As readers of my book Healing know, the book discusses the failings of the health care system, but its overall message is about the importance of compassion, for patients and clinicians. What is compassion, though? The American Association of Colleges of Nursing offers this definition: “The recognition, understanding, and emotional resonance with another’s concerns, distress, pain or suffering, coupled with relational action to ameliorate these states.” That sentence is too wordy, but you get the idea—compassion involves seeing another’s pain and responding by trying to help.
I love the story at the center of an essay I discussed in Healing titled “There’s No Algorithm For Empathy.” Hannah Wild, the author, was a medical student at the time. She described what happened after her dog, who had been her only companion during three months spent in the wilds of Northern Canada, died after being slammed into a tree following a car crash. One of the first responders approached Wild calmly and carefully unclamped her fingers from her dog’s fur. He then moved her to an emergency vehicle, wrapped her in a blanket, and put the dog on her lap. Then he leaned face-first against the tree that broke the dog’s back and yelled, “F-ck!”
Wild feels the empathy in his response, despite its verbal minimalism and its dissimilarity from the empathy algorithms she was taught in medical school: “His firm gentleness required no performance. He won my trust without speaking a word. He would have earned poor marks on the empathy scorecard, but he was unmistakably present with me in my hurt.” The kindness with which the EMT freed Wild’s fingers from her dead dog, and the passion with which he lamented her dog’s death both registered with Wild as compassion, even though they bore no resemblance to the routinized version of empathy she learned as a medical student.
Wild concludes that empathy and compassion need to be authentic. Inauthentic expressions of understanding and concern will only alienate patients who are already struggling with the rigors of illness.
“Compassion in Health Care: An Empirical Model,” is the best article I’ve read on that subject. Published in 2016 in the Journal of Pain and Symptom Management by Sinclair et al, the article quotes patients’ definitions of compassion. These quotations are striking in their similarity and clarity as they describe the traits of compassionate clinicians:
“You can hear it in their voice and you can see it in their tone. They actually care how you are feeling” (Patient 45).
Their demeanor, their body language, how they speak to you, their tone of voice, the eye contact that they make with you. I think those are the pri- mary indicators (Patient 51).
“Compassion means to me someone listening. Really listening and hearing what I am saying rather than what they think I am saying. It’s important that you hear what I’m saying so that we can address this correctly for me” (Patient 32).
“If you’re not receiving compassionate care, you get frustrated, your spirit drops. I become overwhelmed, I become completely frustrated by the situation to the point where little things that should be relatively manageable become unmanageable, so I think it has a huge impact on the recipient” (Patient 10).
The authors themselves conclude that compassion in health care happens when clinicians personally connect with what patients are going through: “The findings suggest that compassion, as experienced by patients, is both situational and dispositional, requiring health care providers to invoke their personhood along with their clinical proficiencies to have an optimal effect in alleviating patient suffering.” The profane shout of Hannah Wild’s EMT would certainly meet that definition.
Be part of Compassion research
I had the pleasure recently of being interviewed by Simmons University doctoral candidate Nicole Guerin as part of her dissertation research on compassion. She is talking with health care providers about compassion on the job and compassion fatigue. You can read more about her study here: Compassion in Health Professions Education.
Nicole is looking for more study participants. If you are a health care worker who has an hour to spend discussing compassion or the lack thereof in health care, I encourage you to get in touch with her and see if you are appropriate for the study. I found the conversation surprisingly moving and healing. So many people in health care are suffering right now—a chance to explore how you feel about empathy and compassion in health care might be personally and professionally helpful. Plus, you would be furthering research on compassion, which can only be to the good.
Compassion is the radicalism of our time
There is so much bad news right now: the war in Ukraine, school shootings, climate change, and on and on and on. Hearing one depressing story after another can be dispiriting and create a feeling of powerlessness. The Dalai Lama’s description of compassion as “the radicalism of our time” paints compassion as an antidote to those difficult, heavy feelings. Embracing someone else’s pain with an eye toward helping them offers a reminder that, cliché as it sounds, good can happen. Simple actions like giving up a bus seat to a pregnant woman, or grabbing an item from the highest grocery store shelf for a shopper on the shorter side, are compassionate and can feel enriching for both parties.
“I see you,” compassion says to someone in need, offering open arms, a ready ear, and the impulse to act in response. That’s the standard I aspired to when I worked clinically. Did I always achieve it? Of course not. Probably even the Dalai Lama has bad days. The point is to try when we feel able. And we also have to try with ourselves, because if we do not respond to our own troubles with kindness and understanding, it will be much harder to be truly compassionate with others. As they say on airplanes, in the case of an oxygen failure, put your own mask on first.
REMINDER: the paperback of Healing pubs on April 11.
How to Promote Healing
Buy the book! Obvious, I know, but still…
Come to my launch event on April 11 at the Penguin Bookshop in Sewickley, PA. (link HERE). Sewickley’s not that far away. Not really.
Snap a pic of Healing and share it on social media. You can tag me at @theresabrownrn2021 on Instagram and @TheresaBrown on Twitter. I’m also back on facebook as “Theresa Brown.”
Pick Healing for your book club. Invite me to join your book group virtually by sending a request through the contact page on my website (link HERE).
Gift Healing to…the nurses, doctors, EMTs, PTs, RTs, healthcare executives, patients, medical and nursing students in your life, or anyone else who’s been frustrated by our health care system. Compassion could do a lot to make American health care better.
Hugs to all—spring is coming,
Theresa
Oh wow, that story of the EMT’s kind understanding about the dog’s death brought tears to my eyes. And I love your point that small, everyday gestures really do matter.
Read this during a quiet moment this morning, then thought about efforts to teach empathy while I was on the faculty of our local medical school. What I recall was thinking that I might enhance a student’s empathy, and perhaps also show how to protect your empathy as you progress through a medical career. What I struggled with was how to instill empathy in someone who was looking at medical care strictly as a technical skill. I concluded that candidate selection for admission was critical in making sure that those preparing to be bedside clinicians had the potential ability to relate to a sick or troubled human being.
Medical care requires both technical skills and a compassionate demeanor, no question. As our healthcare system becomes ever more complex, however, a person-to-person connection is imperative. I say this as a former provider now turned current patient.
Thanks for this piece, Theresa.