Can Clinical Empathy Survive? Distress, Burnout, and Malignant Duty in the Age of Covid‐19

Abstract

The Covid‐19 crisis has accelerated a trend toward burnout in health care workers, making starkly clear that burnout is especially likely when providing health care is not only stressful and sad but emotionally alienating; in such situations, there is no mental space for clinicians to experience authentic clinical empathy. Engaged curiosity toward each patient is a source of meaning and connection for health care providers, and it protects against sympathetic distress and burnout. In a prolonged crisis like Covid‐19, clinicians provide care out of a sense of duty, especially the duty of nonabandonment. We argue that when duty alone is relied on too heavily, with fear and frustration continually suppressed, the risk of burnout is dramatically increased. Even before Covid‐19, clinicians often worked under dehumanizing and unjust conditions, and rates of burnout were 50 percent for physicians and 33 percent for nurses. The Covid‐19 intensification of burnout can serve as a wake‐up call that the structure of health care needs to be improved if we are to prevent the loss of a whole generation of empathic clinicians .

Supporting cancer care clinicians to ‘hold’ their patients during and beyond the COVID‐19 pandemic: a role for reflective ethics discussions

“…1 Patients with cancer require clinicians to engage with their needs both cognitively and emotionally, to assist them to be autonomous and to feel safe. 2,3 Salmon and Young 2 characterise this therapeutic relationship as a type of attachment, where patients are able to rely on their clinician to hold and protect them through a combination of clinical expertise and empathy. Originally applied to parent-infant relationships, in clinical and adult relationships, attachment theory explains the emotional bonds a person may form with someone who has power to protect them.…”

“…Cancer care is characterised by high‐quality research and targeted evidence‐based treatment protocols together with collaborative and integrated models of biopsychosocial care which acknowledge and address the life‐altering impact a cancer diagnosis has for a person 1 . Patients with cancer require clinicians to engage with their needs both cognitively and emotionally, to assist them to be autonomous and to feel safe 2,3 . Salmon and Young 2 characterise this therapeutic relationship as a type of attachment, where patients are able to rely on their clinician to hold and protect them through a combination of clinical expertise and empathy.…”

“…Clinicians' capacities to ‘hold’ their patients are internalised and virtue‐based ethical practices, which animate ethical duties to benefit, to avoid harm and to respect each patient 3 . Although absorbed within their professional identity and role, the ethical work of holding is nevertheless energy intensive 3 and COVID‐19 has both disrupted and amplified this work.…”

Running on Empty

“…1,2 Novel and intolerable pressures have been placed upon health care systems and workers during the crises affecting their capacity to effectively and safely care for patients. 3,4 Nurses are educated to deliver patient-and family-centered holistic care within their health care settings and rely on clinical empathy to understand and meet the needs of their patients and families. Although national organizations such as the Hospice and Palliative Nurses Association, American Organization for Nursing Leadership, American Nurses Association, American Association of Critical Care Nurses, and American Association of Nurse Practitioners have quickly recognized the undue stress nurses are under as they deliver care in the midst of the pandemic, the impact on nurses' clinical empathy is not fully understood.…”

“…The pandemic has placed a severe strain on the ability of caregivers to provide care to patients in the usual manner because of increased workload demands, staffing shortages, deficits of personal protective equipment (PPE), and the severity of the COVID-19 illness 10-13 . Studies have examined the experiences of frontline workers during the pandemic and describe challenges including the inability to provide a human comforting connection, unfamiliarity with the environment, disease, ongoing changes in practice guidelines, and witness to extraordinary patient suffering and death 3,4,6,14,15 . This has resulted in the substitution of clinical empathy by a sense of duty to provide care to patients, putting nurses at a high risk for physical and emotional distress 3,4 .…”