There has been an increasing focus on the professional role of the doctor in the interest of their critical participation in the Covid-19 pandemic. Considering their occupation, physicians have a greater ‘duty of care’ to ‘Apply [their] knowledge and skills when needed’ (AMA, 2002, p. 145) despite potential risks, as and when expected by the public (AMA, 1955). This does not imply such duties are absolute but suggests, particularly in view of a pandemic, a general responsibility for doctors to utilise expertise as well as critical soft skills. Namely, compassion and teamwork greatly contribute to quality patient care.
Compassion can be defined as ‘sympathetic pity and concern for the sufferings of others’ (oxford dictionary, no date). It is intelligent kindness (NHS), that is linked with but ‘extends beyond empathy’ (the lancet, 2020) due to the added motivation to help alleviate suffering in others. Compassion does not involve ‘feeling with the other’ (Tania singer, Olga M. Klimecki 2014) but instead feeling concern for and desire to better their wellbeing. It is what motivates us to take action, a vital skill in doctors, being that they possess ‘the wisdom to know what is required’ and how to implement it (Harriet Harris, Marti Balaam, 2020).
Displays of compassion can vary. ‘Proximal compassion’ involves alleviating current suffering, whilst ‘distal compassion’ refers to the avoidance of future suffering. It is important doctors can identify how to help in the now, whilst also educating patients and implementing necessary measures to aid in their future (Paul Ekman, no date). During placement, I observed a patient who had been prescribed medication to tackle his diabetes but had also, worked with his doctor to make the necessary lifestyle changes, mainly dietary, to manage his health condition in the future. Such discussion builds trust between doctor and patient as well as allowing the patient to feel secure in managing aspects of their care. Showing compassion and building a rapport allows patients to feel heard, thus preventing ‘hasty, undiscerning attempts’ to subdue affliction (Dr kitty whether 2020). This is of particular importance due to Covid-19, which has resulted in an influx of patients, and the inability to physically consult many individuals with unrelated conditions. As such many consultations have occurred over the phone and through the use of photographs. Upon GP observation, I saw a greater emphasis on communication and the ability to explicitly convey information between doctor and patient. Compassion also allowed inference of a patient’s state, allowing GP’s to reassure them of uncertainties surrounding their health and access to care in light of the pandemic. (Tania singer, Olga M. Klimecki 2014).
The nature of compassion continues to be debated with/alongside various studies indicating both an innate and learned origin. Neuroscience has demonstrated neural networks in the brain that ‘are hard-wired to share the experiences of others’ (Beth A. Lown, 2015). Alternate studies, namely Antoine Lutz et al propose compassion can also be learnt suggesting that ‘mental expertise to cultivate positive emotion alters the activation of circuitries’ (Antoine Lutz et al., 2008). We are born with the capacity for compassion which can be developed through our interactions giving rise to use of compassion training (Beth Lown, 2015). Particularly in medical students, compassion can be built upon through training and shadowing of doctors demonstrating such skills. This cultivates a better ability to cope with stress and adapt emotions and responses to individual patients.
Compassion also relates to the self and can have varying physical and mental effects on healthcare professionals. Self-compassion involves ‘taking an understanding, non-judgmental attitude toward one’s inadequacies and failures’ (Neff, 2003). Self-compassion drives reflection and studies have shown it ‘attenuates peoples’ reaction to negative events’ (Mark R Leary et al., 2006) leading to improved psychological well-being and ability to cope when exposed to stressful situations. Compassion for the self and others can reduce stress (Allen & Leary, 2010) and improve wellbeing. Particularly in the time of Covid-19, it also highlights a ‘common shared humanity’. Awareness of a mutual struggle can help us recognise that we aren’t isolated in our suffering (Kristen Neff, no date).
As a doctor, negative implications can include compassion fatigue (CF) which is a condition that arises from secondary stress and ‘unboundaried empathy’, individuals wish to relieve suffering but may lack the capacity to do so (Nolte et al, 2017). It is a ‘state of exhaustion’ (Figley, 1995), irritability, and diminished ability to empathise which can impair a professional’s ability to effectively care for patients (Fiona Cocker, Nerida Joss, 2016). Particularly in context of the pandemic, Doctors and nurses may have insufficient resources or feel perceived inability to help upon witnessing death and distress in many Covid-19 patients in intensive care. Their increased risk of exposure to infection adds to concern and can create an unwillingness to associate with friends or family, for fear of transmitting infection. (Wallace et al., 2020). CF can jeopardise the health of an individual and compromise quality of care for others, it ‘also signals a need to feel more supported’ (Dr. Kitty Wheater, 2020) which highlights the significance of teamwork in the workplace and support in the wider community.
The NHS states that teamwork involves people ‘working through collective endeavours towards a common goal. Teams are an intrinsic component of the healthcare system where common goal primarily refers to the delivery of quality patient care. Teamwork is a ‘cooperative process’ (Scarnati, 2001, p.5), that incorporates a range of knowledge and invaluable skills to deliver better results than could be obtained by isolated individuals (Francis & young, 1979).
According to the GMC, such collaboration involves respecting and encouraging ‘skills and contributions’ of colleagues as well as actively listening to any concerns raised. Diversity of knowledge within teams allows for recognition of errors or alternative routes that may not have been identified by a single individual. Additionally, Lencioni acknowledges ‘fear of commitment’ which involves placing ’artificial harmony’ over ‘constructive criticism’ as one of his five key dysfunctions of a team. In theatre, I observed the importance of contributions in a team, when problems arose concerning insertion of a catheter during surgery, another surgeon debated alternative routes to the current method and upon discussion, they were able to advance successfully. The rapid decision making among the team, and ability to adapt clinical knowledge in quite a stressful situation stood out to me. In addition, open communication is also critical between ‘vertical divisions of hierarchy’ with reviews suggesting that poor response of supervisory teams to medical errors provides limited opportunity for reflection and improvement (Richard N. Keers et al, 2013). This reflects an interdependence in teamwork whereby, there is a reliance on feedback and contributions from all members. As such, team members must be comfortable in sharing their knowledge but also in providing constructive criticism to each other (Harris & Harris 1996) to reflect on errors and progress, building synergy within teams.
Teamwork can ‘offer greater adaptability, productivity, and creativity’ to patients’ care (Salas et al., 2000) given that effective skills are implemented within the team. Clinical care involves transitions of care between specialists and units forming multi-disciplinary teams ‘who must constantly interrelate’ (Sutcliffe et al, 2004), and accurately share crucial information to coordinate care. Research by Sutcliffe et al. reported 91% of medical mishaps related to communication failures, citing it as the main factor contributing to preventable patient harm. Good communication within and between teams creates an environment of trust, allows for individual reflection, and significantly reduces the risk of patient harm.
Team composition is crucial to effective patient care. Members must be clear on their specific roles and be ‘accountable for their contribution’ (Pina Tarricone, Joe Luca, 2002). Upon delegation of roles, it should be ensured individuals have the appropriate knowledge and training necessary. Accountability of the roles you have taken on is equally important, for example, doctors who chose to ‘opt-out’ of frontline work risked placing burdens of workload on their colleagues who were already experiencing the unprecedented stress of the pandemic (Stephanie B Johnson, Frances Butcher, 2020). Whereas recent retirees and senior medical students who volunteered in response to COVID-19 acted to relieve workload and support the other teams by collectively sharing responsibility. Prevalence of such team spirit and engagement particularly in current times can avoid burnout and stress which could compromise patient safety and the general wellbeing of practitioners.
Skills of compassion and teamwork are fundamental for success in a medical career. As a medical student, I should practice such attributes to the same level of professionalism through interactions with fellow students, professionals, and patients. Constant reflection on my experience will aid me in my duties as a doctor to provide quality patient care and procure a high level of trust from my patients and colleagues.