Empathy and Compassion in Diabetes Education, How to Open the Gate
By Kim Campbell, MPH, RD, LDN, CDE
As an RD for over half of my lifetime, and a CDE for over 20 years, I always thought I had enough empathy for my patients. I was moved by the stories people told me about their diabetes, their lives, and their difficulties with managing their complex health demands. I cared, I was kind, I listened, I did my best to help with the education and ideas I had been trained to provide. I have said things like, “I understand”, “I know this sucks”, and “What can I do to help you?” I try to incorporate concepts of motivational interviewing into my visits with people with diabetes, but sometimes I just have an hour to provide education to help someone along to the next step whether it’s group diabetes education classes, understanding meal planning enough to apply it at home, or teach a blood glucose meter and insulin pen injections.
Sometimes I get wonderful feedback from the individuals I teach. Last week a middle aged lady insisted on hugging me because I had explained her new diagnosis and the steps she needed to take so well that she felt worlds better by the time she left my office. Sometimes people cry because they are overwhelmed with everything. Medical conditions, overweight, home life, extreme work conditions, poor social support, etc. People have to deal with so many demands. I’d like to think my compassion and empathy makes my office feel like a safe place where the wary patient can let down his or her guard and be open with me.
But, I am realizing I’ve always had a bit of a fence between myself and my client. Not a wall but a fence, a waist high picket fence or nice split rail fence. I can see through it, make eye contact, reach through it, and talk through it. I have empathy but I rarely open the gate. Part of that is the emotional detachment which is the overarching norm among healthcare providers. A section of the Society for General Internal Medicine defines empathy as “the act of correctly acknowledging the emotional state of another without experiencing that state oneself.” Another part is the fact that I don’t have diabetes and no one in my immediate family or circle of loved ones has it either. I know this will not stay true forever, but it has been my situation for all of those 20 years in diabetes education. Additionally, if I let myself get too attached to my clients I would take their troubles home with me and lose sleep like my sister the social worker who used to work with at risk families and their children.
Recently, due to a medication reaction completely unrelated to diabetes, I developed a health issue that is often seen as a diabetes-related complication. I was upset, aghast, and angry. I saw the specialists, followed directions; I got the lab tests done. My doctor was very professional and matter-of-fact on the first visit. She explained the science. I was horrified and thought, “This can’t be happening to me, I didn’t do anything to deserve this, I was just taking the medication prescribed to me.” And then, in a few weeks, it hit me. No one deserves diabetes or cancer or paraplegia or any serious medical condition. No one. All those feelings are the same ones that many of my own clients have felt over the years. I wasn’t really seeing it or hearing it from them. My compassion had been sterile and perhaps, I hated to admit, tinged with a little judgement.
One my second and third visits to the specialist, the physician, a woman around my age, became more personable and I could see her concern for me. She offered “here’s what I would tell my sister if she was in this situation”, and I relaxed and moved along towards acceptance and action. She didn’t say these exact words, but with her compassionate comparison to what she would tell a loved one, I felt as though she was on this journey with me and I would be okay.
We need to move beyond the science and clinical empathy and embrace the art of practicing diabetes education and demonstrating compassion to our clients. We don’t need to take their stories home and cry about them. We do need to commit to walking the journey with our patients with diabetes. It’s not a one-shot deal, we know that diabetes education is ongoing and the best outcomes may materialize years down the road. Offering a message of support and hope can lessen the anxiety. Heartfelt compassion has incredible staying power. It becomes a beacon for our patients when they know they have a partner in their health care world. We might not always be the ones to walk with the clients we have today, but what a privilege it will be to look back and reflect upon the lives we impacted by showing that we truly cared.
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