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The Epidemic Of “Compassion Failure” In Patient Care

Intueri (Maria) has it. Go read. Really. I’ll wait. Go read then and come back here, because I have something to say, too. She writes beautifully, and it’s a hard read. I almost stopped before I finished it, and I did flinch more than once. The man she writes about was in my ER today, or at least someone very like him. 

He was rolled onto a hallway gurney, given a cursory inspection, and left to sleep it off before being given the “bum’s rush out” when he became more sober and obnoxious. He was viewed by the staff as an irritation, a burden, an annoyance. Smelly, dirty and creepy. Scaring the children as they walked by to their rooms. Nurses were short-tempered and brusque to him, and the doctors avoided him as much as possible.

They were probably angry at him for showing up, and for doing this to himself. He was as thoroughly dehumanized as he is when he lay in the gutter. It’s easy to view these folks though the judging filter. It’s their own damn fault. We’ve sobered them up and put them through detox so many times and they just come back again and again. Why should I have compassion for someone who is trying so hard to destroy himself? Indeed, it’s hard to bring yourself to have compassion for them, and systematically we fail to provide that caring element to our patients.

But it’s not just the bums, though they’re the most obvious victims of compassion failure on the part of the ER caregivers. There are patients for whom it’s easy to feel compassion — the children, the dying, the innocent victims of some terrible disease, the ones in acute pain from some accident or sudden illness. They’re suffering and since it’s not their fault we don’t judge them, but simply feel for them. But the guy with COPD who refuses to stop smoking? The unemployed mom whose teeth are rotten and can’t afford a dentist (though she does have a cellphone and cigarettes)? The fat guy with diabetes, hypertension and a stroke as a result? The chronic migraneur who everybody suspects is just addicted to narcotics? How much compassion do they get? How much do we judge them and find them wanting?

It’s hard to muster the emotional energy to get past the self-inflicted elements of their illnesses, and it’s so easy to slip into contempt for their weakness and frailties. I see it in my co-workers, and I am as guilty as any of them. And I see it in the writings of my emergency department colleagues in the medical blogs and comments. On the net, behind the veil of anonymity, people are more willing to express their darker sides, and the intensity of the contempt and the venom directed towards our patients can be disturbing.  (If I delve too far into my own archives, I might find some expressions of which I am not entirely proud.)

So how do we avoid falling into the trap of judgment and contempt? I think Maria nails it: “What if you remembered how much he laughed when you cycled with him through the park?” By which she means, what if you could identify with him? What if you were him, or someone you loved were? 

I see these poor souls and I remember that once they were 7 years old, like my older son, and their whole lives were ahead of them, full of promise. And I try to see them as they were when they were 7. That works for me. Your mileage may vary. I also try to remember that my children’s lives could easily go wrong and if any of them are someday in the ER, broken and suffering, someone will remember that I loved them and treat them with compassion.

More humbling, I try to remember that physicians are prone to substance abuse, and that I have seen former professionals in the ER, victims of their own self-destruction, and I think, “There but for the grace of God go I.” There are exceptions to the epidemic of compassion failure. On the Net there are people like Intueri, Dr Charles, and StorytellER Doc (to name a few) who strive to capture the human beings behind the cases. In my ER there are nurses who will often go above and beyond the call of duty to help someone. And there are even some docs who manage to approach each patient with respect and a smile. I may not be one of them, but it’s good to have role models who can remind me to refill the old compassion well every once in a while.

*This blog post was originally published at Movin' Meat*

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