Virtues in Modern Practice
Foundational to addressing these questions is a consideration of each of the virtues—altruism, empathy, and compassion—in the context of the modern practice of otolaryngology–head and neck surgery. Altruism is generally considered to be the “unselfish caring for others” in the specific sense of an individual’s person and health. Some definitions might also use the term “disinterested” to convey an objective aspect of health care, so as not to allow one’s personal feelings to influence one’s professional capability for decision making and health recommendations. It may well be that this admonition to be disinterested leads some to believe that empathy and compassion have no place in patient care, as they may tend to disallow the disinterested (dispassionate) evaluation of a patient.
Explore This IssueAugust 2019
This author, after 49 years of being a physician, does not believe that being dispassionate with respect to patient evaluation and decision making negates the ability to be compassionate to patients with regard to their physical, mental, or emotional challenges. Altruism may well be the desire to help others through our range of capabilities from the scientific approach to disease to humanist support for the person with the disease. Altruism in its purest form insists on a “one-way good deed,” where the giver of care does not expect anything in return. Can we as reimbursed otolaryngologists consider ourselves to be altruistic in delivering medical care to patients when we are paid to do so? Can we still claim the moral high ground when receiving six- to seven-figure salaries? These questions are being raised by ethicists and philosophers when examining fee-for-service healthcare systems. This author’s viewpoint is that, yes, one can be altruistic as a compensated physician, although noted with an asterisk that explains the potential diminution of its purity because of compensation. But, it is the best we have in a practical world.
Are the virtues of altruism, empathy, and compassion still germane to the practice of medicine in these evolving and challenging times?
Empathy is, in a sense, one’s resonance with the feelings and difficulties being experienced by the patient—an understanding possibly based on our own experiences, and in part by our knowledge of such difficulties seen over years of patient care. It reflects a sense of concern for another human being, and is not just limited to our patients. What the patients are experiencing can inform our own understanding of the impact of their disease or circumstances on their health in some manner. Thus, empathy is understanding. Compassion has been described as “empathy with a purpose,” the purpose being a desire to help the patient through the difficulty, whether by expert medical care or by an interaction that conveys our understanding of the difficulties they are facing. Sometimes, compassion is best expressed by listening. Occasionally, a permissible touch of support is appropriate. Above all, maintaining an attitude and intent that supports the dignity of the patient and her confidentiality is required.
It is held that “patient-centered medical care” would encompass these virtues on the part of the physician, and that is a salutary goal. There has been a concern raised recently that a physician may suffer personally from both feeling and demonstrating empathy and compassion to patients, which might contribute to the phenomenon of “burnout.” We know that burnout is, indeed, a real-life concern, which could lead to either changes in the way physicians practice (employed, limited hours) or how they approach patients (diminished emotional engagement). Could this also lead to a self-selection by those considering a career in medicine to avoid engaging patients with empathy and compassion, or possibly changing the type of applicant to one who may see a medical career as one requiring only skills in science, technology, engineering, and mathematics? This author realizes that his viewpoint of the requirements for a physician to practice ethically, and to embody the virtues of altruism, empathy, and compassion, may be part and parcel of what has been called “nostalgic”
professionalism. Yet, each day in the clinic or operating room, there remains sufficient evidence that these qualities are still present in students, residents, and colleagues, and in a sufficient volume to continue to maintain faith in the future of virtuous physicians in our profession.
In the clinical scenario, we see a patient who is suffering the loss of her best friend and husband, and who may benefit from the nostalgic approach to understanding her suffering. We should set an example for the medical student about empathy and compassion, listening to the patient’s pain and taking the time to validate her emotions and support her dignity. Yes, we may get behind in the schedule, but for this patient and the time you spend with her, you will be a physician in the true sense. And, instead of feeling “burned out” with stress, we might actually feel good about making her feel better through our demonstrated empathy and compassion.
“The good physician treats the disease; the great physician treats the patient who has the disease.”—William Osler.