Integrative Care
Policy News

Seeing the human being prevents burnout

19 September, 2012 by David Finer

– In a caring conversation with a patient, we may suddenly see them as fellow human beings with their own life story. That is a good prescription against burnout, said kidney specialist and author Astrid Seeberger during a theme day on altruism and compassion in Stockholm recently.

The theme day was arranged by the steering group behind CCARE, a planned transdisciplinary center for research and training around altruism, compassion and social sustainability at individual, group and societal levels.

We may believe that compassion is complicated and time-consuming. But a simple gesture like a telephone call or briefly touching the other person physically can make a big difference.

Wanted to commit suicide
Stefan Einhorn, professor of molecular oncology at Karolinska Institutet and well-known author told the story of a man whose wife had died from cancer. The widower felt so depressed, that he wanted to commit suicide.

But I changed my mind, the man said. A week after his wife had died, a nurse called him to ask him how he was doing, “imagine that, a person who is that busy”. That act of compassion made him change his mind and go on living, said Stefan Einhorn.

A small token of human caring may suffice to communicate compassion and give someone fresh hope. Studies have shown that touching a person as briefly as for 1.5 seconds, is enough to communicate caring and create a positive feeling.

The value of generosity
There is a lot of scientific evidence demonstrating the value of generosity. When we collaborate with one another, MR images show activity in the same brain areas, which are activated by having sex, eating good food or taking narcotics. Moreover, good deeds spread like rings on the water.

There is no end to the number of things we can do for our fellow humans, and simultaneously get something in return. The greatest mistake is to not do anything, because one can only do a little, Einhorn continued.

But it is not enough to do the same things to others that we would like done to ourselves. The golden rule can lead astray. Einhorn suggested an update to 2.0: “Try to encounter others as they need to be encountered.”

Bu how can we possibly know how others wish to be encountered? He continued rhetorically. His answer: ask them or use your empathic abilities. Every human encounter is a training opportunity in empathy, if you really listen and try to elicit the other person’s experience.

Between care and cruelty

But if we know the right thing to do, why don´t we always do it? There are lots of countervailing forces in play, which we would do well to recognize, such as aggression, prestige, time constraints and having a sacrificial mentality.

Experiments also demonstrate that nice, ordinary people are capable of doing awful things, Einhorn said, quoting the prematurely deceased Swedish psychoanalyst Ludvig Igras’s famous book title: “The thin membrane: between care and cruelty” (without explicitly crediting Igra by name).

A thin membrane separates us from the abyss, he said, screening the well-known Biergarten scene from the movie Cabaret, in which Brian and Max a beautiful Summer’s day witness how an idyllic open-air restaurant turns into a Nazi rally to the tune of “tomorrow belongs to me”.

”Shameless” curiosity opens up
Astrid Seeberger, kidney specialist and author of the book “Shameless curiosity” talked about improving patient-physician communication and the art of listening.

– There is a need to improve the way health care staff and patients converse, and it relates to quality of medical care as well. My grandfather often said that you have to be shamelessly curious to have good conversations. It is a curiosity beyond good and evil, being able to listen without judging. When that happens, masks fall away and a person can open up and reveal their innermost core. This provides strength and insights, which may be life changing, Seeberger said.

The consultation talk is also an important instrument for making a correct diagnosis. Studies reveal that 15 percent of diagnoses are incorrect. This is not due to gaps in knowledge but mainly attributable to other factors such as flaws in patient-doctor communication.

But it is also important not to get stuck in diagnostic clichés or rigidly apply guidelines without considering the patient in front of you.

– We may be brilliant diagnosticians and follow guidelines to the letter and still end up all wrong, if we don’t work together with our patients, Seeberger said.

Talking improves concordance
Seeberger mentioned the oft-quoted figure 50 percent of patients, who are non-compliant with treatments. She also referred to the concepts adherence and concordance, however without acknowledging the differences between them.

 – Often the patient is given a brochure, where they can read about the disease and the treatment, but how can the knowledge be incorporated? You have to provide knowledge with emotional putty or cement, and that is where having a dialogue comes in, Seeberger pointed out.  

The mirror neurons were a sensational discovery, and humans have more of them than any other species, which should potentially make us warm and compassionate. People are created for direct meetings face to face, not for encounters in cyberspace, which instead have the effect of reducing the number of mirror neurons, she went on.

In a caring conversation with a patient, we may suddenly see them as fellow human beings with their own life story. That is a good prescription against burnout. Then everything becomes – in Joseph Conrad’s words – “wonder and delight”, Seeberger concluded. 

Recognition behind empathy
Jakob Eklund, from Mälardalens Högskola (billed by the moderator as the leading expert on empathy in Sweden) discussed definitions in the field. Empathy consists of the three intertwined components compassion, emotional (non-manipulating) understanding and altruistic caring.

Empathy means profoundly taking in another person’s existence, involving both people being in touch with cognitively, emotionally and motivationally. But without feeling, empathy would be blind and capricious, like a long-distance orienteering runner without a map or compass, Eklund said. And without care, empathy would be indifferent.

When asked what elicits their empathy, people often say “recognition”, being able to identify with the other person, which then leads to a feeling, an understanding and a sense of caring.

Eklund said there is a need for a Centre for Compassion and Altruism in Sweden, and that it must be inter-disciplinary, since the various academic disciplines currently dealing with the area (psychology, teaching, sociology and so on) do not know what the others are doing. And the same goes for societal institutions.

Self-compassion in adversity
Katja Claesson, PhD, psychologist and psychotherapist, introduced the difference between self-compassion and self-esteem.

Self-compassion is a compassion we can feel in the face of adversity, being able to give oneself support and sympathy, even when one is feeling sad/bad or going through a crisis. Whereas self-esteem is more about patting oneself on the back, when we perform well.

Shame – the subject of Claesson´s thesis – is the worst enemy of self-compassion. The antidote is allowing ourselves to become childlike, vulnerable and helpless, perhaps even to the extent of letting a higher presence take over.

12 years’ with HealthWatch
Dan Hasson, a researcher at Karolinska Institutet and the Stress Research Institutet at Stockholm University, presented 12 years’ experience with, a web-based tool for stress management and health promotion.

The service is complementary for private individuals or groups of up to 25 people, including small companies, which may lack the necessary competence or the resources for proactive environmental work. Currently, the website has 15 000 users.

Content is mainly health news, self-help applications and occupational environment surveys. Positive research results have been registered in terms of social support, ability to concentrate and handle stress, improvements in sleep quality, recovery and more. Overall, these improvements tend to be short-term.

The theme day ended with a panel discussion. The steering group will continue working towards establishing an inter-disciplinary centre, doing a needs analysis and applying for funds. Many questions remain to be answered; such as under which auspices such a centre would be run.


David Finer

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