Ethical Challenges in the Operating Room, Part II

While this is a professional goal each of us strives to reach, the circumstances of a busy operative schedule can be distracting, resulting in short visits with the

When it comes to strengthening the patient–physician relationship, there may be no better way to do so than with the true “bedside” encounter, when the patient is most vulnerable and the physician can be most caring and compassionate.

patient in the holding area and delegation of patient contact to others on the surgical team until the patient is asleep and prepared for surgery. It should be stated that while this is not necessarily unprofessional behavior, valuable opportunities to put the patient at ease and strengthen the patient–physician relationship may be missed. This relationship is an ongoing, dynamic one, begun at first contact and built upon throughout the length of the professional relationship. It is strengthened through mutual respect, along with attentiveness to visual and oral cues, and is primarily the responsibility of the surgeon/physician.

Although emergency department interactions often afford limited time for the establishment of a relationship between patient and physician, a patient who is awake and alert wants to know that the surgical procedure(s) will be undertaken by a surgeon who believes in the sanctity of human life and will care for the patient to the fullest of her/his capabilities. This relationship can be further developed in the postoperative period, when the patient needs reassurance and attention.

Sympathy versus Empathy

In approaching the best way to support and encourage the surgical patient in the perioperative period, it is important to consider the commonly utilized—but actually poorly understood—capacity for “empathy.” Indeed, even though most physicians may feel they understand the difference between empathy and sympathy and realize that sympathy may not be the appropriate mindset for a surgeon, in truth, we often feel sympathy for a patient or his family in very sad and distressing circumstances.

We are taught not to act on that sympathy out of concern that we may not make “unbiased” recommendations based on science and experience. Rather, we are supposed to base our judgment on empathy, which is believed to be less emotional and less distracting. Empathy, in its broadest sense, involves the physician’s capacity to be cognizant of a patient’s emotions, concerns, family, and any social contexts that affect her and her condition, and to understand, as much as possible, how these factors will play a role in the way the patient will deal with decision-making and her personal response to illness. Empathy can potentially lend great depth and breadth to an understanding of how patients deal with their adversities and medical conditions. While empathy is felt for the circumstances and factors in the patient’s life that can affect the disorder, sympathy is a feeling of sadness and/or compassion directed toward the patient herself, and to the family members who have to deal with the difficulties ahead.