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QA: Learning and Practicing Empathy and Compassion

Interview with Sunny Smith, MD, co-medical director of the UC San Diego Student-Run Free Clinic

QUESTION: In your own words, why is compassion such an important part of medicine?

ANSWER: People go into medicine because they are driven by compassion. They're full of compassion. They have desire to serve, desire to help others, desire to decrease suffering. Medicine as a profession is really all about compassion. The problem right now is that the systems that are in place in medical training and in medical practice really cause suffering in the people who are practicing medicine and it makes us lose our compassion. That is the core concept of what we're trying to address.

QUESTION: Do you feel if we're more compassionate to the doctors that we train, they'll be more compassionate to the patients they treat?

ANSWER: Medical trainees need to learn to have compassion for themselves because we are very perfectionistic and the culture exacerbates that. We become our own worst critics and set the bar higher and higher. We have to go faster and faster. Medicine, particularly in the United States, has become a bit of a productivity measurement where we're not making automobiles, we're curing human beings or caring for human beings.

If we can have compassion for ourselves and what we're feeling and compassion for others and no matter what they're going through to just have compassion for what they're feeling, whether it's frustration or sadness or joy because we are there as physicians through the entire spectrum of the human condition, from birth to death and everything in between. If we can be more present and more compassionate with ourselves and with our patients, I think it has a profound impact on the care we're delivering.

QUESTION: The stakes of medical training are particularly high because you're actually dealing with people's lives. You do need perfection. You're addressing life-and-death issues every day. You can't change the stakes in medical training, so how do you bring in compassionate if the pressures themselves are not altered? How do you make that situation kinder to the doctors themselves?

ANSWER: I think one thing that's really important is that we change the people who change the system, who change the culture, who change the expectations. If I'm permitted, I'll say something about when we spoke with the Dalai Lama. He talked about how inner peace and training of the mind and changing the way that you see things because if you believe that you can do something, you can, and if you believe that you're defeated, you are. If we believe that we can create a better, more humanistic caring system, one in which the physician and the patients are partnered together towards a common goal, then we can. What we believe inside becomes reality on the outside.

QUESTION: How do you define compassion?

ANSWER: Compassion is really empathy plus the desire to act. Physicians literally don't even have time to eat lunch or go to the bathroom. They're expected to be superhuman. We too are human. We are just like everyone else. We get sick. We have kids. Our baby sitters cancel. Medical students are the same. They have family members who fall ill or loved ones who get married and we have to treat them as the human beings that they are and allow them to go through the normal human experience while they're in medical training, which is a minimum of seven years, often very much longer. Then it becomes your entire career. We have to allow you to be a human being, to be compassionate for yourself and compassionate for your patients throughout this whole process and to create a culture that's less about perfectionism and more about compassion, understanding and healing.

QUESTION: What do you see the potential implications of this gift being, looking down the road five or 10 years? What changes?

ANSWER: The potential impact, when there's a crisis of burnout, mental health issues, depression and suicide among medical students, residents and physicians, is huge. We could create a culture of wellness and caring for each other and a culture in which your mental health does not decline over the course of your training, but stabilizes or improves. I think that forms the foundation for a healthy society because if your doctors aren't well and they're leaving, who's left to care for everyone?