Interview with an emergency doctor about his search to find his empathy again – a humbling read

Dr Brian Goldman, an emergency room physician, at Toronto’s Mount Sinai Hospital, always felt himself to be a thoughtful doctor, that was until, 30 years into his career. Goldman, accused by the loved one of an elderly patient, of being unkind, found himself in the position of wondering if this was the case? He subsequently did some very honest thinking, analysing of his behaviour and perceived attitude; had he really lost his ability to have or at least demonstrate empathy?

This led Goldman on a 2-year global journey and subsequent book The Power of Kindness: Why Empathy Is Essential in Everyday Life. The below interview by The Star shows some of the deeply human experiences that have empowered Goldman to not only ti use his clinical skills in his work but utilise that human connection, of which empathy plays a powerful role in.

Much study is done on burn-out, with often conclusions stating that the more empathic the health professional is, the quicker they burn out. What often is overlooked though, is the empowering benefits us human beings get from connecting with others. Whether this is in a clinical role or everyday personal life. The problem arises with no support is there for us, when long working hours deplete our energy levels and resilience, when a lack of empathy shown back to us from those in leadership roles is evident, and when  systems and sometimes even patients and loved ones, yes, fail to show us empathy and kindness, then of course, any human being, including any nurse or doctor, can get burn out.

When I train in empathy, one of the things I draw attention to is the need for it to be two way. Whatever our job role, or gender, age or race, we all have the need for empathy and kindness, compassion and care (self-care too!). Burn out occurs from giving too much and not getting enough back, allowing for an imbalance and depletion in our empathy levels. Let’s be honest, we can even get burn out with our own children (particularly teenagers) when we are giving so much and they fail to empathise with us! And we love them!! Dr Goldman, however, listened to someone’s assessment of him and asked himself some honest questions and as a consequence has empowered himself professionally and personally in doing so.

Having lost my child in a hospital and challenged the lack of empathy shown towards me in the aftermath, (forming part of the training I now do with healthcare professionals and complaints teams now), if I was one of the relatives that spoke so honestly to Dr Goldman, on reading the below article I would feel not only empathy for him and kindness but uplifted also. A humbling read.

Original article: 

brian_goldman_cred_christopher_wahl_The emergency room physician, Dr Brian Goldman,  knew he was a thoughtful doctor and a caring husband and father. But he wondered whether his 30 years of treating patients in a busy downtown hospital had worn away his empathy.

Those brooding thoughts turned into a two-year search for kindness that took him across Canada and around the world. On his travels, Goldman, who is also the host of CBC Radio’s White Coat, Black Art, interviewed top neuroscientists, hung out in laboratories and underwent psychological testing to determine his own capacity for kindness.

But even more important to his pursuit, he says, were the extraordinarily kind people he met along the way.

Goldman has turned his journey into a book that describes these encounters and details his own reflections on what it means to be kind.

In , readers get to meet, among others, a woman from Sao Paulo, Brazil, who reunites a homeless poet — a man she calls her soulmate — with his family, the bar owners in New York City who have created a safe space for 9/11 first responders and Mark Wafer, who owns six Tim Hortons restaurants in Scarborough and who has made it a priority to hire people with disabilities.

You tell us at the beginning of the book that you worry you have lost your kindness, that the empathy you remember having as a kid is no longer with you. Is there one particular moment that sticks with you from your career as a physician or from your family life that made you think that you had lost your kindness?

Yes, indeed. It happened when I saw an elderly woman in the emergency department who was in the advanced stage of a degenerative disease. The family had brought her to the emergency department because, though they had been doing their level best to care for her at home, they felt they could no longer do so. She had no acute medical issues that required immediate admission to hospital — she wasn’t dehydrated, she didn’t have pneumonia, she didn’t have a fever — but they were at the end of their rope. They wanted her to be admitted. In fact, I did that. But I wasn’t kind about the way I did it. There was something begrudging in my attitude. At one point, one of the family members asked if I had done the referral and I snapped at this person. A few months later, the woman had passed away and the husband wrote me a letter, inviting me to meet with the family. He told me flat-out in the letter that he thought I was unkind, and the reason he wrote the letter was because he thought I was salvageable, that there was a human being under that moment of unkindness. Eventually, I met most of the immediate family and we all had a good cry in that meeting. It was that encounter, more than any other, that set me on this road and made me want to look inside myself — and also around the world to try to figure out what kindness looks like.

Kindness is the most important thing we learn in kindergarten. As we get older, it seems to matter less and less in our institutions. Why is that?

That’s a tough question. There are many reasons. Christian Keysers (co-director of the Social Brain Lab at the Netherlands Institute for Neuroscience in Amsterdam) told me that we are all hard-wired for empathy, but we also have this giant frontal lobe (in our brain) in charge of executive function. Keysers said to me that empathy is a choice — not including psychopaths and Machiavellians and narcissists — but for all the rest of us, empathy is choice. And for the rest of our lives we will have these competing interests in our daily priorities. So, you’re running to catch the bus for an important job interview and you see a child who has fallen off her tricycle. At that moment, you have to weigh your important job interview against this child who needs you. We are constantly weighing what it is to be kind in the moment. I think the reason why it gets more difficult to be kind is because we have so many competing interests that it taxes our ability to do the right thing at the right time.

You work in medicine, so data and double-blind studies are kind of your thing. But for this book, for the most part, you chose to write about individual people. Why did you focus on stories, rather than studies?

To me, kindness isn’t found in studies. It’s found in the one-on-one relationships between partners, between a therapist and a client, between a mother and a newborn baby, between two friends in a coffee bar who are matching each other’s hand gestures and speech patterns. I included some studies, where they were pertinent, because there is fascinating research into empathy and kindness. But I knew that if I wanted to become a kinder person, I needed to learn from the examples of other people who are kind, by finding out their stories. And I also know that in the emergency department, when I’m seeing patients, it’s not studies that count, it’s me and how I interact with the patients that count.

On your journey, you met many extraordinarily kind people. Is there one person who sticks with you, one person who you think of more than others, even now that your book is complete?

I think most often of Naomi Feil, the woman who pointed out to me, for the first time in my career as a health professional, that people at the end-stage of dementia who say things repeatedly and seem agitated are doing and saying those things for a reason. And, if you give them an opportunity to express what they are feeling, and not try to pull them back into the here-and-now, you can help them by validating their feelings, so they can release those feelings and be less agitated. No one taught me that.

That would be a useful lesson for a physician, but also as a human. Have you had an opportunity to use that lesson since meeting Naomi?

Yes. Since then I’ve had loved ones with dementia, including my father-in-law. Whenever I would see him, I made a point of never testing his memory to see if he seemed disoriented. I wanted him to know that I loved him for who he is and not for what he remembers. And I’ve used that kind of approach, thanks to Naomi Feil, in the emergency department as well.

What steps are you taking to bring back your kindness?

First, I breathe. I breathe into a count of six. I hold my breath to a count of six. And I exhale to a count of six. I’m breathing, I’m feeling air entering my lungs, it helps to centre me. Second, I clear the clutter in my heart and in my head. I try to let it float by like a balloon or a float in a parade. Any intruding thoughts — a bad memory, a conversation that didn’t go well, somebody who doesn’t have nice thoughts about me — I don’t judge them, I just let them float by until they’re gone. I try teleporting myself to the ceiling. I try mentally floating over to a spot above the person that I’m trying to be kind to and I float down right beside them. I imagine I’m with them. How are they feeling? How is life going? What’s bugging them? And finally, I remember to smile. Not smirk — smile.

What is the one thing we can all do today to make the world more kind?

The sweetest kindness in the world is the unexpected kindness. It often comes from people who you believe to be your enemy. You can’t control how they think about you. But you can certainly change things. And the way to change things is be unexpectedly kind to them.

This conversation has been edited for length and clarity.

 

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3 thoughts on “Interview with an emergency doctor about his search to find his empathy again – a humbling read

  1. I commend Dr. Goldman for looking inside himself, and embarking on this book after learning he was unkind. A lot of physicians would be too arrogant to do so. My father, a cardiologist, was in the end stages of heart failure when my sister brought him to Yale-New Haven. The doctor on call told her never to bring him to the hospital again, that he was a lost cause who should die at home and not take up a hospital bed. His treatment was especially shabby and appalling given the number of years of compassionate and caring treatment my father gave to his patients. As we sat with a team of doctors to discuss my Dad’s final days, I thought, “One day you will all be older too, so try not to be so pompous and arrogant.” This book should be required reading for all physicians.

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    1. Thank you for your heartfelt comment. I am so sorry to hear that you, your sister and your dad were treated with lack of empathy and kindness, when you needed it the most. It’s why I am committed to doing what I do. Having lost my child and been treated with a lack of empathy, taking physicians and healthcare professionals on a learning journey of what being empathic means, is something that I not only believe in, but the evaluation from those attended my training shows how it challenges attitudes that can cause so much harm. Messages like yours, demonstrates again how important it is to show care. Thank you so much for sharing this with me. Dr Goldman demonstrated self-reflection that I so yearned for from the clinicians responsible for the treatment of my daughter and subsequently of me, which was why I chose to write an article about it. My background of counselling and psychology also made me realise how vital this was. I wish you and your family well. Thank you for sharing your dad a little with me.

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      1. I’m sorry to hear that you received such terrible treatment and lack of empathy when losing your daughter. It’s hard for me to fathom such cruelty. I was thinking about this later yesterday, and thought how awful it is to be treated so shabbily in the final stages of life. But I think we all have horror stories of being treated poorly by physicians, and I think it’s getting worse. My mother was recently brushed off for weeks by her longtime gastroenterologist when she tried to get an appointment. She was told by the staff to stop bothering them because they had a roomful of sick patients in the waiting room. My mother was particularly offended because she had been married to a physician for 52 years, and knew my dad would never treat someone so poorly.

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