Compassion in Healthcare
Larry Birnbaum, PhD, FASEP, EPC
Associate Professor
Department of Exercise Physiology
The College of St. Scholastica
Duluth, MN  55811

A recent discussion focused on compassion in healthcare, or rather the lack thereof.  What initiated the conversation was an expression of hopelessness regarding chronic headaches.  Nonprescription pain medications did not phase the headaches, so the sufferer sought help from a neurologist.  After a brief interview and exam, he was told he was just going to have to live with the pain.  Those involved in the discussion relayed similar experiences.  They suffered from chronic pain problems such as low back pain, osteoarthritis, and sinus/middle ear pain.  When exams by specialists revealed nothing that could be treated with surgery, the response from the physicians was universally the same, “Well, you could take prescription pain medications or you just have to live with it.”  Being told you have to live with pain is not exactly welcome news, and when the message is delivered with an indifferent attitude, the sufferer is left with a feeling of hopelessness and despair.  Physicians are not alone in their apparent lack of empathy for their patients.  Physical therapists and even nurses were also mentioned as healthcare providers who failed to exhibit compassion for their patients/clients.  In such situations, the healthcare providers have failed to provide adequate healthcare.  The healthcare providers may have legitimate reasons for displaying an indifferent attitude toward their patients.  They may be burned out, pressured to maximize revenue (i.e., too much focus on the bottom line by superiors and/or by themselves), or they are just having a bad day.  Nonetheless, the patients are not aware of the providers’ workplace circumstances, and they expect to receive appropriate healthcare.  Failure to include compassion in the equation makes whatever care is provided less than adequate.

There is a lesson to be learned here for exercise physiologists.  Exercise physiologists work in a variety of settings with a variety of patients/clients.  Regardless of whether the patient is a cardiac patient, middle aged man trying to lose weight, young athlete, or elderly person trying to improve her ability to get around, compassion is an essential component of providing appropriate care.  Without compassion, work can be cold, sterile, and mechanical [1].  If we only “process” our clients in an assembly line fashion, we are not serving their needs.  How can we include compassion in the care we provide?  Possibly the most important component of compassionate care is listening to our clients.  We need to understand why they are seeking our services and learn what is important to them [1].  As much as possible, we need to see the world through their eyes, and we need to do so in an accepting fashion, not from a judgmental perspective [1].  For example, if I am working with an overweight person who has not made any progress for awhile and is expressing frustration, I could respond with, “You are not working hard enough”, or “You have not made the necessary life style changes yet.”  That would be condescending, and I would not be helping him.  In fact, I would most likely lose him as a client.  Instead, I need to carefully listen to him.  I may need to ask caring questions to find out what life has been like for him over the past few weeks.  Perhaps he is suffering from excessive pressure at work, emotional trauma, or the program I prescribed simply is not working.  If it is the former, I should be empathetic and perhaps suggest he consider professional assistance to deal with those issues.  If it is the latter, I need to work with him to develop a program that will work for him.  As healthcare providers, we need to realize that every person is an individual, and exercise prescriptions and recommended life style changes have to be suited to individual needs.  We also know that those needs will change over time.  By being good listeners, we can discover when the needs change and revise the program accordingly.  How well we listen can easily be detected by our clients in the way we respond, in what we say and how we say it.  Our tone of voice is part of the message.

How much clients will share with us depends on how much they trust us.  When clients perceive that we truly care about them, mutual trust and sharing will emerge in the relationship [2].  Trust and sharing are essential for effective communication.  Thus, our chances of discovering their real problem(s) increase considerably when we show genuine compassion for our clients.

The importance of compassion in healthcare cannot be overemphasized.  Covington [2] describes compassion as a caring presence that requires devotion to the client’s well-being.  That puts the focus where it needs to be, on the client’s well-being.  As healthcare providers, it is our duty to serve our clients, not ourselves.  Admittedly, we have to earn a living, and we can do so by providing quality, compassionate healthcare.  This will require spending more time with our clients/patients than the assembly line model allows, but we will more likely truly help our clients and they are more likely to be repeat customers.  Which would you prefer, a revolving-door practice or a relationship-building practice [1]?

References

1.  Bologna, C.  (2006)  An Element of Compassion.  Massage & Bodywork, October/November.

2.  Covington, H.  (2005)  Caring Presence:  Providing a Safe Space for Patients.  Holistic Nursing Practice, July/August.