In a busy and hectic infectious disease clinic in New York City where every seat in the waiting room was filled, Dr. J. made his way through the crowd. The clinic was filled with HIV patients, sexual health cases, and patients with a whole range of transmittable diseases.
As Dr. J walked across the room, the atmosphere in the whole space transformed. Patients called out his name, waved, and fist bumped him as he moved through the waiting room and back to his office. The demeanor of almost every patient in the room had been positively influenced by his presence.
When my friend who witnessed this scene called me later that day, she was excited to share what she had seen.
“Is that what you mean by compassion in medicine?” she asked, knowing my passion for this topic. To an extent, she was right. It was. The challenge for physicians is that although most of us might have witnessed a colleague who possessed this level of connectivity and outward compassion for patients — and we may even have felt that way in the past — we may not know how to experience that now.
The many factors that lead to exhaustion and burnout make it difficult to maintain that level of compassion and enthusiasm in the long run, even if we accessed it in the past. The onslaught of pressure from an increasing workload, cumbersome technology, and lack of support from administration depletes that enthusiasm bit by bit.
Many of us also wrongly believe that compassion is a natural personality attribute and feel deficient and guilty when we cannot access it. But in fact, compassion is a trainable skill that not only benefits the patients we serve but can also be a resource for caregivers.
We’re Taught to Contain Our Emotions
When I first began practicing medicine, I remember a mentor praising me for containing my grief when a young patient I took care of died. I learned to compartmentalize my emotions early on, and adopted a “contained” persona as I grew into my role as an ER physician.
But later in my career, I had my heart cracked open by a series of unrelated events. The most notable one was a 35-year-old male nurse patient who was unable to continue working due to crippling anxiety. He entered the ER clutching his chest and my initial thought was that he was a drug seeker or a “time waster.”
Yet, something inside held me back from dismissing him, and instead, I went against my training and listened intently to his experience. I realized as we spoke for what felt like a long time that we had a lot in common. And, as I was barreling towards burnout myself, something cracked open in me that night almost 10 years ago. It sent me on a road to really asking what compassion in medicine is, and whether it is something that can be learned.
As I went home that night and contemplated the time I had spent with this patient, I realized that we can’t be fully present with another human if we are not fully present with ourselves.
This moment enabled me to clearly see the walls I had built — both consciously and unconsciously — that prevented me from connecting my heart to my medical practice and to myself.
I took time out of my regular medical practice to go on a medical expedition in the far reaches of Nepal, sharing medicine with those who had none. As I took time to reflect, I began to learn how compassion is trainable; I found that there is introspective work that we can do, as physicians, to train this resource in ourselves. Because the truth of practicing medicine compassionately (rather than mechanically, as I had been doing previously) is that it not only has a tremendous impact on our patients — it impacts us as physicians too.
True Compassion Is Not Fatigable
Perhaps one of the biggest learnings that came out of my studies in the past 10 years is this: Most of us have heard of compassion fatigue, but true compassion is actually not fatigable.
In her book, Standing at the Edge, Roshi Joan Halifax, PhD, shared an experiment conducted under the guidance of neuroscientist Tania Singer, PhD, and her team at the Max Planck Institute in Germany. The studies outlined the difference between empathy and compassion. Much of what we think of as compassion is actually empathy. Empathy is where we become immersed in the pain and suffering of another and feel it as though it is our own.
Compassion has a different tone, and the studies show how it lights up different areas of the brain. Halifax wrote that the experiment showed that we can train ourselves to switch into a “warm positive state coupled with a strong desire to be of service,” and that different areas of the brain light up when we are suffering with others than they do when we switch into a compassionate state. Singer suggests that if people can learn to be compassionate, as opposed to empathetic, this could help stave off problems like burnout.
For the past decade I’ve been working on cultivating this state first within myself, and then in the other physicians I’ve supported, particularly those who were experiencing emotional burnout through their work in the pandemic. The key takeaway is that our education, training, and work environment may not foster and support our natural compassion, but we can intentionally train to bring this essential quality forward. This not only benefits our patients but is an essential resource for ourselves.
Wendy Lau, MD, is an emergency medicine physician. She incorporates meditation and Eastern philosophies into her practice to combat burnout. She currently works in addiction medicine and serves as a co-director for Upaya’s Nomads Clinic, providing medical care to remote Himalayan villages. She is the author of Inner Practice of Medicine.