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I told a story at #SGIM19 (thanks to @gradydoctor and the incredible insight of @emilysilverman) about the difference between empathy and compassion. It is a difference I have been thinking about a long time, and would like to share this tweetorial on the topic 1/
In the story I talked about a patient facing deportation, and being separated from her children. My empathy for her situation overwhelmed me. Eventually I found it difficult to engage at all. I realized in retrospect what she needed was not my empathy, but my compassion. 2/
Traditionally, we have focused on the difference between sympathy and empathy. This was the difference that was emphasized in my early training. Let’s start by defining these terms. 3/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5405806/
Sympathy: A pity-based response to a distressing situation that is characterized by a lack of relational understanding and the self-preservation of the observer. 4/
Empathy: An affective response that acknowledges and attempts to understand an individual’s suffering through emotional resonance. (This kind of empathy is further defined as “emotional empathy” as opposed to “cognitive empathy”). 5/
We hold up empathy as the superior emotion because patients prefer it, and it is based on a more genuine connection. But only recently have we started talking about another crucial difference between sympathy and empathy: self-preservation vs daily wounding. 6/
(As a side note, I wonder if those in education don't worry as much about the wounding because they tend to do less patient care and so have more recovery time.)
Those with higher empathy scores are more likely to have chronic inflammation. We do see that empathy is higher in those with lower burnout scores, but the direction of the effect is poorly established. 7/
When we make it clear we mean feeling the emotional distress of the patient, it is more consistently a risk factor for burnout. 8/ https://journals.sagepub.com/doi/full/10.1177/1744987116678902
So why do we talk about compassion as an alternative? First, a definition. Compassion: A virtuous response that seeks to address the suffering and needs of a person through relational understanding and action. 9/
How is compassion different from empathy? The primary differences are motivation and boundaries. It is closer to cognitive empathy, where we reason through what someone is experiencing, than affective empathy, where we feel their pain. 10/
Compassion is also motivated by action, particularly small acts of kindness and an ability to be in the moment, and a clear understanding of our role as caregivers. It is, as @stefankersetz recently put it to me, “engagement with boundaries.” 11/
This difference is crucial and difficult to describe. So I would like to reiterate in a different way. 12/
Sympathy: You recognize the suffering, but don’t feel connection.
Emotional empathy: You feel it
Cognitive empathy: You can think through it
Compassion: You’re moved to action while recognizing your separation from the sufferer, and the small but important role you play. 13/
Emotional empathy: You feel it
Cognitive empathy: You can think through it
Compassion: You’re moved to action while recognizing your separation from the sufferer, and the small but important role you play. 13/
Try this exercise: Consider a person suffering. Try to feel what they are feeling. Notice how it affects you, and your ability to think through the next steps. 14/
Now think about a person suffering. Imagine them being relieved of that suffering. How did they get there? Are you able to more clearly think about their situation, and the small but important role you might play as a caregiver? 15/
Emotional empathy is an overwhelming, visceral feeling that I have almost every day in practice. It can help me engage but it is like a fire: not as illuminating as it is dangerous. 16/
Compassion is a practice that I try to engage in every day. It helps me stay present, and remember my role without being consumed by what I cannot change. It is a skill I will spend a lifetime developing. 17/
For my patient, when I felt empathy deeply, it was painful to be present with her. I undervalued the small things I could do for her because they weren’t going to fix her situation. 18/
When I was able to practice compassion, I could be her companion. I could give her a safe space to express her distress without taking it on as my own. I could think through small ways of supporting her even if I couldn't undo her suffering. 19/
Empathy is important, but it has to be managed. If we mold empathy into compassion, and give what we can, when we can, our relationships will be richer. Our vision will be clearer. Our ability to thrive and keep showing up will be strengthened. 20/
So here's wishing you compassion, for yourselves, for your patients. May you let the fire warm but not burn you. 21/21
Ah woops @ESilvermanMD though @emilysilverman seems great too
Also @StefanKertesz in my defense I just got back from my fourth cross-country trip in two months
