The empathy switch | Sammy Batt-Rawden | TEDxNHS

when people find out I'm an air ambulance doctor I often get asked what's the worst thing you've ever seen I'd read that question I've seen a lot of terrible things but now I'm going to ask you what's the worst thing you've ever seen in your time working in healthcare I could bet that everyone has at least one story that one patient who will never leave them I hope you will allow me to share a story or two of mine one of my worst was also my first and I remember every detail of it I was a third-year medical student on my first clinical placement in A&E a couple of weeks in the red phone rang it was hence the air ambulance they were bringing in a burn victim in those days the resource room was tiny just three Bay's all close together and it was packed when the patient was wheeled in the first thing that hit me was the noise the room was pin drop silence except for what remains one of the worst things I've ever heard the groans of the black charcoaled human being who had become my patient she was elderly trapped in a house fire disabled unable to escape I remember everything about that day the smell of burned flesh the sight of one of her legs incinerates into a child's stump always always the moaning it would later turn out with the only person in the room who didn't know that 80% burns in an eight-year-old was unsurvivable with me the hands doctor was the first to verbalize it quietly at the back of the recess room where I stood something in my face must have given me away because in a moment that would go on to define my career he told me this if I felt everything you are feeling now I wouldn't be able to get back out and get on with the job I was hooked on emergency medicine on Cresskill care on hems but honestly I didn't know if I was right for the job and I wondered other people I so admire born like this or is everything they've seen made them this way I had to know I would spend the next few years researching empathy trying to find out if it was possible to care too much whether there was a switch in my brain that I could flicked that would stop me feeding and allow me to get on with the job my research took me over to the u.s. to Johns Hopkins when I was fortunate to work under an incredible mentor professor magnetism and what we found came as a shock to me as an idealistic medical student just wanting to help those who enter a healthcare profession have a higher baseline empathy than general population but at some point that empathy to clients in fact it falls off a cliff and it's not just doctors this pattern can be seen across health care in nurses in midwives in radiographers paramedics in all of our cases our empathy takes a nosedive and it never fully recovers so what's going on have conditions found the elusive switch have they learnt to stuff their empathy away protecting themselves and their patients it's not that actually really at all fast forward several years and I found myself in the middle of the decline actually in hindsight I don't think I was in the middle I was possibly at rock-bottom I could perform under pressure but suddenly I become the kind of doctor I never wanted to be cynical cold even staggering from one shift to the next another burn out and breaking statistic I was a registrar in an outstanding emergency department that I had once loved but the first NHS winter crisis had hit and it was a war zone there were trolleys of patients around every corridor resource was overflowing the waiting room styling Ramone ambulances stacked outside the doors patients were angry rightfully so and as the most senior doctor on overnight their anger was directed at me every chef was just fighting fires we could never get on top of I lived in constant fear trying to pick out the needle in the haystack the patient who just couldn't wait knowing as exhausted and run ragged as I was that eventually I was going to miss something I was also pregnant in my second trimester nobody was being kind to me and in Treece I was finding it really hard to be kind to others something had to give and it did just not in the way I ever expected at just 24 weeks I broke my waters and went into premature labor a couple of weeks in the University University Hospital Southampton later and Joshua made his dramatic entrance into the world over three months early and weighing less than two pounds it's hard to explain what that time was like mums had their precious bundles of joy and cots next to them proud dads and besotted relatives work you over then and I would look on Hollow over two floors above where I knew my baby was out of reach in the neonatal intensive care unit the next morning my husband will be down to see our little boy immediately I knew something was wrong an alarm I quickly identified as the crash Bell was going off and as we walked onto the unit there are a crowd of people at Joshua's end of the room selfishly I thought please please don't let that be my baby but it was a nurse or ascend to the unit and hurriedly turned us around and we were taking to the rim everyone here will know a room like this that's usually a couple of sofas a water color on the wall and a box of tissues as a nanny and intensive care doctor I spent a lot of times in rooms just like this so we knew what it meant and it meant really bad news about arson and a consultant we'd never met came into the room and sat on the other sofa I'm sorry he said I've not got good news and with endless empathy and boundless compassion he told us what had happened to our son the words hit me thick and fast massive pulmonary hemorrhage prolonged resuscitation violent rates nitric 100 percent oxygen whereas I was all too familiar with words that meant overwhelming me we were unlikely ever to be able to take our baby home Joshua had had a massive bleed into his lungs and the team have been resuscitating him for about 45 minutes they'd done everything that they could tried every trick up their sleeve and Joshua's came into life the consultant had to go back to his team then to look after Joshua all I could think was so far he'd been so fragile that I hadn't even been able to halt in the thought that he would die without him ever knowing his mummy then a face around the door the consultants back I'm sorry I need to be with your son but I think we're winning another excruciatingly weight we squeeze each other's hands until they were white and then he was back do you want to come and see him I think he needs his mummy and daddy I've been holding it together until this point but then I saw our son he was smaller than the palm of my hands in his huge perspex box this missive incubator surrounded by pumps monitors that ventilator he looks so small I couldn't even touch him even putting my pinky into his tiny little hands might be enough to destabilize him off the tightrope of life he was on I wished desperately that he was still inside me where I could keep him safe but I was an outsider his mother thinking this was all my fault that I had done this to our son banished her hovering at the edges of his incubator which had become a surrogate womb an attentive care doctor unable to do anything to save him you're all right said the consultant if this was my child I'd be crying tea and when I turned his eyes were misty he hugged a son and if I hadn't already I now had complete faith in what I now know to be one of the UK's highest performing neonatal teams they all cared so deeply about what happened to my son and they weren't about to let him die on their watch and slowly the nurses coax him back to life it was touching ago the chaplain performed an emergency baptism and whilst hanging unit after unit of blood and tending to all the machines keeping Joshua alive versus still somehow found times to stand in as his godparents desperate for something to do I read Joshua the first chapter of Harry Potter that night it's called the Boy Who Lived I'd like to think that he could hear my voice through all those lines tubes and wires and he rallied three months of intensive care later and Joshua become the Boy Who Lived the nurses in particular but the whole team were not only Joshua's Guardians but became my rock Joshua put them through it it was always two steps forward one step back and just when we thought he would make it he was fallen and he begun on Facebook I would see my friends babies hitting their milestones falling over crawling that first smile and it made by heartache but the nurses made sure that we celebrated every one of Joshua's milestones doubling his birth rate from two to four pounds the moment he finally came off the ventilator after weeks of being unable to breathe for himself and finally the first time I was able to hold my child in what seemed like an age after he was first born I started this journey burn out and breakin a feeling as unwilling as it was possible to be but the endless empathy shown to me by the neonatal team helped put me back together Joshua survived his journey no doubt sir due to their calm excellence and three months later we were able to take home the boy who lived a year later I knew I had to return to medicine I recently read an article in The Washington Post it posed the question would you prefer a kind physician or a smart one but I asked why do they have to be mutually exclusive not being empathic goes against our nature as healthcare workers and actually we know it takes a lot of mental effort to remain detached under pressure and the truth is we just don't know what the long-term effects are of suppressing all of that what we do know is that the real problem comes when that suppression becomes permanent when you cannot flick that switch back when you can no longer allow yourselves to feel at all and why does it happen well what we found was this take a bright-eyed healthcare student who wants to do their best for their patient and put them into a healthcare system it's all changed them sleep deprivation antisocial hours that take you away from your family and friends complaints the blame culture bullying the dark side of Medicine stuff we don't talk about what we really should the list goes on but all of these factors will speed up your descent into cynicism now think about what we do to those who come and work in the NHS it's the best job in the world right but it comes at a price the loss of empathy is one of the three pillars of burnout and burnout really has become the buzzword of not just healthcare systems but corporate organizations hasn't it great let's fix it for the fix they came up with resilience resilience seems to have morphed into a way for employees to say it's not me it's you to make this somehow a very personal failure instead of resilience being a team sport to deflect accountability for putting people into a broken system and then blaming them when they inevitably break what's wrong with all of this is that it's wrong in fact it is exactly those highly competent psychologically healthy seemingly resilient people who were most at risk of burnout I've read this quote it talks about doctors but actually I think it applies to all of us in health care and it says this physicians are smart tough resourceful people if there was a way to MacGyver themselves out of the situation by working smarter harder or differently they would have done it already so I want to reframe this debate and introduce you to the concepts of moral injury moral injury came from the military and is often likened to death by a thousand cuts by seeing things that go against our moral code or what we feel is right one or two traumas one or two ties who weren't able to give the care that we desperately need to a patient because of wait times because of targets because of delivering medicine in the corridor we might be able to get past that but repeated traumas over time not sure way at us and eventually leave to an often unrecognized deep sense of guilt and shame the NHS in my mind is the most amazing healthcare system in the world isn't it it saved my son but it has its flaws and often I think we are also aware of how precious our system is and how lucky we are that we don't talk about the other stuff because the tree says at the and the NHS is understaffed the truth is the NHS is under-resourced and the truth is the NHS fosters a culture of blame which often sees individuals scapegoated when a patient falls through the cracks so let's start talking about it we will all have colleagues who were where I was well turning up for work every day feels like walking through treacle maybe you're there yourself it's a lonely place to be and often it can feel like you're the only one struggling and that you're somehow a failure for not being as resilient as your colleagues seem to be but it's not you you're not a failure for struggling in a struggling system and if I serve as your place of work over half of doctors alone or suffering from burnout so why aren't we talking about it so let's start being compassionate in a place of work that often isn't don't underestimate the power of kindness showing kindness and empathy to your colleagues not only has a direct influence on their empathy but also on their performance and that colleague not showing empathy they're like seeing the decline are suffering from moral injury they are most in need of your compassion so to finish here's a strategy I'd like you take away with you it's something I called the double tap first tap are you okay naturally the answer to this question will always be I'm fine because we're British and that's just what we do but ask again are you really okay or would you tell me if you weren't or my personal favorite are you sure because you just don't seem yourself lately and then a few days later ask them again so how does this story end ja sure is - now he is the Boy Who Lived most people never get to meet their heroes and I gave birth to mine at just one day old and 900 grams joshua showed more resilience that i can ever hope to muster the kindness and empathy shown by the neonatal team helps my family so much but rebuilt me as a connection but joshua is my real inspiration I returned to medicine I founded the doctors association UK fighting every day for a more compassionate place for our staff in the NHS and our patients and soon after I got my dream job I now work for the air ambulance and my mental toughness comes from the resilience of the team around me so that I too can be there for someone on the worst day of their lives and get someone's son home to their family that's why we do the job that we do never forget it in a world where you can choose to be anything choose to be kind thank you you

Channel: TEDx Talks

Views: 18,730

Keywords: TEDxTalks, English, Health, Empathy, Medicine, Research, Workplace

Id: VN9VwX2rUqk

Length: 18min 49sec (1129 seconds)

Published: Mon Jan 27 2020