Upon reviewing SpeakSooner: A Patient’s Guide to Difficult Conversations, Dr. Joe O’Donnell, former Dean at Dartmouth Medical School and Chief of Oncology at the White River Junction VA Medical Center, said, “ With a tool like the Center for Communication in Medicine’s Difficult Conversations Guide, we can get on the same page as our patients, but even better, march together into a frightening future, more aligned with each other and able to support the chaotic journeys that having cancer brings.”
As much as my work as a medical humanist has been to emphasize the patient’s voice, Dr. O’Donnell’s comment made me think of how hard it must be for healthcare providers to “march together” with seriously ill patients. We know it’s uncomfortable to tell patients and their loved ones that a treatment failed or they have a poor prognosis. I have observed how these conversations can wear down doctors and nurses and lead to burnout. It’s not hard to understand why healthcare providers erect barriers to protect themselves. But, is there a better way to cope with the emotional demands of caring for the very sick?
In my experience, I’ve observed doctors and nurses feeling energized by having difficult but meaningful conversations with seriously ill patients. Good communication can do that. Of course, I’m always open to new perspectives about how providers can offer humanistic care without sacrificing their well-being. As things happen, I was recently introduced to the work of Joan Halifax, PhD, a Buddhist teacher, Zen priest and anthropologist, who identified the term “pathological altruism.” In her book Standing at the Edge/Finding Freedom Where Fear and Courage Meet, she notes, “Parents, teachers, healthcare professionals, employees within the justice system, and activists working in crisis situations are especially at risk of pathological altruism from exposure to others’ suffering.” Dr. Halifax observed that prolonged exposure to these demanding conditions can lead to “empathic distress, moral suffering, disrespect, and burnout.”
Writing about the principles of Buddhist practice, she explains the importance of showing empathy and compassion to those who are suffering. However, she goes on to emphasize that those in the healthcare professions need to be careful “not fuse with another’s physical, emotional or mental state” or they will end up in “empathic distress.”
Let me first say that healthcare providers don’t have to become Buddhists. I believe, however, that Joan Halifax is on to something when she says there is no need to emotionally detach from patients who are suffering. In her view, the key to humanistic care is to be an empathic listener and not merge with another’s suffering. If this kind of self-reflection can be incorporated in medical education there could be more open and honest communication about difficult issues. In fact, if patients and healthcare providers could show empathy for one another, they could more readily “march together into a frightening future, more aligned with each other and able to support the chaotic journeys that having cancer brings.”