I have a confession.

I didn’t enter my profession to help people. I know. It’s shocking.

Don’t get me wrong. I take my professional responsibility extremely seriously. I’m only admitting that the primary reason for choosing my profession was not altruistic. I made a practical decision to go down this path because of a junior high career day event. Otherwise, I had no real connection to any health care profession other than liking biological sciences.

Why does this matter? I’m about to go against popular convention. I can almost hear the virtual protest, but hear me out.

The story commonly told is that care providers is that they — being naturally compassionate — have consciously made the noble choice to do this work. We tend to pat ourselves on our backs for being committed to serving the public need. But sometimes, when you’re turned to pat your back, you miss what’s right in front of you.

Although I believe there are countless compassionate providers, I also believe there are just as many ranging from indifferent to merciless. We like to think of those types as the outliers, but I’m afraid it’s far more prevalent than we would like to admit. Some days, I’m unsure if “they” are the minority.

The bottom line is that compared to other professions, health care does not have a monopoly on compassion. Dissatisfied patients and frustrated practitioners can attest to that fact.

Granted, improving the experience of health care for both patient and provider is multifactorial. While many issues exist with the system itself, this article only addresses the human aspect of things. Yes, we function within a dysfunctional matrix, but the system is not responsible for all of our shortcomings. I’m not talking about the individual whose character changes as a result of burnout; I’m referring to people who never leaned towards compassion in the first place. Beyond implementing rigorous systemic changes, we also need to examine the complete makeup of individuals within the field and not get lost in the romanticism.

People are drawn to health care for a multitude of reasons of which compassionate tendencies may or may not accompany:

1. Passion for people. Some are genuinely drawn to relieving the suffering of others. They care deeply about patients and feel personally driven to serve.

2. Passion for the puzzle. Some like to solve the case at hand. They enjoy putting pieces in place to discover the origin of a problem and provide a solution. They’re not all that invested in the person.

3. Practicality. The public will always need the expertise of those who hold knowledge in this arena. Unlike many other industries, the demand for health care workers continues to rise.

4. Profit. Depending on the position, some people come for the potential payoff.

5. Prestige. Some individuals are intrigued with titles. Their identities are strongly tied to their positions and what they believe it says about them inside and outside of the profession.

6. Pedigree. Family tradition and felt obligation often influence the path taken. A genuine desire may or may not be present.

There is no need to judge or assign a hierarchy to this list of influences. Whether moved by a singular motivation or a combination of factors, we are left with a diversified workforce, varying in the individual capacities for empathy. It is only when we’re willing to set the myth aside that we’re entirely able to assess and address reality.

In researching “compassionate competency” and having explored practices of mindfulness, I’ve come to understand that compassion is more than an ideal to strive towards. It certainly shouldn’t be a badge we wear that renders us immune to constructive critique.

It is a skill that can be cultivated and enhanced. It is something that needs to be widely integrated into our training and continuing education. It is the way we ensure we are providing comprehensive care to our patients with the human touch. It is an essential that enables us to simultaneously develop our own resilience as clinicians in demanding environments. It is not something we can continue to take for granted as merely being part of our nature.

There will be those who vehemently protest, those who will claim to be “already compassionate” or “compassionate enough.” But here’s the thing: If it’s truly a part of who you are, you’ll welcome the opportunity to amplify it, not fight against it.

Taking on a defensive stance maintains the status quo by allowing us to evade the necessary self-reflection. As uncomfortable as it may be, self-inquiry (not self-blame) has the potential to transform health care from the inside out.

If there’s anything I’ve learned about growth over the years, it’s that it can’t happen if you’re unable to ask yourself the hard questions. Until we, as a community, are willing to reflect on the less than flattering truths, there’s no compelling reason to initiate and sustain widespread change. Let’s not allow the myth to get in the way of real and lasting progress.

Emelia Sam is an oral and maxillofacial surgeon and author of Compassionate Competency: Healing the Heart of Healthcare. She can be reached at her self-titled site, Emelia Sam.

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