‘I feel your pain’

Compassion is a priceless gift. It’s also becoming an essential requirement for all healthcare professionals.

By
December 26, 2010 03:29
Medical staff at a hospital

hospital doctors health 311. (photo credit: Ariel Jerozolimski [file[)

Compassion – based on the combination of Latin words meaning “to suffer with” – is defined as a feeling of deep sympathy for another who is stricken by misfortune, accompanied by a strong desire to alleviate the suffering.

It is not enough to empathize; compassion demands action. Compassion is visualizing yourself in the situation of the other and helping him in the way you would like to be helped.

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Are Israeli patients – in the hands of community clinic nurses and clerks, doctors who barely have time to enter case details in the computer, hospital staffers overwhelmed by too many sick people and too few hands – treated with compassion? Perhaps government ministers, Treasury budget officials, health system administrators and professional staffers can feel true compassion only when they lose their own identities by getting into institutional pajamas and hospital beds to get treatment. Until then, everybody has heard stories about how they were treated “heartlessly.”

Compassion (or hemla in Hebrew) in the healthcare system was the theme of the recent fourth conference on health organized in the Knesset auditorium by the Ariel University Center in Samaria that in the past 25 years has grown to a student body of 10,000. A survey conducted for the conference showed that 60% of the population do not think that compassion has a high priority in the health system.

Israel Beitenu MK Moshe Matalon, who has been in a wheelchair (the first-ever MK in such a situation) since a military injury during the Yom Kippur War in 1973, and has also headed the IDF Disabled Veterans Association, was a suitable chairman, and showed a personal interest. He noted that “compassion is not a natural word in the health system; profit is too strong a motive.” With his personal experience, said Matalon, he takes this ideal from budget debates to hearings of the Labor, Social Affairs and Health Committee.

In the past, continued Matalon, “AIDS was a death sentence. Today, an HIV carrier can live with it. He works and pays taxes. Helping patients brings economic and social benefits to society.”

Knesset Speaker MK Reuven Rivlin bemoaned the fact that too often, lack of trust develops between patients and physicians. While the Patients’ Rights Law was passed in 2006, he said, it must be enforced out and monitored with alertness.

While “Jews are people of mercy,” said Deputy Health Minister Ya’acov Litzman, the level of healthcare, access to service and life expectancy are not the same in the periphery as in the wealthier center of the country. In general, Israel’s healthcare system is praised all over the world, but there are still cases in which people scheduled to have surgery fast for a day only to be told it was postponed, with the same thing repeated the next day, he said.

Ariel Mayor Ron Nahman, a former Likud MK, also has personal experience – like Matalon – with hospitals and doctors. He was diagnosed earlier this year with prostate cancer. “As a patient, I praise all doctors, nurses, everybody. I’ve been through all of it in the past four months. But patients must have a lot of patience. There are shortages in the whole country.

Schoolteachers face 40 kids at a time. The health system isn’t any different. I don’t like the term ‘compassion.’ Patients have a right to decent healthcare, and shouldn’t have to beg for it. The healthcare system is excellent, but when you get down to the details, things are not so great.”

The person who suggested the conference topic, Assuta Hospitals board chairman Prof Yehoshua Shemer, said “compassion can be internalized. The British held a conference on the subject, and now it is on the agenda of the National Health Service.” Medical staffers here are excellent, said Shemer – a former Maccabi Health Services and Health Ministry directorgeneral.

“We will have to manage with existing resources while making compassion an integral part of the system.”

A FEW decades ago, when a patient went to his doctor with stomach pain, he was examined for quite a while, using a hands-on approach, said Shaare Zedek Medical Center director-general Prof. Jonathan Halevy. Today, doctors typically send him for X-rays, MRIs and CT scans. This major change in diagnostics, he said, may reduce compassion. But not every doctor or nurse is born with compassion. “Medical schools try to filter out people who lack empathy for other people. When a doctor knows that the patient doesn’t, he must have empathy so his power doesn’t go to his head. Compassion does not require resources or cost money. At Shaare Zedek, staffers are forgiven for making medical errors if they are not acts of overt carelessness, but we won’t forgive a lack of empathy.”

Kupat Holim Leumit, the country’s smallest health fund, “looks for employees who have compassion,” maintained its director-general Nissim Alon. “The National Health Insurance Law of 1994 demands compassion, as it states that every member pays according to his ability and receives health services according to his needs.” But since then, the system has gradually eroded by offering supplementary health insurance to to those who can afford it, and copayments that erode the founding principle, he said. “We are judged by the quality of our services.

Our medical staff get very high grades in our surveys.

We check them for empathy. If satisfaction declines, it’s my fault,” He added when when a member’s complaint is heard in an appeals committees, the complainant is invited to attend and speak.

BUT MEDAD GISSIN, the longtime volunteer head of Hatzvi (the Health Consumers Organization) who suffers from a chronic illness himself, was less sanguine.

“I receive hundreds of complaints from patient. I say there is no compassion in the health system. Twentypercent of chronic patients can’t afford supplementary health insurance, or the copayments to buy medications or get treatments to which they are entitled.

Remember that these people could be our own parents – or us, in the years to come.”

Health Ministry director-general Dr. Ronni Gamzu – an obstetrician/gynecologist by training – said he didn’t believe the 90% satisfaction rates reported in polls.

“At the same time, polls show there is not enough compassion in the system. The answers depend on what questions you ask. There are some people who don’t like people. How staffers act is reflected in what you teach them. You can’t inject compassion into the health system; it’s a categorical imperative. You have to show that you care.”

Yet Prof. Yair Shapira, a long-time health system administrator who is now dean of the Ariel University Center’s school for health sciences, declared that “there is no connection between compassion and funding. The richer the country gets, the less compassion there will be. One of the sins of all four health funds is that doctors look for every way to work by the book, without compassion.”

“Legislation is one of the worst ways to create compassion in the health system,” said MK Prof. Arieh Eldad, a leading burns surgeon at Hadassah University Medical Center until he left to join the Knesset.

“One needs to educate generations to care. I voluntary teach about burns treatment at the Hebrew University- Hadassah Medical School once every two weeks. I ask students what they need to treat patients They suggest all kinds of technical things. I tell them they need morphine to relieve pain, which is the worst thing. When a burn patient is taken to the shower, it’s a nightmare. To have compassion for a burn patient, you need an anesthesiologist so the patients don’t scream when you use water and soap to clean them. That will reduce the trauma.

“There is no physician in Israel who lacks compassion.

I’ve never met one; all of them want to help patients,” said Dr. Leonid Eidelman, an anesthesiologist and chairman of the Israel Medical Association.

“It’s part and parcel of the profession.” But, he said, the health system is increasingly starved of resources, forcing hospitals to keep too many patients in corridors.

Compassion in the hospital, he explained, is giving “efficient treatment as fast as possible and with the fewest side effects.” Eidelman was optimistic, however, that when the new generation of young doctors – including a lot of women who are natural nurturers – medicine will become more compassionate, especially if working conditions are improved.

THE FACULTY of Health Sciences at Ben-Gurion University of the Negev in Beersheba from the beginning in 1974 set compassion for the patient and concern for the community as its keystone, said its dean, pediatrician Prof. Shaul Sofer.

Medical students are selected from the applicants not solely according to grades but based on their accomplishments in helping others and the compassion they show while being observed. Once the best of the bunch are admitted, he continued, they are immediately introduced to patients, and expected to regard them as human beings with individual personalities and backgrounds. “They meet babies, children, women, the deaf, blind and physically and mentally disabled even in their first year. In their second year, they encounter seriously ill patients in intensive care and learn how to tell patients bad news,” said Sofer.

At Tel Aviv University’s Sackler Medical Faculty, said its dean, Prof. Yossi Mekori, every student “adopts” a patient with a serious condition (and his family) from first year. “Empathy is predominantly a cognitive attribute involving an understanding of experiences, concerns and perspectives, and a capacity to communicate this understanding. Empathy in clinical care can lead to positive patient outcomes, greater patient satisfaction and compliance.”

For six years, TAU medical students have been hospitalized for a day, and helped to understand what it means to have difficulty walking by having ry corn put in their shoes. This evokes compassion.

Showing warmth and listening to patients aren’t enough to make up for the lack of hospital beds or the patient/doctor ratio, said Kadima MK Rachel Adatto, a gynecologist and medical administrator by training. But she noted a positive change in medical student selection.

“A 780-point grade on the psychometric exam is no longer enough to be accepted. The schools have started to look at the person behind the grades. It is always said that education is the key to every change, and there is no doubt that when choosing the doctors of the future, the change will begin.”


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