The Washington Post featured an article by Dr. Michael Stein, “We all want doctors to be kind. But does kindness actually help us get better?” He presented intriguing but inconclusive data regarding the benefits of a “kind” doctor on control of diabetes or on perceived duration of colds for instances. In the end, Dr. Stein concludes, “At the moment, the best answer to the kindness contrarian is: Even if the evidence in favor of the therapeutic benefits of empathy is weak, there is no evidence that refutes the idea that empathy improves care. And too many patients have stories of how unkindness or the sheer obliviousness of doctors can be devastating and indelible.”
If the value of empathy and kindness from a physician is debatable and difficult to assess, I challenge the opposing paradigm that asks, “We all want to help kind people. But does a kind patient get better care?”
I was rounding for the first time on a man admitted for decompensated congestive heart failure. He had cycled through volume overload then acute renal failure then volume overload four times in three months. I called his caretaker to ask a few clarifying questions. I immediately encountered the wrath of frustration and distrust that predated my meeting this patient by three months.
The two initial encounters occurred at another hospital, and there was great animosity because of that hospital’s “failings.” Needless to say, there was swearing and accusations, and I fell silent and felt unjustly held accountable for perceived failings. I became weak with humanity and felt defensive arms rise. I had to restrain my harsh objections and calm the moment despite my bruised intentions. It drained me to deal with this pent up anger, and when I hung up, I had less left to joyfully care about the ill man. I came ready to care. I was beaten to indifference. I continued on by duty but lost a taste for righteousness.
The next day my partner recanted a story of a person demanding to have her fill out forms for family medical leave for the person’s grandmother immediately. Apparently, my partner had never met the spouse of her patient and this person who was demanding forms “this instant” was the girlfriend of the grandson. My partner shared how suddenly very on guard she felt with the expectations shoved at her under such claims.
It has become expected that physicians and care systems should provide customer service and be kind, yet the same discussion that asserts and mandates patients and their families be gracious and polite seems to be taboo. Asking for patients to be courteous and recognize the well intentions of a physician seems an audacious and self-righteous request. Where is the sign that says, “We reserve the right to refuse service” in this arena of customer care? The atmosphere has positioned physicians who dedicated their lives to caring to be instead the emotional punching bags of society.
Physicians sustain verbal assaults and take on the weight of disappointments, failings, and the often unstoppable rape of disease and illness. In some insidious way, that reality is becoming acceptable. The ill have claim on physicians. I challenge that such claim to allow abuse and dispense abuse without regard will affect care. Physicians do not want to be judgmental or succumb to the weakness of bruised feeling but how would a human soul not be altered by engaging distasteful personas?
At the moment, the best answer to the patient kindness contrarian is: Even if the evidence in favor of the therapeutic benefits of patients being kind is weak, there is no evidence that refutes the idea that it is easy to care for a kind patient. And too many physicians have stories of how unkindness or the sheer abuse of doctors can be devastating to the patient.
Jean Robey is a nephrologist who blogs at ethosofmedicine.
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