Creating Conditions for Humanity in Hospitals

Why aren’t people in hospitals more attentive to the needs of patients?

In a recent post, Dr. Ashish Jha raises this issue as he relates his own story of coming to an ED with a very painful dislocated shoulder. Unsurprisingly, prompt treatment of his pain was deferred while staff diligently completed registration, sent him for an xray, and waited for a physician to see him.

On the bike path where Jha took his initial tumble, people went out of their way to respond to his injury with attention and concern. But as he lay moaning on a gurney in the hospital corridors, waiting for an xray and not yet treated for pain, people avoided his eyes and even walked by a little faster.

What gives? Why aren’t people in the hospital more empathetic and attentive? Is this a “wonderful people, bad system” issue?

In reflecting on his experience, Jha remarks that people seem to leave their humanity at the door when they arrive at the hospital for work, and posits that we get desensitized to suffering. He notes that some workers were able to “break out of that trap,” and responded to him more empathetically when he directly solicited their help and attention.

“It is the job of healthcare leaders to create a culture where we retain our humanity despite the constant exposure to patients who are suffering,” writes Jha.

Culture change is necessary but not sufficient

Culture is important. Yes I’ll admit that I’m usually a bit skeptical when I hear of a plan to tackle a problem through culture change. In my own experience, this has consisted of leaders trying to “create culture” by describing to front-line staff  what they should be doing, and repeatedly exhorting them to do it. (And maybe giving out gold stars to those who do it.)

This, of course, is never enough. Talking the talk does not mean people start to walk the walk, especially if the walk involves a slog uphill rather than an easier stroll down a path of lesser resistance.

If we – whether healthcare leaders or  just concerned citizens who want to see healthcare improve – really want healthcare workers to demonstrate more compassion and empathy while on the job, then here is what we need to do:

  1. We should take seriously the task of understanding what might be interfering with this compassion and engagement. This means not only studying workflow, but also the behavioral psychology of individuals as well as groups.
  2. We should then be serious about creating the conditions that would allow regular human beings to reliably produce the desired behaviors.

Why it can be hard to help people in the hospital

What interferes with showing compassion and engagement? In reading Jha’s piece, I reflected on my own hospital days. Here are the obstacles that I remember, and the impact on me.

Difficulty meeting the needs of patients and families. I remember constantly feeling that people needed more from me than I could provide. Sometimes they needed to talk for more time than I felt I had available. Or they needed a service or other form of assistance that I wasn’t sure how to get for them.

Especially frustrating was when patients needed something like pain medication on short notice. I have been that doctor very concerned about a patient’s terrible pain. Unfortunately, I discovered that my power to help was quite limited by hospital logistics and workflow: although I could order pain meds right away, the patient could almost never get it quickly. After all, the pharmacy still had to dispense the medication, and the nurse had to administer it.

If you are a conscientious person who wants to help (which I think most healthcare workers are), it’s very stressful to recognize a person’s need and not be able to address it.

Hence, as a coping mechanism, my guess is that many people working in hospitals adapt by learning to “not see” those needs that they feel they can’t address promptly and properly. (Perhaps we might consider this a form of learned helplessness?)

That ED doc that Jha praises for addressing his shoulder quickly? He sounds like a good guy, but it also helps that he had the skills and ability to do something right then and there.

Frustration with workflows and workplace tools. It’s no secret that hospitals and clinics often present a “high-friction” environment for front-line staff. Back when I worked in the hospital, every day involved coping with inefficient workflows that generated various levels of annoyance. There was redundant paperwork. There were computers requiring multiple sign-ins, or repeated sign-ins. There were tasks that took three steps when they really could’ve been redesigned to take one or two.

Along with the expected hassles, one also had to contend with frequent malfunctions in whatever system you were trying to use. A printer out of paper. A computer that mysteriously can’t be logged into. A shortage of staff in a certain department, such that a routine inquiry ends up taking twice as long as usual.

To be fair to hospitals, designing friction-free workflows for clinical staff poses a huge challenge, given the complexity of the work involved and the diverse needs that hospital administrators need to consider. And the nature of life is such that often things do not work as expected.

Still, it all added up to a fair drain on one’s energy and attention, and made it harder to provide patients and families with attention when they needed help.

Inadequate levels and reserves of energy. Compassionately interfacing with patients takes energy, especially if pain or emotionally intense issues are at hand. If one is worn out by earlier encounters, or by a long workday, it becomes much harder to muster the energy to engage with those who need us.

And of course the energy one can bring on any given day is powerfully influenced by the overall balance of exertion and regeneration that one experiences over weeks and months. Long workdays stacked back-to-back (as experienced by many hospitalists) take their toll. Young children at home, or other significant obligations outside the hospital, can also reduce one’s energy at work.

On the flip side, certain activities help people regenerate and restore their energy. Adequate sleep, exercise, and close relationships with friends and family are sustaining staples that are needed by all. Plus everyone tends to have some favorite soul-nurturing activities that help recharge the batteries.

For physicians in particular, the problem is that residency tends to leave people with little time to recharge. We form our habits as doctors during a time of chronic stress and fatigue.

And even after residency, many physicians end up with chronically intense work-schedules. What effect does this have on their ability to be compassionate and responsive to patients and families?

My own experience has been that when I work long hours, it feels much harder to give people the support they want. I still try to do it but I suspect I do it less well. I also know that when I’m tired I make an extra effort with patients but then have much less patience with other members of the healthcare team. (And then when I come home I’m short-tempered and crabby with husband and kids; not necessarily a problem for hospital and patients but concerning to me.)

Enabling humans to show humanity

Cultural expectations within institutions and groups are powerful. We do take our cues from peers and leaders. But it’s hard to follow the cues when surrounded by pervasive stressors and obstacles. In fact, it can be demoralizing to be told to do something when your leaders don’t seem to be making enough of effort to enable this doing.

As healthcare leaders take on the important task of making hospitals more responsive to the needs of patients and families, I hope they’ll consider the following:

  • People don’t like being faced with situations that they can’t fix, or that they feel will be a huge time/energy suck to fix.
    • Make it easier for them to do the right thing.
    • Recognize when you are asking them to do something that is a big time/energy suck.  Try to give them more time. Realize that they’ll have less energy afterward for efforts that are cognitively or emotionally demanding.
    • Provide communication and empathy training. Without explicit training, people often don’t realize that patients and families appreciate sympathy and attention, even when you can’t solve the exact problem at hand.
    • Frictions in the workplace add up to material stress and depletion of energy.
      • Reducing these frictions can enable workers to be more responsive to the needs of patients (and colleagues).
      • Adapting to changes in the workplace — such a new computer system or workflow — does create a drain on staff’s energy and attention. Ideally, this is temporary but poorly designed changes often create permanent energy drains.

Be mindful of the overall energy and stress levels of your workers.

  • Workers who are already experiencing chronic stress and fatigue will have difficulty becoming more attentive to patients’ needs.

Now, if you told me that healthcare leaders already know all this, I wouldn’t be surprised. If you’re in a leadership position, it’s really part of your job to learn about managing human capital.

The trouble is that for the leaders of a hospital, addressing the obstacles that I experienced in the hospital feels costly to them. It takes time, energy, and money to reduce workplace frictions. And managers are generally very reluctant to reduce a person’s workload in order to free up cognitive and emotional energy so that the worker can then be more responsive to suffering patients, or even adapt to new technology for that matter.

In principle, these investments in nurturing one’s human capital should pay off down the line: more satisfied patients, less worker absenteeism, better teamwork among colleagues, and possibly even fewer hospital errors and better health outcomes among patients and staff.Will healthcare leaders find a way to walk their own uphill path, and really make it possible for their front-line staff to do better work? I hope so.

Leslie Kernisan, MD, MPH, has been practicing geriatrics since 2006, and is board-certified in Internal Medicine and in Geriatric Medicine. She is a regular THCB contributor, and blogs at GeriTech.

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Here is the link to the blog by Dr. Ashish Jha, for reference (since it was not included in this post).

Leslie Kernisan, MD MPH

Autry, thanks for sharing your insights and experience.

I spent much of my residency at the county hospital, and yes, those frequent fliers are certainly a challenge…


I am an ER nurse in a large urban hospital and I see this every day. The problem isn’t that the staff lacks compassion, or that they intentionally ‘tune out’ people who are suffering… it’s a systemic problem with more than one contributing factor: 1. ER nurses can treat pain with elevation, ice packs, etc. but we’ve learned pretty effectively that people don’t want that kind of compassionate care… they want narcotics… and until they get them, people can be extremely rude. This isn’t true for every patient, but it’s true of enough of them who have NO physical signs… Read more »


Excellent post!! I agree 100%.

Scott Simon

I enjoyed reading this. My immediate reaction is: is a doctor ever fired for treating a patient with insufficient humanity?

If not, then this is all navel- gazing–a vague preference, not a real requirement.

Leslie Kernisan, MD MPH

I’m glad you enjoyed. As far as I know, only in truly exceptional circumstances are doctors fired for treating patients callously. Generally, pretty bad behavior has been tolerated in doctors, esp if they bring in lots of revenue to the hospital. Not sure what you mean re navel-gazing. I don’t think you can mandate humanity at a leadership level; hospital administrators & leaders need to try to create conditions for it to be more possible. But of course patients can and should say something if they’d like to see improvement, and they should also attempt to take their business elsewhere… Read more »

40yearold doc
40yearold doc

Patients can, and do, fire doctors for whatever reason they wish: insufficient humanity, body odor, bad haircut.

But that implies that we still think the doctor works for the patient, not for The Man.


Sad to say, I have witnessed the difference in treatment at hospitals based on the medical coverage you have. That said, there is still a coldness by a lot of hospital staff. I can understand getting desensitized but people notice that and it needs to be addressed.


Just out of curiosity, do you work in a hospital? I’d be curious to hear about this issue from the point of view of someone giving the treatment.

Leslie Kernisan, MD MPH

This sad but I’m sure it happens. I myself felt I didn’t usually know what kind of medical coverage people had per se, but some patients certainly look more likely to be on Medicaid.

I think as providers we’d like to treat people equally regardless of socioeconomic status, but of course we are humans and prone to all kinds of unconscious (or sometimes conscious) biases which will affect how we treat people. To overcome this, we would need to make an effort. To make an effort, we need time and mental energy…just what is lacking in most hospital settings.


How did you witness the difference? Did someone say specifically this is why a treatment would or would not be done was related to their medical coverage? Most hospital staff do not even know what kind of insurance you have, or whether you have any at all. Physicians and private contractors have to know because some testing will only be covered if certain diagnoses have been written or certain pre-testing has been done. They want to get paid, so of course they’re going to know what they need to do in order to get paid for the work they do,… Read more »

Whatsen Williams
Whatsen Williams

Is this a joke? Nope. You are my straight man/woman!

You probably do not read how the user unfriendly idiosyncratic EHR devices have become the disease attracting the attention of the health care professionals, while the real patient lies in neglect.

Just the new way of electronically automating medical care.

I gues you would agree that these new unproven care directing devices are toxic, no?

Leslie Kernisan, MD MPH

Not sure which care directing devices you’re referring to. A well-designed device in principle should help. In practice, many care directing devices do indeed suck up our attention and energy, so unless they are providing a lot of clinical benefit, not clear that overall they are improving care.

Whatsen Williams
Whatsen Williams

EHRs are the care directing devices. They are impediments to care, from the nonsense sign ons to the meaningfully useless drop downs, and their sheer disruption in enabling a consultant to determine how a patient got to where it is today, after weeks in the hospital.