*ever thine

cranquis:

Well, CanadianBee, I decided to post a public reply to your comments — mainly because I was very impressed by those links. Lemme repost them here for easier access:

• Med students start to lose empathy for patients within 1st year of medical school
• A 4th-year Med Student’s perspective on losing empathy for your patients (NOTE: PDF download)
• Empathy for patients sharply declines in 3rd year of med school (NOTE: PDF download)

I have written a post about “How I stay motivated to keep my life in-balance” before, but I don’t think I’ve written anything specifically about “How I hold onto empathy for my patients” — so, here goes:

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I’ve always been an empathetic person. (Possibly “empathic” too, but that’s neither here nor there.) Even as a young teenager, people would spontaneously open up to me and talk about their problems, as if they recognized that I really enjoyed listening to them and could help carry the burden of what they were feeling. It was kind of strange, to be honest — I’ve lost track of the number of teenaged girls who would call me at all hours, “just because I knew you would listen to me.” (Later, in college, one of those out-of-the-blue late-night “I have nobody else to share my sorrows with” phone calls from a girl I only knew casually would become the first serious conversation that I’d ever had with the future Mrs. Cranquis!)

Since I was aware of my skills at empathy and active listening, I definitely planned to use them when I entered medicine. But I found few opportunities during the classroom years of med school (except when I would volunteer to spend time with kids in the Children’s Hospital). And then as a 3rd year med student, I was always under pressure from residents and attendings to “get the history” and “do the physical” and “retract this flap of tissue while someone else does all the fun surgical stuff.” Not a very patient-empathy-friendly environment. I can understand how many med students would quickly slough off any remaining empathy skills at this stage, purely for the sake of survival!

But thankfully, I had some excellent “empathy” modeling by attendings and chaplains in my 4th year and during my Family Medicine residency. I got to see attendings intentionally put aside the pressures of a packed clinic or a crammed inpatient ward — and just sit with a patient. These experiences helped me re-realize that medicine is not all about “# patients seen” and “reimbursement $/patient”. Your medical career CAN become just a “meat factory” if you let it, but it doesn’t HAVE to be.

Specific factors that help me keep my empathy for patients now:

• Preparing for the day. I try to have devotions each morning with Mrs. Cranquis, and as part of that, I pray for God to point out to me patients who may need extra time and sympathy from me today.
• Being realistic about my finances. Keeping a budget helps me to see that, despite all the outstanding loans (educational, house, cars), I am still doing well financially. In turn, this helps me feel less stressed about taking more time with a patient, even if it means that I make a little less money that day.
• The Golden Rule. That’s pretty self-explanatory. I believe that I should treat others as I would wish to be treated. This is the core of empathetic behavior.
• Modeling empathy for others around me. Of course, I’m not always perfect at empathizing. I have days when I get pissed off at a patient’s stupidity or something. But I’ve noticed (to my chagrin) that I am more likely to treat patients nicer if I know that a nurse or a student is watching me. So, when I know that I’m going to be dealing with a particularly difficult patient, I try to bring a nurse into the room with me — this is not only a smart LEGAL move, but it also reminds me to be more professional towards that patient.
• Learning how to say “No” in a gentle way. I think doctors “shut off” their emotional detector because, often, the emotions flowing off of a difficult patient are stupidity, cowardice, selfishness, and similar toxic feelings. If we start to empathize with those emotions, it makes us feel and act stupid too! But if doctors learn how to acknowledge and then work around the emotions of a “pain-med seeker” or other tough patients, without giving in to their demands in order to just “make them go away,” we can be proud that we have done the best for that patient without sinking down to their emotional level.
• Snarking about it on my website. Ok, I’ve thought about this a lot since starting this pseudonymous blog: If I see a “stupidiot” patient in clinic, and treat them professionally and nicely in person, and then snark about them (in a HIPAA-compliant way) online later, does this mean I have multiple personality disorder? Perhaps, but I think that having a safe outlet for “venting” about difficult patients helps preserve a doctor’s sanity. That outlet could be a blog, a fellow physician or healthcare provider, or just yelling and pounding the steering wheel in the car on the way home. In my case, knowing that a stressful patient encounter NOW may also generate a funny anecdote for the blog LATER helps me to put aside my negative feelings about the patient and treat them with tolerance and even empathy. Weird, huh?

Well that’s the empathy-improving tips that come to mind. Thanks for reading! 

***Pending Cranquis-Mails: ZERO! Ask Box: Opening within the next 30 minutes***