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Life in Emergistan

Life in Emergistan

Head of a Doctor, Heart of a Doctor

Leap, Edwin MD

doi: 10.1097/01.EEM.0000655012.30922.c0

    There is a popular trope going around suggesting that somehow physicians lack the compassion of our nursing colleagues. We see it in the PR materials for nurse practitioners that say, “Head of a doctor, heart of a nurse.”

    Even hospital CEOs, in their marketing materials, seem to love images of nurses plying their trade, leaning over patients with furrowed brows, loving hands reaching out to comfort the sick.

    Mind you, my mother is a nurse. Among my earliest memories are those of her in her starched white uniform, including folded and pinned cap, going off to the hospital. Indeed, she was always a model of compassion. She influenced me enormously in my professional path. I have been fortunate to spend my career in the company of some wonderful, caring nurses.

    But now that I have been a physician for 29 years (including residency), I'd like to speak about the compassion of physicians. I can report accurately on this topic having worked in community hospitals, academic centers, and critical access facilities.

    Compassion makes students willing to endure the medical education process. Some physicians may see only dollar signs in school, but they still have to go to the bedside, and the entire process will be misery if they do not care about the suffering humans who populate clinics, wards, and trauma bays. I believe the process is designed to immerse us in suffering to learn to face it and to feel empathy toward those who suffer.

    Without compassion, no sane human would enter a profession where there is so much pain and loss, where their daily lives require them to look into the eyes of another person and say, “You are going to die” or to kneel beside a parent, spouse, or child and choke back tears to say, “I'm sorry; he died.” It may be possible for a sociopath to appear compassionate, to manufacture the appearance of concern, to wring tears from uncaring eyes, but otherwise the profession requires a deep love for humanity.

    If a physician had no compassion, she would not stay for hours after a shift in a busy emergency department arranging a complicated transfer or managing a critically ill patient so that his partner could keep seeing the sick. (All for not one dime more, mind you.)

    Genuine Concern

    I have seen physicians wrecked by the sorrow and pain around them. I have seen them cry. I have cried! I have seen them hold the hands of patients and hug family members. I have seen them pray with patients and call patients in genuine concern. I have known them to write off bills just because they knew the patient needed help.

    It can seem as if we are constantly distracted, that our concerns are economic and driven solely by metrics and schedules. But much of this is not our own doing. EMRs have forced us to behave in ways that can leave compassion masked beneath the imperatives of the glowing screen and the clicking keyboard. Still, compassion rises up. Otherwise, no physician would stay after shift to chart; she would shun the little kindnesses and professionalism of patient interactions, and her charts would be done on time.

    We may also seem distracted because we run in and out of rooms, often because we are chronically outnumbered. There are too many patients and too few physicians. And we are outnumbered by nurses, techs, and others who need our guidance and reassurance in caring for patients.

    We rush, not to avoid kindness, not to eschew human interaction but to avoid disaster, knowing all too well that terrible things often masquerade as simple ones and the young chest pain may be an MI, the fever and cold may well be sepsis, the abdominal pain may be an ectopic.

    Compassion is more than the right touch and a sweet smile, and it is not easily captured in a photo op for marketing material. It's certainly more than tears. Compassion is doing the right thing to provide comfort and preserve life. Compassion is a chiral image of medical professionalism. It means we not only show kindness, but we live persistence, knowledge, and skill in the interest of the people who trust us.

    Physicians are among the most compassionate humans in the world. We demonstrate this in our decades-long dedication to the steep, rocky pilgrimage of medical education and practice. We demonstrate it when we not only show emotion but also give ourselves in mind and body to the comfort, safety, and rescue of the sick and dying.

    “Head of a doctor, heart of a doctor.” How about that?

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    Dr. Leappractices emergency medicine in rural South Carolina, and is an op-ed columnist for the Greenville News. He is also the author of four books, Life in Emergistan, available, and Working Knights, Cats Don't Hike, and The Practice Test, all available, and of a blog, Follow him on Twitter@edwinleap, and read his past columns at

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