Sympathy or Detachment?

As I've written about before, I'm working with a sub-committee of our local children's hospital's Board of Trustees to help develop core values for the hospital.

Before we started, we discussed what core values actually are. According to an article on refresher.com, "Back to the Beginning - Core Values" by Rick Sidorowicz,

"Values are 'core' "if they are so fundamental and deeply held that they will change seldom, if ever." Values are core if they would be held even if they were a competitive disadvantage in certain circumstances.

Core values are deep, very deep. They are extremely important. Core values rarely change in light of market changes. On the other hand it is more likely that the organization will change markets if necessary to remain true to its core values."

The committee asked eight different groups from around the hospital to discuss amongst themselves, and then present to the committee, what they believed the hospital's core values should be, from their unique perspective.

Last night five of the eight groups presented, including mine. We heard from researchers, residents, administrators and the business side of the hospital, volunteers, and families (I presented, along with my colleague Kay, what the families wanted to see as core values). It was fascinating to hear each group's unique perspective, and yet to see how much we agreed on the basics.

One theme that we heard over and over, that is of particular interest to families, is the idea of empathy from hospital staff. Three of the groups, residents, administrators, and volunteers, talked about treating the patient as if they were their own, or trying to experience the hospital the way a patient or family does, or, which was particularly insightful, walking alongside families but acknowledging that you can never walk in their shoes.

I first have to confess a significant bias in the perspective we presented as families. Almost all of the families we talked to about this have children with chronic, ongoing medical conditions. These families are in and out of the hospital regularly and have extensive experience working with the system and advocating for their children. They have very valuable insights from this depth of experience.

However, 70% of the families who use our hospital, only come one time. Their child needs ear tubes, or rehydration, or casting from an injury, or IV antibiotics for a particularly bad infection. Only 30% of families return, and an even smaller percentage are what we like to call ourselves: "frequent fliers." (If only there were some sort of benefit we could acrue from all this hospital experience! But that's beside the point.)

So we really don't know how the majority of families experience the hospital, or what they think about sympathy and professionalism. What we do know is that families differ in the level of sympathy or empathy they desire from hospital staff.

Kay, my colleague, is the daughter of a doctor and has a congenital condition of her own. So she experienced the "never treat your own family because you're too emotionally involved" perspective of medicine. This has colored her approach to the issue of empathy in a dramatic way. She really values a marked distance from her and her child's physicians. As she said last night in the meeting,

"When I come into the hospital with my child, I have my thick skin on. And I don't want anyone to peel that away. I want you to be professional, and I want you to treat me humanely, but I don't want your sympathy. I don't want you to engage in my life. I have family and friends and church and other supports for that. Just be our doctors!"

The chief of surgery is leading one of the sub-groups that will present at the next meeting, the faculty physicians of the hospital. He expressed very well the other side of the story:

"We are people, and we are in this field because we care. I have gotten more hugs from families and patients, and I'm receptive to that if that's the way they feel. We certainly have families that interact with us almost in an anticeptic way, there's a transaction that takes place, and that's the way they want it. But especially when we interact with a family many times over a period of years, we do get attached to them. The key is recognizing how a family wants to interact, and responding to that. And each of us do go into each encounter with our antenna up!"

Our director of pediatric residency explained his group's perspective. His residents wrote their core values themselves, and he presented them exactly the way the residents stated them.

"My residents are really new at this. They are just learning how to walk! They haven't learned how to detach from a situation yet, in many cases. So they are coming at this from this position in their careers. As they discussed the quality of care of their patients, they couldn't think of a higher level of quality to deliver than that which they would demand for their own children. So that's where the statement, "Treat the patient like he/she is one of your own" came from. It doesn't refer to a depth of relationship, but rather to the level of priority and care provided."

For myself, hearing all these differing perspectives on this was very helpful. I have always put my thick skin on when in the hospital too -- I plaster a smile on my face when I don't know how to process something and need time, I have never hugged a doctor, and I hate crying in public. I do my best to be strong for my daughter and save my emotional outbursts and working through of things for times when I can be alone or talk it through with my husband, out of ear- and eye-shot of everyone else.

But at the same time, I have always been a little curious about how the medical staff approaches us -- what space are they coming from? Do they love their jobs and get along well with their coworkers? Was there something going on in their personal life that made that one really grumpy and short with us? What dynamic is going on at the nurses' station? Are they watching us, and if so, what are they seeing and how is it affecting how and what they say to us? And most importantly, what difference would knowing this make to me?

Now that I work at the hospital a few hours a week, I've begun to develop relationships with some of the people who have treated, or still treat, my daughter, that are more of a coworker or even a friend relationship. I have begun to learn some of those things I always wondered about -- this doctor has children the same age as mine and loves to tell stories about them, this nurse has really struggled to make ends meet for her boys after her marriage fell apart years ago and is putting herself through school to get a better-paying job, this administrator also has a son with autism, this team simply doesn't work well with anyone else and their attitudes toward patients are still way back in the Dark Ages. And it goes on.

I have to say... I liked it better when I didn't know. I have learned that I don't really want to be friends with my doctor or my child's doctor, though I really value a great working relationship in which we communicate well and the doctor knows me well enough to know that if I call, there's a darn good reason, and that my observations are worth noting. I really don't want to know about all the office politics -- I want to be peacefully oblivious to all the yucky stuff and assume that everyone is totally focused on caring for my child when they walk into our room.

And for the most part, I believe these people do just that. They learn to drop the workplace and home baggage at the patient's door and focus completely on the patient and the situation at hand.

And in my opinion, that is how it should be. Recognize that I am unique, and do your best to see how I want to relate to you and the other people on the team. Walk along side me without patronizing me or pretending to know what I'm going through, offer the skills and knowledge and experience in treatment that you have, empower me to make good decisions for myself or my child, and as much as is possible, leave your life and workplace baggage at the door.