Kindness in medicine more than skin-deep

TWO of the 12 apostles, Peter and John, were healing the sick during the time of the early church, and were being questioned by the religious establishment at the time about their unconventional methods. In Acts 4:9-11, when questioned, Peter said “we are being called to account today for an act of kindness shown to a man who was lame and are being asked how he was healed”.

Even during biblical times, people were characterising healing as acts of kindness. But is healing the sick the same as showing the sick kindness? Are healers, or in our case, doctors, automatically kind? Is medicine, by definition, kind? It is worth exploring the recent literature around this concept.

Back in 1997, Pickering wrote an article entitled Kindness, prescribed and natural, in medicine, where the author said that “automatically to presume it [kindness] is ever-present is quite wrong”, and proposed that kindness be prescribed as part of the medical practice. So, already there is the notion that kindness is not inherent in health care, and like other treatments, it needs to be consciously prescribed and administered.

More recently, psychiatrists Ballatt and Campling wrote an influential book titled Intelligent kindness, which discussed the reintroduction of kindness back into the UK National Health Service and into the culture of medicine in general. This book suggests that health care used to be kind, but that somehow, over time, this kindness was lost and needs to be returned, like the proverbial prodigal son.

But how do we do this?

Let us return to our original question. Is the act of healing an act of kindness?

In his article entitled Kindness, not compassion, in healthcare, Faust proposed that doctors should separate the act of kindness from the feeling. He went so far as to state that doctors should “act as if they care … without taking on the stressful emotions that emanate from being compassionate or empathetic”.

In other words, it is proposed that doctors can and should act kindly without needing to take on the feelings associated with being kind. This compartmentalising of feelings from action is inherently attractive for clinicians, because it seemingly offers them an avenue to shield themselves from needing to respond emotionally to the human suffering encountered as part of their daily practice. They don’t have to feel kind, but they can appear to be kind, like an actor playing a role of the kind healer.

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But is this acting authentic? And is this even possible? Should doctors have to divorce their actions from their feelings?

More recently, Buetow took an alternative view in Physician kindness as sincere benevolence, arguing that kindness by doctors should be sincere – “rather than faking it, physicians’ kindness towards patients must be genuine”. The author called this “physician kindness”, which is considered a person-centred value that can be exercised as “sincere benevolence”.

I believe that this particular frame of looking at kindness in health care is key to current medical practice. The act of kindness in healing has to come from a foundation of genuine feelings of kindness towards the patient.

I am not suggesting that clinicians need to love, or even like, their patients, but we can still be kind out of genuine feelings of benevolence towards those who are sick and infirm, as healers granted a special place in society to do so.

In a similar vein, more recently Noel wrote an article entitled The kindness of strangers, making the point that “after 12 years of practice, I am no longer a stranger to my patients” and that “building that trust starts with the kindness of individuals not willing to remain strangers”.

Doctors must be willing to be more than just strangers to their patients. Getting to know our patients as fellow human beings, who are going through their own trials and tribulations, is the first step towards developing empathy with them, and genuinely understanding that they require our kindness.

In the words of Wiwanitkit: “Kindness and service mind have to be the necessary requirement for any medical practitioner rather than skill and good knowledge”.

As doctors and health practitioners, let us not just act kind, let us also be kind. As doctors, we can learn the technical skills and knowledge and try to apply this to the actions of kindness, but it is important that the actions are grounded by feelings of empathy and compassion, lest they come across as artificial or forced.

The truth is, our patients can tell when we are not genuinely caring for them, and it lessens the effectiveness of the therapeutic relationship.

So let’s get real, because we deal with real people, not just real diseases. As the Dalai Lama says: “When we feel love and kindness toward others, it not only makes others feel loved and cared for, but it helps us also to develop inner happiness and peace.”

By being kind to others, we may very well end up being kind to ourselves.

Professor Erwin Loh is Chief Medical Officer at Monash Health and a clinical professor at Monash University.