By Stefanie van Zyl, 3rd year Physiotherapy student at UWC, Cape Town, South Africa

My patients started to  become “just another face in the crowd” and without intention, I felt like I  too, was  becoming one of “those doctors,” just another patient, just another day, thank-goodness-it’s-almost-time-to-leave type of healthcare professionals. I relate this to “simplicity,”  because when I started my studies as a physiotherapy student, I, as I believe many before me and those to still come, went into the healthcare profession, with the idea to help those in need. I truly believed that I would always care, always listen, always feel, and definitely never ever be like “those” medical professionals that makes one feel like they are doing you a favour by treating you, those that manages patients in a clinical, detached, rushed manner. To me, I thought of the them as “those” healthcare professionals, but one day after  working in the hospital, I thought to myself, have I become part of the “those,” have my patients just become another face in the crowd, and even worse do they feel like just another face in the crowd in my care?

To truly understand the above title, introduction and illustration, I have to take you back to the incidence that avalanched the concept.

In my first year as a physiotherapy student, our class had a few visits to a home for disabled persons, after which I would be in tears every time. I found it hard to see people struggle and hear their tragic stories and not be affected by it. I realised that I would not make it to graduation if I kept getting too emotionally attached to my patients, it was emotionally draining and making me miserable. In my second year, we had greater exposure to clinical environments and I made sure to be caring, kind, to listen, but to stay within my jurisdiction, I was my patient’s physiotherapist, not their doctor, psychologist or social worker. By the end of my second year, I did my final clinical exam, it was the first time I ever assessed that specific patient. Today I don’t remember much of the physical exam itself, apart from being very nervous. I do, however remember the patient’s main concern, being that his adult son was abusing him at home. Not being sure what to do, I turned to the examiner, as in to ask “do I ignore his plea or address it?” It did not seem to phase the examiner, and I was told that my time is running out and that we are just there for the physical assessment of the patient. Pushing his social concerns aside, I tried to concentrate on finishing the assessment. Afterwards, I thought to myself, that I would never want to be apathetic towards my patient. I might not be a social worker or psychologist, but I have a holistic obligation to my patient, not just a physical therapy responsibility. That mean, not ignoring him because of limited time and his concerns not falling within my scope.

Then third year came. A year where we would mostly be in a clinical setting, assessing and treating patients. I started out motivated, giving every patient my all within our session, but as the months passed, and as I became increasingly more exhausted, trying to juggle a full load of patients, trying to communicate with scarcely spread doctors, many times having to take some of the responsibilities that are more those of the nurses, occupational therapist and even at times fellow students/ colleges, all while trying to juggle tests, assignments, and my personal life, my sympathy, patience  and motivation started to seep away. Over time each patient’s sad story, family troubles, preferences, condition and all the rest, started to sound and feel the same. (Jeffery, 2016)  They became just another face in the crowd and without intention, I felt like I was too becoming one of “those,” just another patient, just another day, thank-goodness-it’s-almost-time-to-leave healthcare professionals. Something I said I never would be, something I did not realise I was becoming. With trying to juggle my professional life, student life, personal life and trying to fit in everyone and their feelings, I realised, I was becoming all of that I said I never would.

The drawing above is named, Simplicity, yet even though the lines are uncomplicated in themselves, the picture as a hole is intricate and elaborate. While trying to focus on one face, one can easily get pulled into the next face, and the next one and so on, until it becomes hard to know where one face starts and another one ends. All unique on their own, yet convoluted and connected in the same way. This drawing demonstrates, how each of our patients are unique in their conditions, their life stories, their circumstances, their needs and in their treatment. Yet, there is a common thread. This drawing metaphorically illustrates, how patients are all individuals, but how they can easily just become a sea of faces. Sad stories and sad circumstances and even sadder prognoses, become so commonplace in hospitals, with healthcare workers working long hours, limited human resources available, while all still trying to be normal functioning human beings at the same time. I think this leads to feeling emotionally drained as professionals at times, resulting in decreased motivation with patients, less patience, less ability to sympathise and decreased capacity to care. (Singh et al, 2018) Our work is at core simple; do what is best for your patient, guided by our professional ethics, but also by our morals, our consideration and our compassion. Once we let go of these principles, it is then that our view of our patients and our performance becomes convoluted.

According to Kyle Ridgeway in the article, Do you need to care to be caring? Sympathy, Empathy, Compassion, and Caring in Healthcare, “A certain type of detachment from the potential suffering and emotional struggles of patients is vital for a clinician. Shouldering the burden of the many unfortunate clinical, emotional, and social situations encountered within healthcare can easily leave one with a sense of hopelessness. It’s quite easy to succumb to pessimism and apathy when the grand scale of suffering, inequality, and just plain bad luck occupy the beds and treatment tables daily.” However, he goes on to say, ” Establishing and enhancing alliance,  rapport, and an environment of care is necessary. An explicit connection with the patient is a precursor to, or maybe even the foundation of, the therapeutic process.” So how do we maintain our compassion in our practice,  preponderating all internal and external influences that make up our work environment?

Realize that you cannot fix everything! Thinking one can fix everyone’s problems is a sure way to burning out and increased emotional stress. Try to stay within your jurisdiction. It becomes so common, especially in government facilities, where hospitals are short staffed and over populated with patients, for healthcare workers to take on the responsibilities of other healthcare workers. It is great to be helpful, but not to such an extend that one burns out, rather try and reach the needed healthcare professional or leave them a note in the patients file, than trying to do it all. Entrust your colleagues, that is why there is more than one of us. Lean on your corresponding colleague when you need assistance, guidance and even to tell you when they feel you are not acting in a professional and compassionate manner (rather them than your patient or your superiors). Take a step back from your initial emotional reactions and rather take the time to understand and work through your emotions. This is beneficial for future encounters in your career as well as for the patient. Keep in mind the meaning and privilege of being a healer. By keeping in the back of your mind why you wanted to become a healthcare worker and what a honor it is to be part of a patients recovery, you will more likely be grounded and maintain your compassion.  Have a balanced life & claim the time for it! without a balance between work and your private life, one becomes easily fatigued and irritable, which makes it very hard to feel compassionate. Be empathetic, but the patient’s suffering is not your suffering, in other words, let go of burdens that are not yours to carry. Lastly, talk to someone, if you feel that you are struggling to keep your compassion and need some guidance and to vent.  (Stephen, 2011) We can’t help everyone, but everyone can help someone, and sometimes that someone who needs help is the healthcare worker. If your compassion does not include yourself, then it is not complete. 

In conclusion, it is natural to stray, from why we wanted to be physiotherapist originally at times. There is a reason, why there are so few seats available at the metaphorical healthcare table, it is at best a challenging profession and takes a lot of heart and will to make a path where there seems to be no path at times. I believe, that if we check in with ourselves from time to time, especially when it feels like our patients are becoming just another face in the crowd, if we recognise when we feel overwhelmed, lean on our colleagues and their disciplines, and above all be true to our professional ethics and to our patients, the convoluted lines, will yet again turn into individual faces, trusting us to treat them as we would like ourselves to be treated, if we were to be in their shoes.

References

Canadian Medical Association Journal. (2011, January 24). Showing empathy to patients can improve care. ScienceDaily. Retrieved August 26, 2019 from www.sciencedaily.com/releases/2011/01/110124121543.htm

Do you need to care to be caring? Sympathy, Empathy, Compassion, and Caring in Healthcare. (n.d.). Retrieved from https://ptthinktank.com/2014/11/30/do-you-need-to-care-to-be-caring-sympathy-empathy-compassion-and-caring-in-healthcare/

Jeffrey, D. (2016). Empathy, sympathy and compassion in healthcare: Is there a problem? Is there a difference? Does it matter? Journal of the Royal Society of Medicine, 109(12), 446–452. https://doi.org/10.1177/0141076816680120

Singh, P, Raffin‐Bouchal, S, McClement, S, et al. Healthcare providers’ perspectives on perceived barriers and facilitators of compassion: Results from a grounded theory study. J Clin Nurs. 2018; 27: 2083– 2097. https://doi.org/10.1111/jocn.14357

Stephen G. Post PhD – Stony Brook University. (n.d.). Retrieved from https://www.stonybrook.edu/commcms/bioethics/_pdf/CCE.pdf