Monday, November 5, 2007

Health-care professionals and empathy

Earlier today, I read an article in Newsweek titled, "Sorry, But I Can't Help You: One study found that, in doctors, the brain circuits associated with empathy were suppressed."

The article went on to discuss one chemical engineer's path to find new and improved cancer treatments because his wife had dealt with breast cancer (and survived). The chemical engineer, Mark Davis, has been successful, thus far in the research process, in finding a better treatment for certain types of cancer. (read the article if you are interested in the specifics, it's not pertinent to mine).

The article ended by saying that David has had to stop answering his phone because potential subjects (cancer patients) kept calling, and he hated having to tell them his study was full.

"So I've stopped answering my phone, because I can't keep saying no to people. It's depressing. I guess doctors learn how to tell people they can't help them. But I'm not a doctor," he was quoted as saying.

Newsweek went on to claim: "He's right about doctors. Jean Decety, a psychologist at the University of Chicago, compared a group of doctors with laypeople, watching a video of patients receiving a painful acupuncture treatment. In the laypeople, parts of the brain associated with pain and with empathy were activated, but in doctors those circuits were suppressed, Decety found. Instead, they showed activity in areas associated with logical thinking. Decety said he wasn't surprised by Davis's experience.

'Doctors see people dying all the time,' he said, 'and if they couldn't modulate their emotions, they couldn't get through the day.' So you may be smart enough to cure cancer, but first ask yourself: are you tough enough?"

While the article is misleading in that it barely mentions empathy and doctors, it did get me thinking about how my experience of "empathy" has changed since I have been a nurse.

And for the record, doctors don't "see people dying all the time." Nor do nurses, or nurse practitioners. It is largely dependent on area of focus and whether you are in an acute care setting or primary care setting (or research, or some other setting). I doubt primary care providers, for example, have seen many (if at all) people die right before their eyes. And I doubt they would not feel empathy if they perceived one of their patients in extreme pain. I don't know that anyone, aside from someone antisocial personality disorder or an autistic person, could completely lack that kind of empathy.

Thus, the distinction should be made between "clinical empathy" and "layperson empathy" (for lack of a better term right now). Perhaps there are different parts of the brain involved in the two. I think it is misleading for an article to insinuate (or lead its readers into the assumption) that doctors are no longer able to feel empathy towards patients because they are so desensitized to pain and suffering.

A general definition of empathy is "one's ability to recognize, perceive and feel directly the emotion of another. Since the states of mind, beliefs, and desires of others are intertwined with their emotions, one with empathy for another may often be able to more effectively define another's mode of thought and mood. Empathy is often characterized as the ability to "put oneself into another's shoes", or to in some way experience the outlook or emotions of another being within oneself, a sort of emotional resonance."

To contrast, "sympathy" is feeling sorry for someone and wishing to share in their suffering. That is a big no-no in the health-care world. Not only would it be impossible to carry the burdens and suffering of every single patient on our backs, it is insulting to the patient to assume they would want us to do so. It is not our sympathy that patients want, it is our empathy. People with empathy can put themselves in another's shoes. And while we may never exactly understand what our patients' experiences are, it is important to try. For, by trying, we are letting them know that we will be their advocates and help them to our professional capacity. It is through empathy that we do our best to do what's best for our patients.

I did a quick internet search of "empathy and nurses" and "empathy and physicians" and honestly did not find as much material as I thought I would. When I have more time, I would like to do a scholarly search. Right now, I have enough work cut out for me.

In the internet search There was a story of a breast cancer survivor, also a former nurse, who had a horrible time in her hospital, thanks to unempathetic nurses who didn't explain anything to her or offer anticipatory guidance or patient education. I can't imagine working on an oncology floor and becoming so desensitized to the suffering of the patients, that I mindlessly wheel a breast-cancer survivor down to discharge while complaining about breast-feeding.

I've had similar experiences with nurses, too, when I go to my doctor. (yet not that extreme)

For example, I go to my doctor no more than once a year, and it's only for my annual exam and bloodwork. When I am sick, I tough it out without ever calling my doctor, because I know that most of the time, I have a virus. Being a nurse, I am careful to not be one of those annoying patients calling all the time, asking for special treatment, prescriptions for needless antibiotics, etc. The nurse (I assume she is a nurse, though she never actually introduces herself and doesn't wear a name-tag) places me on the scale, takes my vital signs, and leaves. I call for my results 2 weeks later, and she acts like it's the biggest hassle in the world. Once a year. If that. I won't be back there with my insurance money, because I know that the services I am requesting from her are like a 0.01 on the scale of easy to hard nursing duties.

And that's ignoring the times I have seen nurses mistreating my relatives and others in hospitals.

On the other hand, being a nurse, I have been lied to, screamed at, cursed at, physically threatened, hung up on, manipulated, and used as a verbal punching bag by patients in my career. I've been belittled for being young, for being a woman, and for being "only a nurse." I've been hit on, asked way too personal questions, thrown up on, shat on, peed on... I've seen nearly every body fluid that exists. And I have seen people on the brink of death. It could be very easy to become disillusioned with this career.

Thus, I am often torn between wanting to stick up for the millions of people in my profession who I know are overworked and underpaid, and chastising them for being so cold and uncaring during the most difficult parts of people's lives.

Now that I have been on both ends of the spectrum, I can try to find some common ground.

Do nurses become less able to empathize with people over their careers? Are they so burnt-out from dealing with thousands of ungrateful patients year after year who take advantage of them and the system?

This is the career I have chosen for myself. Not only that, I left my first career for this one. Do I have any right to complain as I did four paragraphs earlier? I knew what I was getting into when I went back to school. My mom was a nurse, after all.

It's all about finding that middle ground, so I'm learning. One can be nice, have empathy, be knowledgeable, and at the same time not take any crap from manipulative people who try to take advantage of your system.

There are simple rules I have learned in my short career to positive, successful interactions with patients/clients:

Most people have good intentions.

Most people are incredibly vulnerable and scared when they are sick or injured. Oftentimes, all they want is a friendly face.

Most people are seeking someone who will try to understand their position.

Most people are extremely grateful when you let them know you are trying to help them, when you introduce yourself to them, when you make eye contact with them, and when you are nice to them.

The nicer you are to patients, the greater the chances that they will NEVER sue you for malpractice.

Letting people know you are trying to empathize with them greatly increases the chances that the interaction will be positive.

If someone is immediately confrontational or combative (but without threat of physical harm) let them know you are trying to understand where they are coming from.

Anyway, I think the key in any "caring" profession (social work, nursing, teaching, etc) is finding a job that you love, that you are dedicated to, and that will keep you looking forward to work each day. I have found that, so far, and feel extremely lucky. My employer's mission is very similar to my life's/career mission and that helps me keep my focus, and keeps me from losing my ability to feel empathy towards our patients.

I'll end with a nursing quote I found earlier:

"Nursing encompasses an art, a humanistic orientation, a feeling for the value of the individual, and an intuitive sense of ethics, and of the appropriateness of action taken."

~Myrtle Aydelotte, 1992

More on that later...


Fannie said...

Your perspective as both patient and professional is interesting.

As a patient, I suppose we need to be aware that nurses have to put up with a lot- from doctors, from patients, from administration- and are still expected to be compassionate.

As a general rule, though, I wish nurses would treat patients compassionately and nicely unless the patient is rude/threatening/inappropriate. A few times, I have seen nurses be really mean and short to patients who only needed a kind word or some reassurance during a scary time.

Jane Know said...

Yes, there is no excuse for being rude to a patient right off the bat. Or at all. We have to remember that we are the professionals, and they are the patients. Too many nurses do it, I think, because they know they will get away with it. And if they don't get away with it, they can easily leave and go to a different job.

Nurses, whether doctors/admin/or anyone admits it or not, are in a major position of power due to the nursing shortage.

The choice is whether or not we abuse that power by being assholes, or remember the real reasons most of became nurses in the first place.

I will always stick up for my profession, but I will not stick up for the men and women in my profession who abuse their power over sick people or the system.