Am I being compassionate?
- Hannah Todd
- Jan 16, 2022
- 5 min read
When I talk about compassion in the clinic or in my personal life, this point of view inevitably comes up: even if we intend to be empathetic or compassionate, we will never really know how our actions were interpreted. It’s kind of a convenient way to think about soft skills like compassion, because it offers an easy out. “That patient thought I was being condescending, but I was just trying to be compassionate” or something like that. As medical professionals, we like things to be measurable and objective. So, if we can’t measure our soft skills, they can’t be as important to work on as our manual skills or our diagnostic skills, right? But, after reading some of the more current research on compassion from a few different fields of study, it’s apparent that compassion actually is measurable. Each clinician can assess her own compassion by doing some internal, emotional work, wrestling with the 3 big questions that this post discusses. It's also an option to ask the patient, either verbally as a check in (maybe at progress note time), or more formally after a plan of care ends with the validated, well researched 5 item questionnaire[1] (also linked on the resources page). Today I want to discuss measuring compassion via examining individual motivations and beliefs.
One definition of compassion that I find frequently in the research is “a benevolent emotional response toward another who is suffering, coupled with the motivation to alleviate their suffering and promote their well-being”. In order to experience the emotional response that drives our desire to alleviate suffering, and therefore to demonstrate authentic compassion, we need to hold 3 beliefs toward our patients[2] :
1) the patient suffering has some relevant relationship to us
2) the patient doesn’t deserve to be suffering
3) we are capable of reducing the patient’s suffering.
These items can be difficult to think about, and they can bring up some difficult ideas to confront. Perhaps this is why some authors discuss compassion as an intention that we set each day, rather than a skill to possess.
The first belief, that the patient has some relevant relationship to us, requires that we take ownership of our patients. This may seem like a no brainer – obviously the patient has a relevant relationship to their provider. While this relationship is made up of pre-established roles, a real relationship is between two individuals, and it takes time, active listening, and engagement to build a therapeutic relationship. Carving out the time and attention required for this step can be difficult, especially in high volume clinics, or with employees who are disengaged and burned out. Achieving this first belief requires being present in the moment, and really seeing the person present instead of the diagnosis on the page. Active listening is paramount, and trusting that patients are the experts on their own experiences requires suspension of personal judgement.
The second belief, that the patient doesn’t deserve to be suffering, can be more difficult, and arguably more painful to confront mentally. Implicit (or even explicit) biases can impact whether we think the patient deserves the level of suffering they are experiencing. The most timely example I can think of is the attitude that prevails when unvaccinated patients become very sick with COVID. It is easy, and perhaps enticing, to blame people for their own suffering, especially when their actions seem to lead directly to the illness or injury. But, if you are harboring blame toward your patient, you can’t behave compassionately. In the best case scenario, you might demonstrate pity or sympathy – both emotions that place the provider on a pedestal compared to the patient. Empathy or compassion place the provider on equal footing to the patient. It’s the difference between “It’s sad to watch you suffering, but you made those choices, and I’m glad that I didn’t” and “As a human, I’ve suffered too, and we can get through this tough moment together.” People pick up on a pitying vibe, they feel judged, and your therapy outcomes suffer. Confronting internal biases first requires identification and examination of said biases. Once you can recognize that they exist, it's possible to notice when they crop up in clinical scenarios, at which point it's important to actively try to set them aside in favor of a judgement free acceptance of the patient.
The third belief, that we can reduce a patient’s suffering, can be a blind spot for clinicians. We are armed with an arsenal of interventions and years of training to address myriad mechanisms of suffering. However, I have found that some providers either do not believe they can alleviate a patient’s suffering, or because they don’t have the skills to alleviate a patient’s suffering themselves, they think it can't be done. These providers say things like “just wait 6 months and come back if it’s not better” or “yeah that's normal, you're fine”. My plea is that if, as a provider, you feel unequipped to alleviate a patient’s suffering, that you act compassionately by referring that patient to a provider who actually can. This may take some research or local networking to find out what different specialists and practitioners can do, but it’s in the patient’s best interest. Additionally, people respect providers who can say, "I don't know, but I know someone who can help".
Thinking back to the patient in last week's post, it's easy to see where her providers were not operating compassionately, from these 3 big questions. First of all, they did not respond to her as though they were in relevant relationship with her. Belittling someone's concerns is an unkind response. Second, rather than thinking she deserved to be suffering, they minimized the idea that she was actually suffering at all. And finally, they did not believe they could alleviate her suffering, and they communicated that it would not even be worthwhile to attempt. This is where language matters. The same bottom line answer, please don't call again for a few days because this is all to be expected, can be communicated compassionately or rudely. It's the delivery that makes all the difference, and it is our own attitudes that create the delivery.
Self evaluating these items can be uncomfortable, and the answers sometimes reveal unpleasant truths. It's important to recognize that being compassionate to yourself as you learn to be compassionate toward others is critical, and that trying counts for something. Perhaps the best news is that, when we do this internal, emotional work, it’s not just our patients who stand to benefit, but our entire social sphere. We will be better able to treat our friends and family compassionately, and create better connections. It’s unusual that a skill to improve our clinical outcomes would improve our personal relationships too.
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