Thank you so, so much for this discussion. I am a Clinical Social Worker on an inpatient medicine unit (We love our Hospitalists!) in Houston, Texas. A significant portion of my work is educating IM residents about the psychosocial aspects of medical care. Our population is US Veterans.......and oh my, if there is a population that is set up for empathy gone wrong....it’s this one. I’ve started to use the term “practical compassion” with our residents in response to some very unattainable “social problems” that I am consulted for during the beginning of their residency. A few examples....”He needs help getting the title on his car changed. She needs a different babysitter. He wants to relocate to New York and needs to know the best route to take.” Ok, so maybe not completely unattainable....appropriate requests for someone admitted to an acute medicine bed?.....no. For a while, I found myself building up resentment towards physicians and nurses because I felt insulted by the very benign consults I was receiving. Then a light bulb flipped on......They haven’t been taught and I can teach them. So, instead of rolling my eyes when asked to take Johnny downstairs for a cigarette break, I started talking them through the request. I would thank them for their genuine concern for Johnny’s comfort. Then, I would do a quick triage of my active top 3 consults. ‘“ I’m headed to see Mr. B who is actively psychotic, profusely volume overloaded and refusing an IV for lasix. Dr. M and I can usually talk him down before calling a code green, so that is top priority. Then I need to visit with Betty for crisis management before her LP because she tends to decompensate before procedures. Mr. B was told today that his prognosis is extremely poor and the recommendation from his team is to transition to hospice care at home. He doesn’t know how to tell his wife who is 3 months pregnant. Would you like me to see Johnny after these 3 patients or do you think it’s more urgent?” You can imagine what the response is. It would be pretty cruel of me to not have a follow up discussion with the resident afterwards, so I always make a point to debrief at the end of the day. The theme of that discussion is the idea that being practical with your promises and expectations is the more compassionate thing to do for someone. Whatever the reality of their life is....it IS their reality, so we have to figure out a way to make our treatment plan fit with that reality. If we go in circles trying to come up with an impossible housing plan immediately after discharge, for a patient who will need to first spend some more time in an emergency shelter then we have made empty promises that will destroy our therapeutic relationship. And....we will destroy our very capable brains with the emotional empathy you discussed. Bravo. Bravo on this discussion.

This is great! Empathy is harmful. It's a lack of boundaries. I don't deserve to feel bad because someone else chooses to be negative

I just try to be a nice human being, trying to treat them the way I would want to be treated. Thats it. Beyond that, I try to look at each situation objectively and determining the right pathway of treatment. I try not to "feel" anything when dealing with tough cases, it clouds my judgement. Ive learned that messed up things can and will happen to everybody.

As a NICU nurse of 9 years this really makes sense and is helpful for the times when our babies don't make it!😔 p.s. the light shining on your head makes it look like you are wearing a yarmulke! 😁

One of my friends is in psychology. He says some of the best providers/nurses are those who can have empathy, but also have the ability to stop just short of being affected by their own empathy.

Thanks for this ZDogg MD!

I'm so glad you are talking about this. All through nursing school I've felt like I'm not empathetic enough. I can understand that someone is upset, and that I should comfort them; However, I just plain can't feel emotional empathy when I'm in "work mode". Sometimes after clinicals I'll start feeling true empathy for them, but never ever when I'm on shift. I've just been hoping it won't kick me in the balls too hard. It's never occurred to me that it might be helpful!

Thank you so much! You put into words what I gave been seeing and experiencing in the ICU. I have encountered all 3 methods...knowing how to consciously choose resilience is priceless!

Hi! Just as a student applying to medical school at this current moment, I wanted to write my opinion on this. I read about the article you mentioned previously actually when it first came out after learning about empathy as a peer advocate/counselor for mental illness. I totally, TOTALLY agree with what you've pointed out about empathy burnout and the toll of constantly walking in someone else's shoes. It applies to all kinds of jobs that deal with hardship and illness. What I wanted to point out, however, is that I have found many pre-medical students jumping too early to compassion before experiencing empathy first- eg, they don't fully understand the patient's hardships and human suffering before applying their good intentions and determination to help. I saw you cry in a different video for a child who pulled out their hair as they died, because of how terrible you thought that must have been for the poor kid. THAT, again in my opinion, may be a powerful basis for your compassion and the root of many people's eventual ability to both care for patients and themselves. I would like to point out that perhaps some students (not all, but many of us) need a lesson on empathy first in order to practice compassion at the level which I understand is necessary to keep you sane in the high pressure and emotionally charged life that is medicine. It's not easy to walk in everyone's shoes, and again I TOTALLY agree that it's best not to do that forever. Way too stressful. But it can definitely be a very necessary or at least helpful exercise for some inexperienced students to help develop that healthy sense of motivation to address each patient's unique story of suffering with the correct and most comprehensive treatment possible.

Over the years, I have had different kinds of empathy. From a floor nurse, to a charge nurse, manager of a dementia unit, now as a director of nursing in assisted living. I now have the stressful empathy! Not only with my patients, but their families and even my staff. I'm a nervous wreck most of the time. I didn't realize it until you broke this down. I can't turn off my concern. It is taking a toll on my body. So, now what? How do I turn it off?

Great stuff, Z. Paul Bloom wrote about this idea in "Against Empathy". It's a great read and highly recommended. It's an important concept and in the book he applies it to lots of settings. In medicine I think it's especially important. Health Care providers are burning out and in some cases suffering from PTSD as we expose ourselves, unguarded to harrowing events, not our own. Thank you for your intelligent articulation of this issue. It's a subtle but important distinction.

Compassionate empathy, in the way it is defined here, is a MASSIVE misnomer. Com-passion - literally means, 'suffer with'

Stress empathy from working in hospice, for mr resulted in : Elevated cortisol, elevated cholesterol B12 and D3 deficiency, total burnout to the point of needing FMLA. I slept 12 to 14 hrs a day for almost 2 months.

Thanks, Z!

Great video

No wonder I kept burning out!

I love ZDoggMD.

hmmm....doesn't "compassion" mean quite literally "together-suffering" and be more akin to the emotional empathy which is so physically taxing?? I get the "caring-empathy" idea, or a level of outside-in perspective to suffering (driven by a desire to help suffering individuals *cliche*) which we are privy to as physicians/nurses. thanks for such a cool vid. - JB a future M4 @ USC SOM :D

Compassion as "I suffer with you" do not exist in Buddhism, we use Karuna (Buddish compassion) that means: wish for all beings to be free from suffering.

BALANCE

I think the big thing is not to get EMPATHY confused with SYMPATHY

Go home and read Kohut

point your back rim light towards your shoulders, not the back of the head. its not flattering. Thanks for the great videos!!