What’s the difference between giving amazing, effective care to our patients in a sustainable and purpose-filled way, and the depths of miserable “burnout?”

Turns out it may be empathy. And not in the way you think.

Psychologist Paul Bloom argues that it’s precisely the wrong type of empathy that not only burns us out, but also serves to harm the very patients we seek to help. Empathy (“affective” empathy in particular) is feeling another’s pain as your own and acting from that feeling to relieve the pain. This type of empathy:

  • Leads to short term pain aversion and hence short term answers that may not be in the best interest of our patient’s long term suffering.
  • Is like a spotlight, only able to focus on one individual or a tiny number of individuals, ignoring the larger community and larger good.
  • Tends to favor those who “feel” like us…our race, our gender, our nationality etc.
  • Is associated with more pain and burden as the pain is taken as our own.

In this piece I argue for something different: compassion. Love in the face of suffering. Understanding pain and seeking to relieve suffering, but not taking the pain as one’s own. A broader, more inclusive, more wise, and more sustainable type of caring. Check it.

Hey guys, it’s ZDoggMD aka Dr. Zubin Damania. Okay, you are gonna hear in health care that everybody needs more empathy. We need to have empathy in order to do our jobs. What’s missing in the world is empathy. That is 100% unadulterated horses**t and I’ll tell you why.

Empathy is a terrible thing, especially in health care. What is empathy? It is feeling somebody else’s pain as if it were your own. Now, how does that work? If I feel a patient’s pain as it were my own, I will act on behalf of that patient to relieve the pain. Now, that act may not be the right decision for that patient. It may not be act that actually improves their life in the long run. If somebody’s addicted to opioids and you feel their pain, you give them the Dilaudid to take the pain away. So empathy has this spotlight on feelings and you take it on as a burden to yourself.

The second problem with that as a healthcare provider is well, you’re gonna burn out feeling everyone’s pain. The idea is not to take the pain as your own. The idea is to understand what the patient is feeling and act out of love and that’s a different thing. Now the third problem with empathy is it is very hard to empathize with more than one thing at once. So you can empathize with a little baby, but you cannot empathize with a population of people. You can’t empathize with a people and this leads to really bad short-sighted decisions.

Empathy is a spotlight and it can fool us into doing the wrong thing. It can lead us to emotional fatigue and exhaustion and it can lead us down the path to moral injury and its end stage, which is burnout.

So what do we do if we can’t use empathy? It’s really pretty simple. It’s compassion. What is compassion? Compassion is love in the face of suffering. You recognize somebody is suffering, you understand it. You don’t take the suffering as your own, but you care about that person. You care about relieving the suffering, which means you’re playing the long game. It means you’re doing the right thing for the best interest of that patient and that person to relieve their suffering. That may mean tough love in the short run. It may mean a rehab referral and a Suboxone prescription instead of, here’s the Dilaudid so that you’re not suffering right now.

All right, and it may mean that love in the face of suffering is something that you can cultivate, you can grow. It’s inexhaustible. You never burn out from compassion. There are monks in caves who practice this 24/7 and they are crushing it. So the bottom-line call to action is let’s stop talking about empathy and let’s start talking about compassion. Love in the face of suffering. There is no such thing as compassion fatigue, it’s empathy fatigue. So let’s get our terminology right, so we can get our minds right, so we can get our hearts right, so we can take care of our patients while taking care of ourselves. All right? Become a supporter. Get the unfiltered on the supporter page. And we out, that’s compassion.

– [Tom] Cut! That’s cut, ZDoggMD. Good job, buddy.

– You shut your hole, Tom!

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