Frontline Empathy is a Two Way Street

Empathy may be a confusing and contrary word, but one with great value, particularly in providing a buffer against professional burnout and in building positive relationships with patients. As one of those "soft skills" integral to the paramedic's toolkit, it is encouraging to see how widely it appears in research, training, leadership and culture.

Confusion arises, for the most part, around the definition itself. Amongst similar concepts of sympathy, compassion, mimpathy, compathy, unipathy and transpathy, each holds different meaning to the individual. For simplicity's sake, a broad overview of empathy may be that of understanding how another may feel in any given situation. 

While we may also use words such as compassion and sympathy interchangeably, they are considered less developed, more reactive counterparts to the higher level of skill involved in being empathetic.

In the current climate, paramedics are feeling both the warmth of widespread empathy, for the role we are playing in pandemia, and the contrasting cold of its absence. 

Unintentional though this may be, the chill occurs when others fear our potential to contaminate, or we are dismissed by other health professionals, as we have no central hub to safely contain ourselves within, or forge solidarity against the danger of the outside world.

Never before has it been more evident that maintaining empathy must not be forgotten or taken for granted. It's a two-way street whether we're amid a pandemic or stepping through the routine of everyday life. 

With the mutual co-operation of experienced, empathetic road users, both directions can flow in synchronicity. Keeping to our expected paths, indicating intentions, acknowledging courteous behaviours with thanks and resisting the urge to yell aggressively demonstrate our understanding. 

Respecting and following directions or signs, exercising patience when deviations arise and slowing down to give way when necessary, make our empathetic approach to the situation apparent. So how does this apply to prehospital roles?

Patients

We became paramedics to care for patients during emergencies. 

Attempting to understand their situation and how they may feel briefly, can help us to deliver the best type of care. It might be "just another call for chest pain" but labelling such may render us blind to their needs and decrease patient satisfaction. 

In return, anger and complaints become more likely with a possible compromise to our physical, professional and psychological safety.

Bystanders

Passers-by don't sign up for emergencies in which they unexpectedly find themselves involved. They stop to assist out of kindness or a myriad of potential, unknown reasons. 

An empathetic approach to enlisting their help, or moving them along, may gain mutual understanding and co-operation more quickly while reducing unnecessary frustration. Theirs as well as our own!

Colleagues

We wear the same uniform, but we're not necessarily the same people. Although it's easy to assume that someone may be better or worse off, based on what little we know, unless we are intimately connected, the reality is that we have no idea. 

Maintaining empathy for colleagues, without preconceived opinion, may help to create unity and decrease work-based stress, while one-upmanship and pity contests only widen any divide.

Support Staff 

No matter our understanding of each other's roles, frontline and support staff work in vastly different environments. The nature of emergency services is that any interaction between the two is limited or non-existent.

Throwaway comments, therefore, regarding the perception of each other's demands, habits and attitudes quickly become inflammatory. Primarily when delivered by third parties interacting between both areas. 

Bi-directional empathy may be integral to avoiding resentment and increasing mutual respect when the ability to build in-person relationships does not exist.

The Organisations We Work For

Embracing an empathetic approach to organisational culture, while more challenging to adopt, may benefit morale, motivation and mindset. 

Every ambulance service comprises a group of humans surrounded by infrastructure. That's all. If we aim to understand and therefore empathise with how any organisation, as a whole, aims to fulfil its purpose, we gain more precise direction relating to the individual role that we choose to play. 

We may find ways of working with others to make this happen. We may realise that we do not fit the organisation's overarching aims and can begin seeking alternative career pathways. We may strive for a leadership role from which we attempt to promote positive change. 

We may ultimately free ourselves from the shackles of frustration by taking the "personal" out of the "entity" and potentially increase our professional longevity as a result.

Interprofessional Service Providers

Interaction with police, firefighters, other emergency services, nurses, doctors, patient care assistants, nursing home staff, roadside recovery technicians and other personnel will involve some level of presumption. Our assumed perception of the challenges they face, or lack thereof. 

If we can gain a better understanding, by seeking clarification through collegiate conversation, we may encourage similar empathy towards the challenges we face as paramedics, thereby improving rapport.

The Paramedic Profession

Overall, paramedicine garners a positive response, but it is not something to be taken for granted. We continually step over the line from our territory, into that of others, quite literally. 

Most professions work at their place of business, where patients and customers step in, then step out. While visiting, they form an opinion of that industry, before leaving and returning to their domain. Paramedics, however, must enter the realm of others for every single call. 

Appearance, body language, demeanour, words and actions are the only tools available to create an instant, positive impression. There are no pleasantries such as impressive infrastructure, plush surroundings, ambient music, soothing aroma or polished reception staff to engender positivity. 

If we can utilise empathy and seek to understand how patients, families and bystanders may perceive our arrival and interaction, we create the significant potential to set the scene, proceed safely and communicate effectively.

Our Loved Ones

Those that keep the home fires burning rely on us to be ourselves when we are not in uniform. If a family member greets us with a problem similar to three patients we've encountered today, this does not make them the fourth. The clock must re-set so that we listen, understand, validate and support them with a fresh approach. 

When they mention stressors which sound trivial to us, after the enormity of what we've experienced during recent shifts, we absolutely must empathise, or risk losing this meaningful personal connection, should we dismiss their concerns. 

Maintaining empathy for those we care most deeply about, may be vital in avoiding any reluctance to interact with us over time.

Ourselves

We must, at all costs, maintain individual wellbeing otherwise, as with primary surveys, we are of no use to others when we put ourselves in danger. Self-empathy is pivotal in maintaining the boundaries that each of us must uphold, to feel physically and psychologically safe.

Ultimately, throughout each shift, we have a choice in whether we stick to our side of the empathy street or not. 

We can choose to travel in a one-way direction, where we continually run into obstacles along the way until we are left wondering why all other road users are frustrated with us. Would it be fair to then bask in praise for the paramedic profession, despite a lack of empathy and understanding for others? 

Alternatively, we can harness and enhance this skill, with the same level of pride we afford to our clinical prowess. Although it requires a little extra effort, without doubt, we may then feel more comfortable with the reciprocal rewards of empathy and compassion from those traversing the other side of the two-way street. 


First published in the Australian Emergency Services Magazine Vol 18, Issue 2, 2020