Patients provide us with the opportunity to experience our humanity—the part of us that wants to give to others. In this way, can we increase the joy of human connection that is at the core of healthcare and perhaps decrease the emotional exhaustion leading to burnout?
I don’t know.
Please share your thoughts with me.