Compassion: A powerful skill for emergency trainees

‘How do you do it? ’ I once asked my consultant, who is consistently calm, kind and on top of things, even on the most turbulent shifts. She told me about a nightshift she had worked in a hospital that had run out of cannulas and IV tubing on the same night the heating failed. ‘You just do the best you can with what you’ve got’. She had taken warm fluids from the shelf and handed them to patients as makeshift hot water bottles. ‘You have to remember that you didn’t create the situation. You are just here to help as best you can, using whatever resources you have’. We meet people on their worst day, at their most anxious and terrified. The way we do what we do matters. In a study of life-threatening medical emergencies, patients who perceived greater compassion in their healthcare providers developed fewer symptoms of post traumatic stress disorder. Patients who feel their practitioners are more compassionate are more likely to comply with treatment recommendations, take prescribed medications and follow discharge instructions. Compassion does not have to be something extra we do in our shift, another tick box, a chore. It takes only 40 seconds to make a meaningful difference and many of us already do it without realising. Compassion in medicine is not ostentatious. It is hidden in plain sight. It is the way you crouch down to eye level with the patient when you take their story; the way you ask, ‘what questions do you have for me? ’ and the pause at the end. It is in the softness of your voice when you call a family member to say they need to come in, quickly. It comes so easily when we have the time, but as we are squeezed tighter and tighter by flow, bed block and ramping, any extra seconds at the bedside feel like a luxury we can no longer afford. Trainees occupy a unique role in the ED, taking on their own patient load while supervising junior staff and learning how to manage the department. As we gain experience, our patient assessments become more efficient and the time we previously spent at the bedside is funnelled into other priorities such as hearing a story or helping with a difficult procedure. As we progress to consultants, is compassion something we should delegate out? Senior clinicians set the tone for the whole department and the difference between someone who leads with compassion and someone who does not is palpable. As registrars, we have the power to amplify or dilute that tone as it filters through the team. If we do this well, we set the standard for those around us – regardless of the hierarchy. The ED is the source of acute work for much of the hospital. We interact with inpatient teams, radiology, security staff, allied health, administrators, paramedics, ward teams and more. There are many points of friction within this network, but we have the power to decide what that looks like. It has been shown that incivility in medical settings increases error and reduces the standard of care. Sharing a joke with the surgical registrar may seem trivial, but the flow-on effects are not to be underestimated. Frequent interactions with inpatient teams give us the opportunity to drive interdepartmental collaboration, with positive effects on both patient care and broader hospital culture. The effects of such compassionate interactions can reverberate for years. On my first rotation through ED as an intern, a consultant took 15 min to coach me through a fascia iliaca block. It was the best moment of the term. I felt seen and supported, like I was more than just a line on the roster. I recalled that moment vividly 4 years later, as I walked an intern through the same procedure for their first time. They were excited, and I was surprised. I had not realised teaching would be just as rewarding. Truly compassionate care does not deplete us. It is not something we give to others at the expense of our own well-being. Functional magnetic resonance imaging scans show that when someone experiences empathy – the feeling and understanding of another person’s emotions – the pattern of activation overlaps with the experience of pain. However, when they focus on compassion – which involves actively trying to alleviate another’s suffering – activation occurs in brain areas that are associated with positive effect and reward. We get to help, and it feels fantastic. The evidence suggests that these things help us, too. The simple act of doing something to help others can boost our sense of efficacy and purpose and can mitigate the effects of stress on our emotional state. Compassion is an essential skill that improves the health and safety of our patients, the experience of our colleagues and the culture of our departments and hospitals. But Correspondence: Dr Charlotte Durand, Emergency Department, Royal Darwin Hospital, 105 Rocklands Drive, Tiwi, Darwin, NT 0810, Australia. Email: charlottedurand@icloud.com