The boundaries of caring and empathy are moving targets

As a life-long dedicated health care provider, caring about those in physical and mental need is always a presumed requirement of the field. You’re ill, I act. You’re hurt, I act. I care enough to help educate about prevention of injury and disease. I’ve sacrificed a great deal of comfort, sleep, and mental energy to care enough to help those in need — even for those who don’t seem to care about themselves.

But in many ways, we seem to be crossing an historical threshold. The long-held virtues of western culture including temperance, delayed gratification, chastity, modesty, thriftiness, kindness, sacrifice and hard work are giving way to just the opposite. Gluttony, rampant immorality, instant gratification, laziness, crudeness, wastefulness, drug abuse, selfishness, envy, and jealousy are now a common denominator of everyday life in much of our culture. With that comes a myriad of health problems: obesity, hypertension, diabetes, kidney failure, STD’s, measles, hepatitis, and many other chronic, disabling diseases. Much like in the movie Wall-E, it appears that we are headed toward a time in which everybody is trapped in a lounge chair, too big to get out. And we no longer seem interested in being part of the effort to prevent transmission of communicable disease; especially those that carry them.

Given that the large majority of our culture is and will continue to be racing down this road to oblivion, the question arises with each passing work day, “Am I still required to care?” and if so, how can I possibly find the empathy to do so? The question arises because it appears too few of the participants in the “let’s destroy our bodies contest” care about their condition enough to make changes. We warn, prod, cajole, encourage, educate, and practically beg people to make lifestyle changes, take part in screening opportunities, and get immunizations, screenings and vaccines — to little avail.

Next office visit, same old, “Thanks, but no thanks, but I will take that pill to fix it.” The cultural coolness in avoiding vaccines and immunizations, keeping weird diet regimens that never work, being drug addicted, avoiding work, or tailgaiting another 5000 calories into my body every Saturday is just too good to pass by. Material wealth and prosperity have become pathways to deadly indulgent and self-gratifying living excesses.

In today’s medicine, when a patient states they have quit smoking for over a year, lost 80 pounds, or been monogamous, a caregiver is almost in disbelief — it seems reason to celebrate. But the counter-effect is that we will then be renewed in our efforts to convert the other 100 patients to such success, only to be dashed by the reality of their resistance. The patient insists that I esteem them highly with commensurate caring, but they do not reflect that same kind of caring about themselves. I am to consider them an equal partner in decisions about their healthcare and outcomes, but in reality I am the unequal partner in their poor outcome. I am to respect their decisions about lifestyle, while they reject my offerings of help.

And I am continually required to be happy to see them, empathize with every poor outcome, and be there for them in time of illness — and perhaps to do it for free. No wonder the boundaries of caring and empathy are moving targets.

Tim Mosher is a paramedic and nurse practitioner student.

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  • Dr. Drake Ramoray

    “I am to consider them an equal partner in their decisions about healthcare and outcomes, but in reality I am an unequal partner in their poor outcome.”

    So true, and its only going to get worse with pay for performance.

  • Alene Nitzky

    Placing a Band-Aid over a gaping, purulent hole and expecting it to fix it overnight…that seems to be both the expectation many patients have as well as the expectation that our new model of health care is supposed to fix. The problems we have in health care run deep, from lack of personal responsibility for their own health, to lack of education about health from kindergarten on, to the profit-centered model of corporate health care. It is largely political and we are suffering the consequences of decades of political neglect. When we step into the role of health care providers in this broken system, this is what we are up against. I wish I knew the answers too. I wonder how long the status quo can sustain itself before everything collapses in a heap. It is getting more and more difficult. You see this as a student, which is a good thing- you’re not going in with any fairy tale fantasies. Getting the public to wake up and fight the current system is what it will take, and I’m not sure if that will ever be possible barring a major catastrophe.

    • Tim Mosher

      Alene,
      You touch well on some of the large issues. I have been involved in direct patient care for 33 years in EMS, ER, ICU, and urgent care. I have watched the increasing patient expectations, who at the same time have a decreasing sense of personal responsibility. Lots of people pontificate on solutions to the problem, but when you are right on the front line, much of it rings hollow in practice. Nevertheless, I still consider it a privilege to help those in need on perhaps one of the worst days of their life.

      • Alene Nitzky

        It is a privilege, there is nothing better than knowing you made someone more comfortable or eased their anxiety when they are at their most scared and vulnerable moment. Those of us in direct patient care who thrive on that are the ones who suffer the most from the way the system works. As far as increased patient expectations and decreasing personal responsibility, I can understand why you would see that, and I think you’re right. I have seen that in ICU and in the outpatient infusion clinic where I worked. In oncology, some of the patients are there because of their own self-neglect, but truly many cannot and could not in the past afford health insurance and chose to forego medical attention at an earlier time when it would have saved their lives. It’s in the eye of the beholder whether that is shirking personal responsibility. Perhaps to some extent it is, because they ended up in the system later rather than sooner, when all costs are greater. I don’t know whether the changes in health care are going to fix that. I hope so. I hope you find satisfaction in your new career direction and continue to find rewards in working with people. I got out of the “system” and I am doing it in a small business, a struggle financially, but there is no doubt that the rewards are great and the need is greater.

  • B. Andrews

    It’s frustrating and exhausting to realize that all that warning, prodding, cajoling, encouraging, educating, and even begging people to make lifestyle changes to modify their risk of serious health consequences is frequently in vain. Theories and models of change can be harnessed for more productive interactions. By understanding patients’ values and knowledge and meeting patients where they are, a handful of simple but powerful communication skills help to make clinicians and patients partners, working together toward shared goals. Check out the “Choices and Changes” curriculum offered by the Institute for Healthcare Communication.

  • Stacy Richardson

    So am I to assume from this that all those who choose not to vaccinate after careful research and making an informed decision are on fad diets, drug addicted, and generally just lazy drunkards? While I respect doctors and the medical field and appreciate medical advances, taking every medical fad at face value is no wiser than choosing to not care about my health at all. Blood letting was a thing once suggested by doctors to cure illness. While we have come a long way, does that mean I have to be subjected to be the next guinea pig to “prevent” something that may not need to be prevented? While I agree, each person needs to take responsibility for their health and their actions and not just expect a bandaid to fix something they could have prevented with proper diet, exercise, and healthy living and natural remedies. I just hate to be lumped into the group of degenerates that just want a pill to fix it when I may choose a different pathway than the medical norm to live a healthy lifestyle.

    • Tim Mosher

      Stacy,
      Your thoughful post shows that you are an engaged, educated, and involved patient; definitely not the patient of topic. While we would go around about vaccines (I think history is on my side) I doubt that you are obese, smoke, and sit around. Whole segments of society are uninterested and unengaged in their health, yet expect me to somehow provide care. There is also an increasing cultural coolness in being anti-medicine. This creates strain however, when the anti-medicine person is now truly in need of medicine. I am no doubt affected by my medical work in the 3rd world. Americans are able to form their opinions from the loft of medical safety and low incidence. The real ugly of diseases making a comeback is still out of sight for most.

  • Doug Capra

    You make some good points. But what’s often missing from posts like this is “them is us.” We’re all patients. I’m relatively certain that the rate of non compliance with healthy life styles is about the same with health care workers as it is with the general population. There’s no substitute for leading by example. Patients notice caregivers who don’t seem to take care of their own health and yet seem insistent that “patients” need to take responsibility for their own health. This, of course, is no excuse for patients to disregard their own health, but seeing unhealthy caregivers sends a more powerful message that does a mere intellectual approach to motivating patients. Just a thought.

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