Last month we continued our examination of Dr. Herbert Swick's article "Toward a Normative Definition of Medical Professionalism." Swick included demonstrating "core humanistic values" as one of the professional behaviors that define professionalism.1 We began our discussion by defining the values of honesty and integrity, caring and compassion, and applying them to our practice. We discussed how these values form an important component of the foundation of professional behavior and give us direction when we face choices. Values help guide our actions.
This month we continue our exploration and discussion of professional behaviors by completing our examination of core humanistic values. We will discuss altruism and empathy, respect for others and trustworthiness. As we continue, we must always remember that we demonstrate our values through our actions.
Altruism and Empathy
What does the word altruism mean to you? Take a moment to think about how you would define this concept. To clarify what altruism actually means, we return to the dictionaries to get accurate definitions. Altruism means "unselfish regard for or devotion to the welfare of others"2 or "unselfish concern for the welfare of others; selflessness."3 These definitions show that this value concerns other people and their welfare--that it is outwardly directed. EMS practitioners, when they are demonstrating professional behavior, put the welfare of other people ahead of their own.
What exactly is empathy? What do you think it means? According to Merriam-Webster, empathy is "the action of understanding, being aware of, being sensitive to, and vicariously experiencing the feelings, thoughts and experience of another...without having the feelings, thoughts and experience fully communicated in an objectively explicit manner."4 This definition is somewhat complex and hard to grasp, so let's break it down. The first part is understanding, being aware of or being sensitive. If we apply this to our practice, it means we are paying attention and are "tuned in." The second part tells us that we are tuned in to feelings, thoughts and experiences. The third part tells us we are relating to other people.
Another definition says empathy is "identification with and understanding of another's situation, feelings and motives."5 Still another, "the power of understanding and imaginatively entering into another person's feelings."5 Consider these definitions. How do they apply to EMS practice--to how EMS practitioners should behave?
There was an old Star Trek episode entitled "The Empath."6 In it, Captain Kirk, Mr. Spock and Dr. McCoy encountered a humanoid woman who turned out to be an empath. If someone were sick or injured, the empath could absorb that sickness or injury from that person into her own body. The sick or injured person was thus cured; then, using her own energy, the empath would cure herself. Empathy is about being able to understand another person's feelings, their emotions, and comfort them by showing that they are not alone. With empathy, we help people bear the burdens of their injuries or illnesses by providing emotional support.
Altruism and empathy are difficult words to define and difficult concepts to put into practice. We can compare them to the values of compassion and caring from last month to help us to continue developing our understanding of professional behavior.
Respect for Others
Rodney Dangerfield never got any. Aretha Franklin demanded it. R-E-S-P-E-C-T: What is it?
The American Heritage Dictionary says respect means "to feel or show deferential regard for; esteem."7 Merriam-Webster's Online Dictionary says "an act of giving particular attention" and "high or special regard."8 Using these definitions, we can conclude that showing respect for others is paying particular attention to them, showing deference and due consideration for their thoughts and feelings. We might say it means treating our patients and their families the way we would want them to treat us and our family members.
Respect for others must be extended to all the people with whom we come into contact during the course of our day. That means patients and their families, and also nurses, doctors, other crews, other companies' crews, students, instructors, colleagues, partners, bosses and subordinates.
When we respond to calls, we often enter people's homes. These people who call us trust us. They trust that we will do the right thing, that we will take care of them, and that we will not not take advantage of them. Being trustworthy means being reliable and being someone in whom others can have confidence. Just like we should respect all the people we work with and serve, all of those people should be able to trust us.
I remember a case I had many years ago. My partner and I responded to an upscale apartment for "severe abdominal pain." When we arrived, the patient described her pain as feeling like something was tearing inside, and said it went through her from front to back. We immediately considered the possibility of a dissecting abdominal aortic aneurysm. Unfortunately, our diagnosis was correct, and the lady died during surgery.
During our trip to the hospital I noticed this lady was wearing beautiful jewelry: a watch, a pin and a ring. I found out later the jewelry was worth more than $200,000. The watch was platinum and encrusted with diamonds. The pin was platinum as well, and had three diamonds the size of peanuts surrounded by many other smaller stones. The ring had a stone bigger than any I'd seen before except as a toy. I found all this out because at some point the jewelry went missing. I was called in as part of the investigation. Luckily, the emergency room nurse had documented the jewelry on the patient's chart.
Evaluating Empathy and Respect
Teaching and evaluating these values, and behavior related to these values in practice, is difficult. We have already considered some methodologies and techniques, such as role-play scenarios, moderated or facilitated discussion, discussions in response to viewing videos or films, and role-modeling. The Professional Behavior Evaluation in the EMT-P National Standard Curriculum lists empathy as the second dimension of professional behavior to evaluate. It describes examples of empathy as follows:
· Showing compassion for others;
· Responding appropriately to the emotional responses of patients and family members;
· Demonstrating respect for others;
· Demonstrating a calm, compassionate and helpful demeanor toward those in need;
· Being supportive and reassuring to others.9
Respect is another dimension of professional practice included in the evaluation form. The behaviors listed under respect are:
· Being polite to others;
· Not using derogatory or demeaning terms;
· Behaving in a manner that brings credit to the profession.9
Rating people as competent or not competent in these areas of affective domain performance is often a subjective effort based on opinion. We must take care to be as objective as possible. Consider carefully what it means to be competent in these areas of practice.
After all we have talked about in these articles, it is clear that EMS practice is not about you, the practitioner. What we do is about other people--the people we serve. As I've said many times to my department's students and cadets, if you're selfishly motivated in your EMS practice, if you got into EMS to be a hero or for the glory or excitement, things will, in the long run, go poorly for you. Selfish motivations shouldn't be what drive us. Ours is a discipline that requires us to put others first. People trust us; we must be trustworthy. It is part of our job to make the right choices, resist temptation and do the right thing based on the right values. We must always and continually behave professionally.
Next month we will discuss the next of Swick's professional behaviors, accountability for ourselves and our colleagues.
1. Swick H. Toward a normative definition of medical professionalism. Acad Med 75(6): 612-616, June 2000.
9. National Highway Traffic Safety Administration. Emergency Medical Technician-Paramedic National Standard Curriculum, Appendix F, Affective Evaluations.
Michael Touchstone, BS, EMT-P, is chief of EMS training for the Philadelphia Fire Department. He has been involved in EMS since 1980 as an EMT, paramedic and instructor. He has participated in EMS leadership, management and educational development initiatives at the local, state and national levels. Contact him at email@example.com.