Compassion Stems From Knowledge
I’m supposed to help lead a session today with some preclinical students and discuss the challenges of being on the wards as it relates to maintaining perspective and understanding patients outside of a strictly medical realm. I’m starting to posit that it’s almost a physician’s duty to be compassionate, if only for the fact that we contain knowledge about a person’s disease or medical state that most other people don’t. I think an example will highlight this:
I saw a patient yesterday in clinic who was on chronic high-dose steroids for rheumatoid arthritis. He was totally Cushingoid from his steroids–he had a big round face, major abdominal obesity, thin skin, extra hair growth, and had fractured multiple bones because of the osteoporosis from steroids. And I thought to myself, “You know, I bet when she walks around, or is pushed around in her wheelchair, most people just assume she’s obese, call her fat, and think she just has no control over the food she eats.” Most people wouldn’t necessarily recognize a person with these features–or even realize that these features together equal a medical syndrome. Because we understand her disease process, we absolutely must show compassion–if we don’t, and we supposedly understand her condition, how can we expect anyone else to? (I’m of course not assuming that I understand what it’s like to have a chronic disease, or live with any of these symptoms daily, but just that we understand the pathophysiology behind it, and realize the cause is not primarily a character flaw.)
Or the Middle Eastern man who took tiny steps, wincing with pain with each; no one else could tell he had an enormous, incredibly painful rectal cancer. Or the woman with throat cancer who had to have her neck opened up to remove the lymph nodes, and had her shoulder and neck nerve (Accessory Nerve, CN XI) cut on both sides? Unfortunately these people are probably just assumed by passers-by to be weirdos, freaks, geeks, mentally retarded–the epithets go on and on. But it’s the health professional, who understands the disease, prognosis (chronic pain for many years? 3 more weeks to live?), and challenges of patients that must show care.
It seems to me the toughest thing is, not just compassion, but empathy for the patient suffering from the self inflicted condition.
The drunk driver who was in a crash. The patient who put off care, in denial, about the growing mass in her abdomen.
Is there then a logical extension to this? If compassion for medical abnormalities that can be misinterpreted stems from knowledge, then this applies to every other field as well (e.g. psychology, anthropology, religion). So if you cannot assume anything about a person because you can never have the full breadth of worldly knowledge, you should be compassionate towards everyone.
rightly said about the compassion toward “the ill” but what about those people who are ignorant of the conditions..can he or she be blamed?…it is entirely based on the organism reacting with the environment…they cant help it…but with the knowledge we can…thats why we are in this field to be not like common man but someone who is aware of how to solve the problem.
As a formerly able-bodied young woman now physically disabled and living with chronic pain I could not agree more.
In the disability community we talk a great deal about ‘invisible disabilities’, and how observers misinterpret our maneurisms and behavior. I can honestly say that the ‘looks’ from others and the resistance to empathy and understanding is what makes living with a disablity difficult. People do not realize the impact that their quick judgements can have.
To comment on Amina’s comment:
Even the “common man” should try to find compassion for those whom he does not understand … or who look or behave differently.
You never know what another person’s “walk” is like …
It’s not just those in medicine who should practice “compassion” because of what they do understand, but rather all should practice compassion because of what we do not understand.
I agree, we must find compassion for everyone, but in order to help our patients we have to be really careful; because there is the possibility to get too much involved with the patient situation(disease), and that won´t help us to help them. So we have to do twice the work.
The exact logical extension I was looking for, Kamal.
Medicine is forever accussed f being incompassionate as well, having experienced this first hand as a student. It is not always ignorance that contributes to prejudiced judgment. I have heard plenty of times during report and rounds when discussing patient histories, etc. especially with regards to diagnoses such as FAS, FASD, etc. Yes, the logical extension, compassion toward all, is it really not the human condition to judge and to conclude?
Hi Graham. :)
The conclusion of “compassion towards all” is sound.
The challenge, though, is to *remember* that conclusion when it seems that the system has no compassion for *you*.
Spoken like a true resident, Maria!
in the full sense of the word health, most of us if not all have some aspect of health impairment. would it suffice to show compassion only to those who are visibly impaired? in malaysia not everyone has adequate basic amenities, and not everyone has insurance to cover them or their families. bearing that in mind, compassion to all fits perfectly. the question is, in spite of the late nights and early morning and flood of people waiting to be managed, how do we portray that we understand?