ASRA Pain Medicine Update

We’ve seen a tremendous focus on regional anesthesia procedures that might be useful in the setting of cardiac surgery, or in terminating aberrant arrhythmias in the August and November issues of ASRA News, and our authors should be commended for their attention and dedication to this often-overlooked patient group. The creation of the Regional Anesthesia Cardiothoracic Enhanced Recovery Special Interest Group is further evidence of the resources that ASRA has devoted to the provision of regional anesthesia services for cardiac surgery patients.

Despite some impressive advancements, mustering the “heart” we once had for the practice of medicine or provision of sympathetic and empathic care for particularly challenging patient populations can be difficult, especially when pain- and opioid-related issues are involved. Those patients may be incredibly complex to medically manage, consume considerate time and material resources, and negatively affect a physician’s ability to maintain empathy for patients’ medical or social conditions, ultimately increasing the risk of burnout.

Why Empathy Matters

Empathy represents an understanding of or sharing the feelings or perspective of another person and is core to developing a therapeutic relationship.^[1] Alternative definitions have called empathy the ability to “see the world as others see it, be nonjudgmental, understand the feelings of others, and communicate the understanding.”^[2] Empathy is also described as being at “the heart of patient care and without it, physicians cannot meet the expectations of our calling, measured or not.”^[3] Unfortunately, there is a growing sentiment that the ability of providers to deliver health care in an empathic manner is under attack and may be significantly responsible for the increase in physician job-related burnout.^[4]

It is imperative that we recognize our patients’ vulnerability and strive to retain or rebuild our dedication to providing empathic patient care.

Certain specialties (obstetrics-gynecology, pediatrics, psychiatry, and thoracic surgery), female gender, and those with a doctor of osteopathic medicine degree appear to possess increased levels of empathy for their patients.^[5] Unfortunately, a lack of perceived empathy can be associated with a number of potential adverse consequences for both patients and providers. When patients sense a lack of physician empathy, they may be significantly more likely to be noncompliant with medical advice.^[6] In contrast, providers with higher levels of perceived empathy may be more likely to score higher on patient satisfaction surveys.^[5] Within anesthesia, delivering information in an empathic manner to women presenting for gynecologic surgery was shown to improve their perception of the anesthesiologist’s attitude and quality of the information.^[7]

But What About Burnout?

Burnout is described as feelings of physical depletion; helplessness; negative self-concept; negative attitudes toward work, life, and others; emotional exhaustion; depersonalization; and negative personal accomplishment.^[1],[8] Although any career has the potential to result in burnout symptoms (13%–27% in the general population), physicians appear to be particularly susceptible, with rates reported to approach 70%. High degrees of job-related burnout have been associated with decreases in quality of patient care and increases in patient dissatisfaction, medical errors, lawsuits, employment attrition, and the number of workdays lost to illness.^[1],[6]

The interplay between burnout and empathy appears to be fairly complex. Alternating theories have proposed that high levels of burnout may result in a diminished ability to demonstrate empathy. However, diminished empathy might be a self-protective mechanism to minimize the development of burnout. Empathy and burnout may also have an inverse relationship: as empathy increases, burnout symptoms decrease, or vice versa.

Although the provision of compassionate and empathic patient care seems like a simple concept, it might be incredibly difficult at times. We collectively suffer from job-related stress and burnout from many angles: electronic medical record requirements, burgeoning clinical demands, increasingly complex patients, legislative issues, or others minimizing our expertise and value are all a constant source of background job-related stress. Given their own struggles, physicians may find it challenging to reflect on the difficulties and stressors that others encounter. In certain circumstances, physicians may intentionally depersonalize patients as an act of self-preservation when they find that the collective emotional burden of patient suffering is too much to shoulder.

Strategies for Empathic Patient Care

So, what can be done? As providers of analgesia (acute and chronic), it is imperative that we recognize our patients’ vulnerability and strive to retain or rebuild our dedication to providing empathic patient care. As I’ve outlined, this might be an incredibly challenging proposition, but it may pay profound dividends for you (improved provider well-being, decreased burnout, improved patient satisfaction scores) and your patients (improved outcomes, improved adherence). A few strategies might improve our collective ability to provide empathic patient care. Previous research demonstrated that brief empathy training sessions might have a significant impact on patient perceptions of physician empathy.^[9] Being mindful of barriers to empathic care or seeking out opportunities to learn the struggles patients are encountering may help to improve patient care.

Likewise, working on being empathic toward other people in your life can have benefits. First, try to consider how your long hours might affect your family and the sacrifices they made to buoy your career (thank you, Carrie, Cora, Rose, and Evie). Consider the difficulties that the nurses that you work with encounter, and the impact that the physical demands of their job and increasing regulations might have on their career satisfaction. Consider how your anesthesia colleagues are experiencing the same work-related stress as you, and how you might be able to improve their day by providing them with a break, or pitching in when their clinical demands become overwhelming. Perhaps even take a little time to consider why a surgeon might seem so unreasonable. Is he or she stressed, knowing that an operating room delay prevents him or her from attending a patient-family conference, or will make a whole clinic of patients upset over appointment delays or cancellations?

We have no easy answers. However, this fall I encourage you to be mindful of your ability to practice medicine and interact with colleagues while providing empathy to those who cross your path. Improving your ability to do so will improve your relationship with patients, the care that they receive, and your career satisfaction.

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