Energy News July/August 2008

A Lost Art?

Balancing compassion and burnout in healthcare is a struggle. By Susan Weiner
As practitioners become more specialized, medical technology evolves and insurance providers play an omnipresent role in healthcare, many wonder what happened to the kindly family physician who made house calls. The answer: Doctors today are being squeezed by a managed care system that discourages spending time with each patient in the name of efficiency and profit. Has compassion in healthcare become a relic?
Truth is, there’s a fine line between compassion and professionalism, where caring too much can have detrimental effects. The real challenge for practitioners, it seems, lies in striking a balance.

Working Among the Poor

At the Koinonia Primary Care clinic in Albany, New York, Robert Paeglow, MD, counts drug addicts, alcoholics, homeless people and the uninsured among his friends. He has paid for prescriptions, bought Christmas presents, advised every patient that they matter and been told “I love you” more times than he can count.
Paeglow—who is known as “Dr. Bob”—hasn’t taken a salary since opening his clinic in 2002; what keeps him afloat is his belief that compassion is the key to serving the community of West Hill. The 2006 recipient of the AAMC Humanism in Medicine Award, he is something of an antidote to a medical system that he says discourages compassion.
“Most students enter medical school with altruism and we then put them through an incredibly expensive and stressful process,” says Paeglow, associate director of Pre-Doctoral Education for the Department of Family and Community Medicine at Albany Medical College. “By the time they’re done, the altruism is beaten out of them. They’re broke, they’re tired, they’re stressed, they’re confused. As physicians, we are taught not to enter into those feelings of compassion.”
The problem is one of maintaining equilibrium. By becoming overly involved in patient care, healthcare professionals risk internalizing the patient’s suffering and may experience burnout in the process. Simultaneously, caring too little can undermine the healing process.
The key, according to Linda Klein, MD, a resident at Providence Milwaukie Hospital in Portland, Oregon, is to take a holistic
approach. “You really have to have balance in your own life,” says Klein. “If you can keep that balance going, then you can keep that compassionate energy going. The really important thing for physicians to remember is that even the littlest thing like listening to your patient can make an impact in their life and in their healing. When you remember those small things, it helps to alleviate that burnout.”

Compassion Can Cure

The few published studies show consumers overwhelmingly believe that compassion is crucial to healing, no less than groundbreaking new treatments. A 2004 study by Swedish Covenant Hospital revealed that 95% of surveyed Chicago residents agreed that compassion aids in the healing process, and 88% saw compassion as an important aspect of healthcare.
Marilynn Van Nordstrand, 85, attributes a caring nursing staff to her quick recovery when she was hospitalized at Arnot Ogden Medical Center in Elmira, New York, with influenza and pneumonia.
“I don’t think I would have gotten up and out of there as quickly as I did if they didn’t show me such compassion and care,” says Van Nordstrand. “It helped me to heal quicker.”
Paeglow has witnessed acts of compassion that not only hasten recovery, but prompt people to turn their lives around, including a drug-addicted single mother with six children who have been arrested, stabbed or shot at various times. “We started to care for and love her family, and we have seen tremendous change,” he says. “She’s being a better mother and her kids are starting to turn around and do better in school. Their overall attitude and outlook has changed and now there’s hope for them.”
In April the Dalai Lama, at his annual checkup at the Mayo Clinic in Rochester, Minnesota, spoke about the role of compassion in medicine. “The key is the doctor’s sense of concern. His sense of commitment, his sense of responsibility, with affection. Genuine affection for the patient,” said the Dalai Lama, who is believed by Tibetans to be a manifestation of the Buddha of Compassion.
For those concerned that their own healthcare providers come up short on compassion, there is a choice. “I think people are intimidated by doctors and don’t speak how they feel,” says Paeglow. “Tell the doctor, ‘I need someone who really cares for me.’ That is why I think patients are seeking alternative medicine and medical practitioners, because that is where they can get that personal attention.”
Perhaps more important, we need to broaden our definition of healing. “There are far more healers than just within the medical profession,” says Paeglow. “You can be a healer in your home, your family, your neighborhood and your circle of friends. Sometimes healing means a prescription of penicillin, but sometimes it involves baking an apple pie for someone who is lonely.”