AMA Journal of Ethics®

Illuminating the art of medicine

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AMA Journal of Ethics®

Illuminating the art of medicine

Virtual Mentor. December 2002, Volume 4, Number 12.

From the Editor

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Commuting with Fear, Traveling with Hope

The journal editor believes that in order to provide compassionate and empathic care, physicians must be as comfortable dealing with fear and anxiety as they are with hope and optimism.

Audiey Kao, MD, PhD

Running to the window, he opened it, and put out his head. No fog, no mist; clear, bright, jovial, stirring, cold; cold, piping for the blood to dance to; Golden sunlight; Heavenly sky; sweet fresh air; merry bells. Oh, glorious! Glorious!

"What's to-day?" cried Scrooge, calling downward to a boy in Sunday clothes, who perhaps had loitered in to look about him.

"Eh?" returned the boy, with all his might of wonder.

"What's to-day, my fine fellow?" said Scrooge.

"To-day?" replied the boy. "Why, Christmas Day."

"It's Christmas Day," said Scrooge to himself. "I haven't missed it. The Spirits have done it all in one night. They can do anything they like. Of course they can. Of course they can."

In keeping with the efficiency of Ebeneezer Scrooge's personal and spiritual transformation, Charles Dickens began writing his Little Carol in October of 1843, finishing it by the end of November in time to be published for the holidays. The best known of Dickens' books, A Christmas Carol has come to symbolize the power of experiential understanding and reflection in shaping how we see ourselves and, in turn, how we relate to our fellow humans, especially those who are vulnerable and less fortunate. In the case of Bob Cratchit, Scrooge finally realized the importance of providing his employee and family with "health insurance benefits." Fortunately, Scrooge rediscovered his empathy and compassion in time for Cratchit's son, Tiny Tim, to get the medical care he desperately needed but that his father could not afford.

As physicians, we are expected to treat our patients with empathy and compassion. Like Scrooge, we possess experiences, inside and outside our professional lives that can remind us of these importance attributes of good doctoring. Unlike Scrooge, however, we do not have the benefit of transformative "slumber parties" in which to reflect on our experiences and change overnight from what we are to what we should be.

Scrooge had more than 1 response to the scene revealed to him by the Ghost of Christmas Future. He feared that Future—the lonely death of an unloved man; Tiny Tim long since dead due to lack of needed medical care. Besides his fear, though, Scrooge experienced the desire and willingness to change the future he feared; he had hope.

To renew our spirit and commitment to empathic and compassionate care, physicians, like Scrooge, may need the occasional experience or remembrance of fear. We are more comfortable, of course, with hope. Prolonging hope in others is part of our business. Hope is the more desirable travel companion in life for the simple reason that we prefer feeling upbeat, looking forward to the future rather than dreading it. But to provide empathetic and compassionate care, we may need occasionally to commute with fear.

The capacity for empathic and compassionate care depends on our ability to understand and appreciate the experience of another and on our willingness to share and participate in their experiencing. To do this, we need to reflect both on times when we have felt hopeful and confident and, maybe more importantly, on times when we have experienced fear and anxiety. Remember when, as medical students we feared we were afflicted with the disease du jour? Remember, even more forcefully and poignantly, having been ill and, due perhaps to our medical knowledge, fearing the worst?

Few prefer to commute with fear and anxiety. But physicians who want to practice empathic medicine should regularly reflect on these uncomfortable emotions because doing so may recall them more potently to the human experience of their patients. Scrooge, some would argue, may not have changed his ways but for the fear instilled by his vision of Christmas Future. We may wish we could be transformed once and for all into compassionate physicians; that "The Spirits [could do] it all in one night." Unfortunately such transformations are (with few exceptions) the stuff of fiction. Professing medicine in an every day, every night rededicating, week in and week out; commuting regularly with fear as well as traveling with hope.



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