Depersonalization of the patient and the loss of compassion

A common complaint about modern medicine is the depersonalization of the patient and the loss of compassion.

So let’s take a look at compassion.

Compassion is derived from the Latin “cum” (together with) and “patior” (suffer). From the perspective of clinicians, compassion is defined by two concurrent emotions: (1) a feeling of deep sympathy and sorrow for another who is stricken by medical misfortune accompanied by (2) a strong desire to relieve that suffering.

So why are clinicians trained to keep all their sympathies in check? The explanation most often offered is that clinicians’ emotions can get in the way of making difficult decisions or performing procedures that are gruesome or cause patient pain.

My awareness that clinicians’ emotions can interfere with their ability to provide care that optimizes the benefits of modern medicine is the main reason I have not socialized with my colleagues who are also my physicians. More than I want their friendship, I want them to be able to make dificult choices in my care.

But complete detachment is not the answer. DISpassionate care is incompatible with COMpassionate care. What’s a clinician to do?

I suspect that when Dr. Frances Peabody said, “The secret of the care of the patient is in caring for the patient,” he intended the implied ending “while maintaining a proper balance of objectivity and sympathy.”

Sympathy with patients may heighten clinicians’ senses, helping them pick up clues from the history provided by patients or from their physical examination of patients.

Clinicians’ desire to save lives may energize them when they have gone without sleep and help them focus when they have gone without food.

Clinicians’ desire to relieve suffering may help them find equanimity when caring for angry or mean patients. It may push them to search the literature and obtain curbside consults from colleagues when usual remedies don’t offer patients relief.

Clinicians’ hopefulness may help them guide patients through Plan “B” or “C” or however many it takes, when Plan “A” doesn’t fix patients’ problem.

When clinicians are grateful for and happy about patients’ recoveries, these patients feel their healthcare team cares about them as well as cares for them.

Wendy S. Harpham is an internal medicine physician who blogs at Dr. Wendy Harpham on Health Survivorship and is the author of Only 10 Seconds to Care: Help and Hope for Busy Clinicians.

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  • michelle

    How about being laid out for an emergent c-section – not emergency – naked, being catheterized w/ 2 people on one side of my naked body talking to two people on the other side of my body. My doctor and the anesthesiologist were hanging out there too. Totally humiliating and made me feel like a hunk of meat not a person w/ dignity. So, how’s that for depersonalization? Even in vaginal childbirth, women are afford more respect and privacy for their bodies. And, no one in the room cared that I was laying on the table crying.

  • http://www.wendyharpham.com Wendy S. Harpham, M.D.

    Michelle,
    It pains me to learn about patients who were treated without compassion. Until we see a return to compassion as the basis for every interaction between a patient and a clinician, patients who find them in a situation such as yours have some options.

    Patients can try asking for compassion, for example by calling to the nurse or doctor, “Dr. So-and-so, I’m frightened and uncomfortable. Can you help me through this, please?”

    Patients who would not feel comfortable doing that because they fear repercussions (or for any other reason) can talk about the unpleasant experience at a follow-up visit or in a note to the staff. This wouldn’t change what happened, of course, but it may change how these clinicians treat other patients in a similar position.

    I want to emphasize that patients should never be put in a situation have to ask for compassion. But if an unpleasant situation arises, patients have a right to call clinicians on it. As with any other situation when you criticize something someone is doing or did in the past, your tone and choice of words affects how well the constructive criticism is received.

    Today the forces driving clinicians and patients apart are powerful and many. I address this topic from both the physicians’ point of view and the patients’ point of view in ONLY 10 SECONDS TO CARE. We must all work together to preserve compassion in modern medicine.

    With hope, Wendy

  • horseshrink

    “Patient” is derived from the same roots as compassion, coming from patientem (nom. patiens), prp. of pati “to suffer, endure.” (www.etymonline.com)

    The psych/social work arena has jogged diligently upon a euphemism treadmill of its own creation with some mysterious need to avoid using the word “patient.” There were “clients,” “residents,” and, now “consumers.”

    The last term bothers me a lot.

    Clinical services have no purpose if there is no suffering to which to attend or prevent. When I go to see my doc, that event and relationship should NOT be equated to a trip to Wal-Mart to buy milk. “Consumer” trivializes the real suffering of those who want or need care.

    Additionally, the etymology of “consumer” reveals a deeper insult: L. consumere “to use up, eat, waste.” (www.etymonline.com)

    So, according to the proponents of the politically correct term, “consumer,” the people to which I attend are merely using up/wasting our time and effort together.

    Dr. Pinker speaks well to the larger issue of euphemisms:
    http://articles.baltimoresun.com/1994-04-06/news/1994096202_1_dutch-words-language
    (Also published as an Op-Ed in the NYT 4/5/1994.)