“Watching Someone Die and Feeling – Nothing” writes Dr. Seema Marwaha. I’ve been thinking a lot about the stress she described over the lack of emotional response she had in the face of a patient tragedy. I was struck with the magnitude of her aspiration to find a balance between managing the needs of her patients and feeling their pain and suffering. I keep thinking there is nothing wrong with Dr. Marwaha. She is obviously a sensitive, reflexive individual who cares enough about her patients and their families to interrogate her emotional responses to their suffering. Nothing in her account leads us to believe that the patients received sub-par care, nor in the second case, that the wife of the patient felt the health professionals and trainees in the room were uncompassionate. Yet in that moment Dr. Marwaha was unhappy with herself and now is committed to change the system. But is it physicians like Dr. Marwaha who we need to “fix”?
After reading her blog I wondered whether in our fervent to reform a health care system which is under-performing, we are inadvertently burdening our health care providers with worry over things outside their control, exacerbating in the process their tasks which are enormous to begin with. I have heard versions of Dr. Marwaha’s story from clinical colleagues for years. Some claim that desensitization to the suffering of their patients allows them to do their job better. Others worry that if they allow themselves to feel all the time, they will lose themselves in the process. Others yet, speak about routine and non-routine forms of caring, or about learning how to “act” compassionate in the moment, even if they don’t feel it. The science of compassion and empathy is not my domain, yet from a sociological point of view a number of questions arise. Does being empathic and compassionate mean that health providers must suffer in some magical measure in the performance of their work? Does balance mean that everyone must behave with perfect emotional composure and responsiveness in all contexts and under all circumstances? Is it productive to strive towards this idealized internal perfect balance or do we need something altogether different?
I write these questions as I too stress over compassion and the work I have set out to do over the next year. I’ve chosen as my object of reform the nebulous health care organization aiming to elicit deliberate compassionate responses in the management of human and other resources – precious social commodities entrusted to health care organizations to deploy responsibly. More and more, I think that striving for balance means striving to reform people, institutions and the system with equal measure. Otherwise I fear that many current imbalances in the health care system which we are neither proud about or want to tolerate any longer, will remain unchanged.
With rising rates of burnout and suicidality amongst health professionals of all ranks, the widening gap of health inequities, and growing complaints from patients and their families about mistreatment in the hands of ‘caring’ professionals, it is clear something needs fixing. Hearing the day to day struggles of clinical staff trying to keep up with the numerous change agendas making their way down the pipeline and into their lives (improvements in technology, new safety protocols, new patient record systems, revisions in curricula), it seems unfair to continue to ignore the elephant in the room. We are asking health care providers to do more with less and keep smiling as they do it, oh and make sure that they also take care of themselves in the process. Where is the logic in that?
Changing an organization requires learning. Learning requires work. No matter how high functioning and compliant healthcare providers are to the numerous reforms that keep coming down the pipeline and into their professional lives (rewriting identity scripts in the process) there are only so many hours in a day to accomplish the old and new work, and some tasks will be ignored. More likely than not, health providers will neglect themselves, and in the process, deplete their resilience to engage in relationships with peers and patients.
If we are to believe the financial forecasts that bellow out warnings that resources are scarce and will become even scarcer in the future, then shouldn’t we be taking care of the health providers we have, instead of expecting them to find time to take care of themselves? Somehow, we have to create a reciprocal relationship between caring organizations and health care providers. I see my work as complementary to that of Dr. Marwaha and others who are engaged with health professionals at an individual level aiming to nurture empathic resilience, emotional engagement and wellness. My focus though is on the organization.
Imagine if instead of Dr. Marwaha writing a blog for AMS, executives at a caring organization recounted how terrible they felt when they first realized that when reading reports of increases in health provider burnout, suicidality and work attrition, they felt – nothing. That they realized they had come to accept this reality as routine or out of their control, and as a result had adopted a dangerously complacent attitude. Imagine, that this realization motivated them to engage in organizational self-care, a commitment to lead, manage and administer their employees with care and compassion in the same way they expected their employees to care for their patients. Imagine if they in the process started to strive explicitly for a balance between efficiency and care and invested resources in locating and eliminating discrimination and other contributors to toxicity in the workplace. Imagine if such organizational reflexivity led to new ways of thinking about quality and outcomes; perhaps the wellness of employees might become the base ingredient for all organizational transformation and change.
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