Subscribe to The Podcast by KevinMD. Catch up on old episodes!

Join Scott Abramson, a neurologist, as he explores the delicate balance between medical efficiency and genuine compassion in the fast-paced world of health care. Discover practical insights and strategies to nurture empathy, enhance patient care, and find meaning in the daily hustle of medical practice.

Scott Abramson practiced neurology with Kaiser Permanente Northern California for over 40 years, from 1979 to 2020. Throughout those years, Dr. Abramson was passionately involved in physician communication and physician wellness endeavors. Some of his insights and stories from his experiences in these endeavors can be found in video format on his YouTube website channel: Doctor Wisdom.

He discusses the KevinMD article, “The myth of compassion fatigue.”

The Podcast by KevinMD is brought to you by the Nuance Dragon Ambient eXperience.

Ambient intelligence augments human capabilities to make our lives easier. The applications are many, especially in health care. Ambient clinical intelligence is offsetting the most pressing challenges in health care today, such as burnout, physician shortages, physician and patient dissatisfaction, and underperforming financial outcomes, by applying the technology to clinical documentation. 

The Nuance Dragon Ambient eXperience, or DAX for short, utilizes artificial intelligence and natural language processing to automatically document care. It securely listens to and captures the natural, clinician-patient encounter conversation unobtrusively, and turns that conversation into a clinical note for the clinician’s review and signature directly in the electronic health record. You just talk naturally, and DAX does the rest. 

DAX is being used by thousands of physicians across 30 different specialties nationwide. It has already won the Silver Stevie award in the health care technology category and was ranked #1 for improving clinician experience in KLAS’s top 20 emerging solutions.

VISIT SPONSOR → https://nuance.com/daxinaction

SUBSCRIBE TO THE PODCAST → https://kevinmd.com/podcast

RECOMMENDED BY KEVINMD → https://kevinmd.com/recommended

GET CME FOR THIS EPISODE → https://earnc.me/V4w3uI

Powered by CMEfy.

Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we welcome back Scott Abramson. He’s a neurologist, and today’s KevinMD article is titled “The myth of compassion fatigue.” Scott, welcome back to the show.

Scott Abramson: Thank you, Kevin. Thank you. I’m a retired neurologist, by the way.

Kevin Pho: All right. Scott’s been on multiple times, so just go to KevinMD.com/podcast, and in the upper right-hand corner there’s a search bar where you can look up his name for his prior episodes and his story. But today, let’s jump right into it: “The myth of compassion fatigue.” So how did this article and story come together?

Scott Abramson: Well, Kevin, I think I’ve told you before that I’m kind of an opposite guy. If somebody says A, I’m thinking B; it’s just sort of my nature. I was impressed that so many people were writing articles for you that, in one way or another, talked about compassion fatigue. They used that term, “compassion fatigue,” again and again. Now, I take that to mean that we as physicians are naturally so filled with compassion that we’ve just used it all up. We see these patients with horrible things, and this and that, and all our compassion just gets drained. Our compassion tank is empty; the meter is down to zero. We’ve given out all this compassion, and we’ve got nothing left to give. And of course that feels bad, because we are idealistic people, and we believe we’re supposed to have compassion for everybody.

But you see, Kevin, I think that’s a myth. I think it’s a lie we tell ourselves. I don’t think our compassion tank is drained. I don’t think we’ve used up all our compassion. I don’t think we have any compassion to give, and I don’t think we have the time or the inclination to give compassion.

I have a colleague, Kevin, a hardworking OB/GYN. She comes home one night, and her husband is there. He’s had a rough day at work; he’s not a physician or anything. She comes home, and he’s looking for a little TLC. She looks at him and says, “I’m sorry, honey. I gave at the office.” But the thing is, she didn’t give it at the office. We don’t give it at the office, because we just don’t have the time or the inclination.

And Kevin, let me say one more thing about this. I’m not telling you this from a review of data or lectures I’ve heard or anything. I’m telling you this from self-examination. When I think about my own practice, and in the article I wrote, I asked people to consider this: Of the patients they’ve seen in a day, for what percent did they feel genuine compassion? When I examine myself, on a great day, it’s 5 percent. That’s it. We work in this environment where we’re seeing a patient, there are three in the waiting room, there are about 10 e-consults to answer, and there are staff messages, phone calls to make, jury duty excuses, all these kinds of things. We just don’t have the time or even the inclination to give any compassion.

So, Kevin, it’s not compassion fatigue; it’s physician inbox fatigue. I don’t know whether you remember those old “I Love Lucy” shows, but Lucy’s in the chocolate factory, and these things are coming down the line. We’re in that world. It’s Lucy-in-the-chocolate-factory fatigue. We’re just waiting for one more thing on the assembly line of EMR data coming down that we have to address.

Kevin Pho: So you’re saying that physicians aren’t necessarily having compassion fatigue; it’s all the nonclinical burdens they have to endure, whether it’s the inbox, the EMR, bureaucracy, checklists and all that, that are preventing them from giving compassion in the first place. Is that right?

Scott Abramson: Yeah, that’s basically what I’m saying. We are just so preoccupied with everything else. And I think, Kevin, there are two kinds of circumstances where we’re not giving compassion. The first is where compassion, I guess you could say, is appropriate; it should be given, and we feel guilty that we don’t. This would be the kind of patient I would see in neurology: let’s say a mom with multiple sclerosis who comes in in a wheelchair, and her nine-year-old daughter is helping her change diapers. When I see a patient like that, boy, that just tears at your heart. But I would find, wait a minute, I just don’t have time for that. There are three people out in the waiting room, and I’ve got to get to the inbox and do this. And I feel bad about that. I feel guilty that I wasn’t able to feel any compassion in that moment. So those are the ones we feel guilty about.

Then there’s the other kind, which I think we don’t feel that guilty about. These are the run-of-the-mill patients, patients with chronic low back pain, chronic headaches or a nighttime cough that’s been going on forever. With those patients, we just don’t have the inclination to give compassion. In the first case, we just don’t have the time; in the second, we don’t have the inclination. Now, I know some people are going to hear this and be upset. And if you are feeling genuine compassion with the majority of your patients, God bless you. Really, I admire you. But I just have to look inward, and when I examine myself, that was not the case with me.

Kevin Pho: Now, when you were practicing, how did you handle that tension, where you had all of these things that would rob you of your compassion? How did you handle that?

Scott Abramson: That’s a great question, Kevin. I think a lot of times I would rationalize it. I would say, “Well, you should, but look, look at what you’re up against. Look at all this. Look at the burden you have to deal with. So it’s understandable. We’ll give you a hall pass for this.” I think in some way, I may have said that unconsciously to myself, and in some ways, on a deeper level, I probably did feel disturbed by this. And maybe other people do the same thing. Maybe when we talk about compassion fatigue, that’s one of the ways people are dealing with it, so they don’t have to admit to themselves that they’re not feeling anything, that they have no compassion to give. They say, “Oh, I’m just drained. I’ve given too much.” That’s what struck me as I did my own self-examination.

Kevin Pho: Now, short of structural changes that would relieve these obstacles to compassion, whether it’s improving the EMR, solving inbox fatigue or decreasing the administrative burden, short of fixing all that, how can physicians today maintain a semblance of compassion? Because, let’s be honest, it’s unlikely that any of these obstacles are going to go away anytime soon. So what kind of tips can you give physicians who may be overwhelmed by all of these burdens that prevent them from giving the compassion they should?

Scott Abramson: I’m so glad you asked that, Kevin, because I have the answer for you. It’s a very simple answer, but it’s really difficult. All it takes is one flip of the mind switch. Let me tell you how I came to this wisdom. I was seeing a patient, a young woman who worked at Kaiser. She was in the member assistance program, which is actually the complaint department. And this young woman had this great solution, this great wisdom, and I hope I can share it with people. I said, “Gosh, how do you do this? You must have the toughest job. People are always yelling at you, screaming at you. You’re the guilty one every time they have to wait in the doctor’s office for 20 minutes, or they’re looking for parking for 30 minutes, or they’re at home waiting for the doctor’s phone call that doesn’t come. They’re screaming and yelling.”

Here’s what she said, and I just think there’s so much wisdom in this. She said, “You’re right, it is a tough job. But here’s what I do: I try to put myself in their shoes. I try to think of myself waiting in the doctor’s exam room for 30 minutes when I have to pick up my daughter at day care. I think about what it’s like to be driving around for 30 minutes trying to find a parking place, feeling frazzled and frustrated. I think about what it’s like to be home with my sick child, waiting for a doctor’s phone call. I put myself in their shoes. And you know what? I know my job is tough, but I love it.”

So my advice, and what I tried to follow, is that we can put ourselves, just for a moment, in our patients’ shoes. Try to imagine what it’s like for that guy with chronic back pain who can’t play catch with his son, or the guy with chronic headaches who lies awake at night thinking it might be an aneurysm that’s going to burst, or someone with a chronic cough who’s up all night and doesn’t get any sleep. What’s it like in their shoes? If we can put ourselves in their shoes for just a moment, forgetting about changing the EMR or all the systemic changes that maybe could be made in medicine, it’s that simple flip of the mindset.

And Kevin, believe me, it’s not easy. I can tell you this: I practiced for over 40 years, and if I have one regret in all those years of practice, it’s that I didn’t understand this lesson for so many years. It was only at the end of my years at Kaiser that I really understood and learned this. And it was still hard. It’s still hard, because you’re still under the same pressures. But I think that, at least in that way, there may be salvation.

Kevin Pho: We’re talking to Scott Abramson. He’s a retired neurologist, and today’s KevinMD article is titled “The myth of compassion fatigue.” Scott, tell us some of the take-home messages that you want to leave with the KevinMD audience.

Scott Abramson: Well, I think John Maxwell said this: “Instead of trying to put people in their place, we should try to put ourselves in their place.” That would be the message. And Kevin, I was thinking about one story that really impacted me in this regard. I don’t know if I ever told you the story about the three most intelligent words a doctor can utter.

Kevin Pho: Go ahead.

Scott Abramson: OK, so this is the three most intelligent words a doctor can utter. When I was doing my training as a neurology resident, I rotated to a hospital where they were doing a procedure for MS patients, and these were the worst of the worst. They were putting in spinal cord stimulators. I was a resident, low man on the totem pole, and my job was just to go interview these people, do an exam and document their history. These people came from all over the country. They were people in the prime of life, just shut down in the prime of life. They were in wheelchairs or bedbound. They were looking for any hope; they were desperate. And once you got talking to them, they would all ask the same question: “Why me? Why me, Lord?”

I worked under the chief resident of surgery, a man named Dr. Sergio Pacho, and he answered that question with the three most intelligent words I ever heard. They would say, “Why me, Lord?” And he would sit at the bedside, look in their eyes, sometimes take their hands, and then utter those three most intelligent words. He would say, “I don’t know. I don’t know.” And the thing is, Kevin, people didn’t want an answer. They knew there was no answer. All they wanted to know was: Did you hear the question? Are you listening? Are you walking in my shoes? And for that brief moment, I know that Dr. Pacho was walking in their shoes.

Kevin Pho: Scott, thank you so much again for sharing your perspective, time, and insight, and thanks again for coming on the show.

Scott Abramson: Thank you, Kevin. I appreciate it.