Making time for love and compassion in clinical encounters

These past weeks have been a time of deep reflection for me, looking for ways to reconcile new tools in Information and Communications Technology (ICT) with basic holistic components of who we are as family physicians.

It has dawned on me that COVID has robbed us in so many ways, removing that inner sense of self and purpose while leaving us feeling isolated and alone. The tools we quickly put in place to maintain continuity of care with our patients were the same demons that had already begun to erode one critical ingredient needed for compassionate relationships with our patients – time!

My entry into the world of electronic medical records began literally the day the pandemic was declared. The ICT tool that in so many ways rescued my practice allowed remote patient encounters, SMS, video and sending requisitions and scripts to pharmacies. An effective platform to maintain billable services as a family physician is now the beast needing to be tamed and kept under grip lest it steal even more from my relationships with patients I am privileged to care for.

Sylvia MacSpadyen, an expert in system design, told me during this journey that there is a difference between “caring for patients’ and “making patients feel cared for.”

How so? How might I express caring and compassion, true empathy to the people I know as patients?

Ian McWhinney, known as a founding father of family medicine,  would have spoken about “friends with expertise” but building friendships takes time. Patient/provider friendships are more than episodic and convenient digital encounters to fill a script, order a test or address a symptom. They are longitudinal relationships built upon trust, at times precarious and uncertain but at others precious and endearing.

During my counselling for patients struggling in marital or family relationships, I will often reference Gary Chapman’s The 5 Love Languages. This concept, while ridiculously simple, is one of the most common ways that couples fall out of love, neglecting periodic barometer checks of their relationships and practicing the simple means of staying connected with their spouses.

But what if we were to look at these five love languages in the context of the doctor-patient relationship. What if we replace the word “love” with “compassion?” How might this look within our dealings with patients?

Chapman outlines that each of us feel loved when we are on the receiving side of one of five ways people express love – or compassion – to each other.

1. Words of affirmation: “Great job;” “You’re a great mom with your kids;” “What a great story.” There are many ways we can make people feel good about themselves or their abilities. In the context of the clinical encounter, we can do this without breaching boundaries by complimenting our patients on their parenting skills, telling them they are kind, sincerely thanking them for their time waiting or reassuring them that “it’s OK.”
2. Gifts: While perhaps harder to do and not always appropriate, the gifts can be simple and small. We used to have a gumball machine at the office that children could put a penny in and receive candy after vaccination. A digital e-card for birthdays or special occasions may go a long way toward expressing compassion and are not expensive endeavours.
3. Acts of service: Helping our patients get up; pulling off their socks or helping them slip shoes back on during their visit; wheeling their chairs back to the waiting room. These are not frivolous acts but rather acts that speak volumes to our patients as to how we really feel about them.
4. Quality time: Note the element – TIME! We all know how annoying it is to tell our spouses or children about an event all the while their noses are buried in a digital device. Quality time is active listening – “yes, so what happened next;” “really, so what did you say” – and looking our patients in the eye during the encounter. I believe this is the most critical element stolen from us during patients’ visits.
5. Physical touch: Understanding boundaries and the need to be careful and respectful of our patients’ feelings – the soft hand on the shoulder as the patient leaves the room; a hug during incredibly trying and upsetting encounters. The most powerful part of the clinical encounter and the exam is that of touch. The laying on of hands to palpate, percuss or apply our analytical protocols has much more than rudimentary intent. It is that precious moment of patient and provider intimacy when we are allowed into their physical spaces, allowed to touch them and trusted not to harm them.

What is interesting about these five love languages is the way that love or compassion goes dim when we fail to distribute these elements. It is noteworthy that we tend to “give” to others what we ourselves “desire.” By failing to receive what we desire, our love or compassion “tanks go dry,” according to Chapman. Withholding an element a person desires not only diminishes the feeling of being loved or cared for, it can feel abusive or hurtful. A person whose love language is words of affirmation will be devastated by criticism.

While as physicians we would never intentionally harm our patients, we may inadvertently diminish trust, compassion and caring within our clinical encounters by not giving “quality time,” “words of affirmation” or “acts of service,” for example.

However, to perform these elements well requires time. Time often stolen from us typing our encounters, filling out yet another field, referral form or lab requisition. That precious ingredient to build compassion in our therapeutic alliance with our patients is too important to ignore.