Could “compassion” be a dirty word?
Why do I think working in healthcare is not “just a job?”
In the context of a tribalistic exchange about which discipline in medicine is the hardest working (and hardest done by), a colleague and mentor referred to a recent thought-provoking article by Louis Profeta .
In it, Dr Profeta makes a number of assertions, many of which resonate comfortably with me. But there are a few statements which, while not offended in the slightest, I have been battling to reconcile since I read the article some days ago. The fact that I am still ruminating on them prompted me to put my thoughts into writing.
I have trouble with the concept that compassion may be more of a liability than an asset. But then again that may be why I suffered a version of burnout as a second year trainee, and Dr Profeta has managed to practice for nearly 25 years without experiencing this emotional exhaustion. It is tempting to wear a burnout experience as a badge of honour. Indeed, soon after my experience, I reacted in typical Type A fashion and informally researched the topic, happily validated to discover that it is a condition most likely to affect high achievers.
The Latin root for compassion is indeed co-suffering, but the meaning we derive from this word is more closely associated with that in the Merriam-Webster dictionary: a sympathetic consciousness of others’ distress together with the desire to alleviate it.
Yet I agree that boundaries and separation are important.
An intensivist friend of mine was debriefing with me after a rough day. She described leaving a family discussion about a 20 year-old man who had sustained an unsurvivable head injury. As they departed the relatives room, a junior doctor asked her “How do you cope with all this – this loss and grief?”
She told me that she turned to him and responded firmly “That feeling that you’re feeling – that overwhelming sense of sadness for the man and for his family? You take that feeling and you put it in a box and you shut the lid firmly. If you don’t do that, this job will destroy you”.
Perhaps this is not wrong. For some of us this works – it has to. But for others, the box starts to burgeon and eventually the lid cracks open and the “stuff” spills out. I think that we need to work out what works for us, and we do this over time, by trial and error. Sharing our experiences is important.
Dr Profeta’s assertion that the bartender’s job is equivalent to that of doctor’s blurs value of role versus value of self. The fact that the bartender is a dedicated and hard working father does not change the merit of the job he does. Sure, he is a spectacular human being, but this doesn’t mean that pouring drinks is equivalent to administering adrenaline in anaphylaxis. Neither does it mean that the doctor is more of a hero than the bartender.
The stakes in health care are unarguably higher, particularly for the decision maker. The wrong drug, dose or route can have devastating consequences. Serving up the wrong draught of beer is more forgivable. But this compares the merit of the two roles, not the two people.
With the privilege of practicing medicine comes prestige and, typically, renumeration. It also comes with gratification and a sense of contribution. It is, thus, far from altruistic. And it’s true that it’s what we signed up for. But while we may not merit reward or recognition beyond those listed above, it’s okay for us to derive support and comfort from our peers, to share our stories and our humanity.
I also agree that it is a personal or family crisis that will likely remind us of our priorities, and lead to the discovery that working in medicine does not take precedence over other aspects of our lives.
A late and revered colleague of mine returned from his first bout of treatment with the attitude that he wouldn’t sit in a meeting longer than it was worth. His synopsis was “I don’t know how much time I have left. I don’t want to waste it in here”. Certainly, his terminal illness changed his approach and perspective to his work.
He continued, however, to contribute to our emergency department until he passed away, conducting tutorials at his own bedside days before he finally left us. Without a doubt, his passion was his family, but he had enough to extend his energies into the work and people he loved.
I agree that working in medicine is not our life, but I don’t think it’s just a job either.
Certainly we all have colleagues for whom it is “just a job” and those who put a little or a lot more into it. The latter aren’t bigger heroes than the former. But what I do know for sure, however, are the ones with whom I most like to work.