8-14 November 2013 #680

The care in healthcare

Dhanvantari by Buddha Basnyat, MD

It is often said that more mistakes in medicine are made by those who do not care than those who do not know. Beyond a strong understanding and background in medical science, being compassionate towards patients is obviously a very important part of a healthcare worker’s job description.

When we were in medical school, there were no special classes on compassion. But teaching this skill is easier said than done - some would even argue whether it can be taught at all. And in countries like ours where many citizens still struggle for access to basic health services, there is always the debate of quality versus quantity. Nevertheless, it is imperative that we inculcate a sense of responsibility and greater concern for patients among future doctors, nurses, and healthcare workers.

Compassion comes from a 14th century Latin word which translates to ‘suffering with’ or a ‘co-sufferer’: com means with and passion is suffering. Another word almost synonymous with compassion is empathy. Tracing its root to the German term ‘einfühlung’, meaning ‘a feeling into’, empathy is probably a notch below compassion in the intensity of feelings generated for the suffering of others.

Many of us whether involved in the practice of medicine or not would agree that treating patients with care and understanding can relieve much of their emotional suffering and make an important contribution to their recovery, often times rivaling the effect of drugs (although scientifically this may be hard to prove). But in practical terms, not everything requires scientific proof if the outcome is successful with no harm done.

Clearly a doctor cannot be very emotionally involved with her patient because this may interfere with rational, proper treatment. But in many doctor-patient encounters, excessive emotional involvement is not the problem. Rather it is the unfortunate and utter lack of care on the doctor’s part for her patients’ feelings that is more worrying.

For decades, both scientists and healthcare workers have been deeply interested in the moral implications of properly understanding and sympathising with patients in order to help them more effectively. With research on compassion/empathy growing rapidly, cognitive neuroscience is definitely undergoing a revolutionary change.

Studies show that some of the same neural systems that are activated when we are in physical pain become engaged when we observe the suffering of others. Researchers are also working on finding out more about how empathy develops in chimpanzees and other primates, how it is elaborated in children, and the circumstances that trigger empathy.

However, one could argue that our preoccupation with biomedical medicine has clearly diminished the compassion and empathy part of medicine. But a deeper sympathy for our patients has to be an essential quality of the modern technology of medicine.

US President Barack Obama often speaks very articulately about empathy. In 2006, a year after Hurricane Katrina ravaged New Orleans, Obama emphasised the importance of seeing the world through the eyes of others who are different from us in a commencement speech he gave at Xavier University. Clearly when healthcare workers choose to broaden their ambit of concern and truly sympathise with the plight of their patients, we will have taken a giant step forward. Our goal should therefore be “to cure sometimes, to relieve often, but to comfort always”.