Hospitalists care for a variety of different types of patients, serving anyone and everyone in need of acute care. Because of the nature of our work, it is difficult to maintain empathy and compassion for all of our patients, especially in light of our unpredictable workload, long hours, and high stress. As such, all hospitalists need to be aware of what exactly compassion is, why it matters, and what we can do to guard against its natural erosion.
What Is Compassion? What Is Empathy?
Wikipedia defines compassion as “the emotion that one feels in response to the suffering of others that motivates a desire to help.” The Latin derivation of compassion is “co-suffering.” Empathy is the ability to see and understand another’s suffering. So compassion is more than just empathy or “co-suffering”; with compassion comes yearning and a motivation to alleviate suffering in others.
Many important pieces within the definition of compassion need more explanation. Notice the three distinct “parts” of the definition: “the emotion that one feels”… “in response to the suffering of others”…“that motivates a desire to help.”
The first part outlines the fact that we have to be willing and able to conjure up an emotion toward and with our patients. Although this may sound basic, some physicians purposefully guard themselves against forming emotional responses toward or with their patients. Some actually think it will make them better—and more “objective”—providers if they guard against the (potentially) painful burden of sharing such empathic emotions.
Social science research has found that providers’ concerns about becoming emotionally exhausted might lead them to reduce their compassion for entire groups of patients, such as mentally ill or drug-addicted patient populations. There is also evidence that your ability to have empathy or compassion for another correlates with the ability to picture yourself with the same issue the patient suffers. This causes a major obstacle for many providers, who find themselves unable to relate to patients with “self-inflicted” issues, such as habits that increase the likelihood of disease (e.g. smoking) or not participating in habits that decrease the likelihood of disease or successful treatments (e.g. not exercising or not taking medications correctly).
Providers are more likely to be compassionate toward patients with whom they can identify; I would have enormous compassion for a 43-year-old female with new-onset ovarian cancer but would have less compassion for a 43-year-old male with new-onset alcohol withdrawal seizures.
The second part of the definition brings up the need to acknowledge suffering, in whatever form it takes. When we think of suffering, we often connect the idea with physical pain. But there are innumerable forms of nonphysical human suffering, including psychological and social trauma; this includes the anxiety that arises from known and unknown diagnoses and treatments and the emotional exhaustion resulting from such diagnoses and treatments. We need to be able to acknowledge all forms of suffering, not just physical suffering.
The last part of the definition shows that after we have allowed ourselves to “feel” the emotion of others and to acknowledge all walks of suffering, we then need to be motivated to help. For a hospitalist, this would mean “going the extra mile” for patients, such as continuously checking and rechecking on how treatments are (or are not) working, keeping the patient and family informed (in their terms) about what is happening, or ensuring that transitions of care (to other services or in/out of the hospital) are done with keen attention to reduce the risk of “voltage drops” in information.
Two videos help illustrate the nature of compassion (see the video sidebar for URLs). Both depict young women who have been called upon to sing the national anthem before a large crowd at an athletic gathering. Both women are clearly excellent singers, and both have a similar outcome in mind: to sing the national anthem in a manner pleasing to everyone in the crowd. In both cases, they forgot the words of the song.
In the first scenario, the woman is heckled, literally “booed,” then quickly shuffled off the ice rink after falling backwards on the ice. In the second scenario, a similarly talented young woman starts out strong, then forgets the words. An unrelated gentleman comes to her aid, puts his arm around her, and sings the words with her. As he continues, he looks to the audience, making hand signals to encourage them to join in supporting her during this presumably highly anxious moment.
The second scenario exemplifies all three components of compassion: The gentleman feels the singer’s anxiety, he acknowledges her “suffering,” and he is motivated to help. What I noticed about his assistance is that he is not even a very good singer! But his kind persuasion and ability to motivate the entire crowd in assisting her remarkably transform the outcome for both the singer and the crowd.
Though both scenarios start quite similarly, they end remarkably differently; the second scenario was completely changed by the compassion of a single person and a simple act of human kindness.
Why It Matters, and How to Build It
As depicted in these short videos, compassion can completely change outcomes. You will not find placebo-controlled randomized trials to support what I just stated. But there are plenty of social science studies to support the notion that compassion is a learned trait that can be improved or eroded over time, depending on the willingness of the person to try.
Compassion is a learned behavior. It is not a personality trait that you either have or you don’t. It is a set of behaviors and actions that can be learned and practiced, and even perfected, for those willing.
The Cleveland Clinic has created several videos (see video info box) that help us consider how to think about the nature of compassion and how to learn and practice it. A hospital is ripe with emotion in all areas, from the elevators to the hallways to the cafeteria. Due to the nature of our work, we are all at risk of compassion erosion toward our patients.
We first have to acknowledge such a risk is present and actively seek out opportunities, as depicted in these videos, to learn and practice compassion. As the Dalai Lama once said, “Compassion is a necessity, not a luxury.” We should all learn, demonstrate, and live compassion as a necessity in our practice.