Every day in hospitals we’re seeing the finest examples of how empathy can benefit patients in a time of crisis. The positive effects of empathic communication under ordinary circumstances seem limitless: improved patient and provider experience, patient safety, adherence to medical recommendations, better health outcomes, and beyond. We’re also reading about the consequences of empathy deficits in times of crisis. How much does empathy matter during the COVID-19 outbreak?
As straightforward as the concept seems, a sobering reality exists when it comes to empathy in times of crisis. While crises bring out the very best and even heroic measures in many providers, others regard empathy as a “nice-to-have” quality while bemoaning (in the very same breath) that they just don’t have time for it now.
When I was in psychiatry residency training, I learned about Heinz Kohut’s theory of Self Psychology, which explains that empathy for patients with mental illness is an essential ingredient without which there could be no cure. In Kohut’s words, empathy is “psychological oxygen.” When people feel understood, they feel whole and integrated; when they feel misunderstood or neglected, they feel fragmented and find it hard to function optimally.
This lack of psychological oxygen can have damaging effects. Its absence leads to breakdowns in trust and safety at three levels: (1) the organizational level, (2) the inter-professional level, and (3) the patient care level.
Organizational Level: Focus on patient care can obscure focus on workforce morale
Healthcare organizations can model empathy by the language they use to communicate respect, caring, and gratitude for the people who are taking care of patients and risking their own health. Healthcare leaders need empathy as they are faced with making critical decisions that affect thousands of lives each day. Empathy tends to have a trickle down effect, so if it is to be preserved a generous supply must come from the top.
Several new hospital protocols across the country are requiring all healthcare workers to come to work during the COVID-19 crisis when called and to be prepared to either return to work or be redeployed to departments where they are most needed. Though not intentional, in some cases harsh language has been used that does not acknowledge the risks to these workers. Some healthcare workers have been threatened with discontinuation of pay if they do not comply and have been required to use paid time off, or go unpaid or have wages they already earned be denied. They have also been told they’d be subject to corrective action for refusing to return to work without providing a clear process for reporting extenuating circumstances these workers may be facing.
History has shown that doctors and nurses risk their lives in times of crisis even though they don’t take an oath to do so. Using language that requires frontline workers to show up in a crisis without acknowledging the risk of harm to themselves and their families shows an unintentional lack of concern for the workers whose services are needed now more than ever.
Taking care of patients is emotional, and in times of crisis, emotions run very high. Healthcare workers need safe ways to manage these emotions through support from peers, especially when dealing with unprecedented numbers of sick and dying patients.
In addition to our patients’ needs for vital oxygen, we also need to measure our peers’ psychological oxygen to ensure they are getting support to manage and process the enormous emotional toll that this pandemic extracts. Some hospitals are implementing hotlines for their clinicians and personnel who need to have serious conversations.
Healthcare workers need support to care for very sick and dying patients and to be able to maintain compassionate delivery of news that could profoundly affect patients and their families. Interprofessional support also comes from humane acts of kindness including checking in with colleagues, asking them what they need, and referring them to trained chaplains or social and psychological support services if indicated.
Patient care level
Empathy and compassion blossom at the patient care level when a culture of empathy is embedded in organizations.
In times of crisis, a sense of panic can infect relationships as deeply as a virus. Patients may become desperate out of fear and behave in both rational and irrational ways until we understand their fears. It is most important that healthcare workers remain grounded in their roles and values. Desperate tactics may be used, such as anger, criticism, blaming and scapegoating of healthcare workers in times of crisis. It’s vital that health providers not take such tactics personally, but recognize these as tactics of fear and despair.
Patients may not only needed oxygen prongs — they may also need psychological oxygen. The sole focus on physical health may obscure patients and their families’ needs for psychological help. Patients and their families also must remember that healthcare workers are human beings doing the best they can and try to maintain respect for what they are called to do.
It’s time to step back and take a deep breath.
Federal funds must be made available to support and protect healthcare works so they are not subject to physical, emotional or financial threats at this critical time. Before implementing new policies, organizations need to engage a diverse team including psychological considerations to envision the impact on patients and healthcare workers. In addition to asking clinicians and staff to take on additional demanding tasks, their physical and mental health must be considered.
Before we judge our patients, we need to understand the fear and terror they are facing. When we fail to do so, we fail to provide the oxygen masks that are needed. But when we do, we can all inhale and exhale the psychological oxygen that is so vital to everyone involved in healthcare.
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