Issue 25 / 6 July 2015

AS health care professionals, particularly in hospitals, we are faced with human suffering every single day as our patients, many unwell and some dying, seek help.
We are also often faced with angry, confused and grieving family members.
From the first day of internship, we have to deal with these different emotions in our own way, while grappling with our own sense of identity. At the same time we must remain professional, compassionate and deliver quality care.
It is not an easy task. Some of us manage to cope through physical activity, or emotional relief via extracurricular functions. Others develop defence mechanisms, which may not always be healthy.
However, over time, as we become more experienced, we smooth out this initial emotional rollercoaster and wrap ourselves in a protective shell so we do not become overwhelmed by the tragedies we encounter.
After all, we can only cry so much, for so many days.
We “learn to deal with it”, often emulating our senior colleagues.
Another way of coping with the emotion and stress of health care — something all clinicians face at some time in their career — is by increasing our workload,  so we focus on “doing things to patients” rather than “caring for people”, with the added pressure of ensuring we keep relationships on a professional level.
This hardened exterior can, unfortunately, become maladaptive, leading to a perception by the very ones we are meant to be serving that we, the caregivers, no longer care.
Health care professionals really do care but, because of the need to keep emotionally intact, they develop a certain tolerance to the pain and suffering they see every day — not intentionally, but as a psychological defence — and this, unconsciously, comes out in their behaviour.
Perhaps, we should reflect on and be conscious of the chances of this happening to us. As doctors, we should lead the need for change among all professionals in health care.
I am not suggesting that we start becoming emotionally involved with patients and cross professional boundaries with families. I am saying we should start to walk in the shoes of our patients once in a while, to develop not just sympathy but some level of empathy.
In the busyness of our day we should always have time to show our patients we do care. It won’t cost us much — maybe a quick smile, a caring touch, an extra minute to ask how they are going — rather than just focusing on their disease or illness.
In this way, we can bring care back to health care and humanity back to hospitals.
Professor Erwin Loh is the chief medical officer at Monash Health, Victoria.

6 thoughts on “Erwin Loh: Bring back care

  1. Dept of Families Housing Comm Svcs and Indigenous Affairs says:

    Emotions bottled inside will one day find its way out. We are human beings with emotions and at some point during our medical practice we should be able to express our human emotions to our patients. Remember, relationships are not just built on being with another individual but good relationships have its foundation on sharing emotions. When one’s hardened exterior continues to pervade in one’s medical practice, it is a matter of when that hardened exterior will insidiously creep in to that one’s inner self and eventually affect his or her own emotion including how he or she would interact with those he or she loves most. I remember an advice from an ED Director when I was still a RACMA trainee. The ED Director advised me ‘….you have to be a person to another person and just do not treat another person as another bottom line in the organisation.’ Expressing our emotion comes with a price but surely it is worth it. Thanks for sharing this, Erwin.

  2. Bronwen Howson says:

    We are clinicians and doctors, but we are fundamentally human beings with our own vulnerabilities and weaknesses. We can easily think that we are the ones that ‘treat the patients’ and other people are the ones ‘that get sick’.

    However, to have ones own experience of pain and suffering through illness helps to develop empathy in the clinician. Maybe it is not the preferred way, however I have found experiences of severe illness in myself and my family over the last few years have altered my perception and understanding of what it means to be unwell, to be a patient and the vulnerability of that experience. There is nothing like being on the other end of the medical machine to develop an understanding of what this means to ones humanity.

    So, I completely agree with Erwin. Sometimes it is the simplest act of kindness, the smile, the listening, the compassion and care in the midst of the medical model and consultation that may be the thing that means the most to the person you are caring for on that day. 

    As a GP, my opening line with a patient is most often, “How can I help you today”. I genuinely mean that, and most often I feel it is the care and the compassion that is what heals and helps most, of course mixed in with all the other things that happen as part of the holistic model of health care.


  3. Dr Louis Fenelon says:

    It is a very personal thing, dealing with the real humanity of medicine. Being capable of professional guidance in the face of human emotion is what defines medicine in the purest form. It is, I think, a bit unfair to focus on our own ability to manage our clinical empathic skills without considering all the things that come between us and those skills.

    I remember a script on toilet paper, families and neighbours managing social and mental health drama without my direct involvement and how much snow would fall based on an old lady’s arthritis – not hers, her dog’s. I also remember patients and families and their feelings because filling in mindless template referrals under the EPC system was not part of the agenda and I didn’t have to stare at a screen instead of a person. Add endless business and other professional insults and random changes forced on us via all levels of government, Medicare, WorkCover, other insurers, DVA, PBS, accreditation, CME, all manner of hanger’s on and other parasites and you do not encourage a professional or nurturing environment conducive to care.

    For a long long time I struggled to understand why the public health system treats patients as the enemy. Sounds a little extreme, but it’s pretty true in general at all levels. Almost 3 decades ago the public system decided death throes may be concealed by passing on all the things it couldn’t handle due to its own constipation to the private sector, including unsubstantiated concepts of endless reporting and other justifications for doing what you are well trained to do.

    We are ruled by decisions made by those with no experience in patient care. It’s sad that is now more imporatant than medical care

  4. Mark Woodrow says:

    The patient doesn’t care how much you know until they know how much you care.

  5. Urban Sundvall says:

    I think it is a great shame that the medical professions are not given the same courtesy as ‘therapists’ of all varieties are. One of the major benefits that those of us who work as therapist’s have, is that as part of training to gain our qualifications we are not only taught, we are also expected to; see a fellow therapist.

    In our field it is described as “Preventing Transference” and the benefits of it are to have the tools and skills to ensure that we do not bring into our next client’s appointment any ‘negative residue’ from prior clients. That, of course, has real value. In my opinion the most value is for us. To keep us from the dilemma described above. It is my firm belief that all medical professionals would find it a lot easier, to be the kind, caring and empathetic person you want to be with your patients, without being personally affected in negative ways or having to “Harden Up”, if that same courtesy were ‘par for the course’ in your field.

  6. Max Kamien says:

    Professor Loh joins a long list of commentators who have decried the dimishing supply of empathy in Australian hospitals. I have been a recent participant-observer patient in three hospitals- two private, one public and a doctor in one busy RRMA 7 hospital. In terms of patient care the latter was several logarithmic factors better than the other three. The pre-university hospital trained  nurses were light years better than the university trained ones both in competence and interpersonal skills.

    The city hospitals are awash with logos and slogans about their aims of compassion, respect etc that are mostly lacking in a form of impersonal care where you are known by the number of your room or bed. The only person who ever stops to talk and offer a bit of interpersonal humanity is the cleaner. She is probably the only person who could tell the 30-second visiting consultant how you were really getting on.

    This lack of human contact is not due to a lack of staff or time since the nurses spend a lot of time gossiping with each other. It is a lack of interpersonal skills and empathy. The first obvious, but impractical , solution is for all doctors and nurses to become patients about every three years. The second solution is for healthcare workers to ask themselves this simple question: ” If I was that patient would I have be satisfied with that consultation or care?”  

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