My friend, emergency medicine colleague and educator Barbara Tatham, MD, died of metastatic sarcoma at the age of 32 in October 2019. During her last year of life, in between rounds of chemotherapy and radiation, she gave lectures on compassionate care that were inspired by her journey as a patient. This column is part of my vision to continue her voice as a champion of compassionate care into the future.
Explore This IssueACEP Now: Vol 39 – No 04 – April 2020
Emergency medicine demands we regularly face patients with extreme emotional lability, pain, and suffering. We pride ourselves in adapting to repeated traumatic events, apparently unscathed. We do this to protect ourselves, partly because we all have an innate ability to depersonalize after these repeated traumatic events, as humans do in wars and famines. We also do this so we can expertly execute a pediatric airway or thoracotomy despite the chaos of the emergency department.
This adaptive depersonalization poses a significant problem to quality patient care—and specifically to compassionate care. We have a responsibility to provide compassionate care, as stated in the American Medical Association Code of Ethics: “A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights.”1 Compassion is an emotional response to another’s pain or suffering that involves a desire to help. Compassion is not simply “feeling bad” for a patient. It requires a desire to help and act accordingly. Compassion, like any behavior, can be learned—contrary to the popular belief that compassion is an innate quality that one either possesses or does not.
It is no surprise that emergency physicians are not experts in compassionate care because few training programs include it in their curricula. Our ability to provide compassionate care erodes through the course of our training and, as a community, with each passing year.2,3 The person (as opposed to the patient) in the stretcher in front of us is more than a particular diagnosis or a disposition dilemma. They are often frightened, anxious, concerned, or emotionally numb. Addressing these emotions is paramount. The good news is that it is easy to provide compassionate care in an efficient manner. There is evidence to suggest that when physicians spend only 40 seconds saying compassionate statements, patient anxiety is significantly reduced.4 Although it seems counterintuitive, when you invest time in other people, you feel that you have more time, that you are not in as much of a hurry. Effective communication that incorporates compassionate statements results in shorter, more efficient visits.5