Compassion Competency: Interview with Emelia Sam

Emelia Sam, DDS is a former clinical associate professor of Oral Maxillofacial Surgery at Howard University and author of the “360 Soul Blog” and Compassionate Competency: Healing the Heart of Medicine. She joined Emil Chuck, PhD to discuss compassion and how students and healthcare professionals can express compassion to their patients and themselves. An excerpt from this interview is highlighted below, which has been lightly edited for clarity.

Emil Chuck, PhD: How did you discover that writing and that type of expression was something that you were really good at?

Emelia Sam, DDS: I think it started with just books. I love to read books. I was reading quite early. So yeah, I was a voracious reader. I think it was probably by 10 or 11 when I started to write. So for me, that started with a journal or a diary, that sort of thing. And then it kind of graduated to poetry. And then, of course, you had your English classes and you’re learning about essays and structure there and that sort of thing. And it was just something that I looked forward to doing <laugh>, it never felt like a burden or an assignment to me. So that’s when I discovered my love throughout those years. But I have to say, going into dental school, I think a lot of us may do these things where we might leave some of our hobbies or our interests behind because we need to focus, or we’re told we need to focus on this thing. So I left some of that behind in dental school. I mean, that would, I don’t wanna say haunt me, but it would come back and let it be known that that was a part of me that wasn’t being fed. So it was something that I had to get back to down the line, but it was on hold for a few years.

No, I appreciate that you addressed the fact that so many students feel that they have to drop (hobbies) while they’re in school. So, thanks for bringing that up. You kind of sort of rolled a little bit into my next question here. Blogging, was that something that you discovered while you were in dental school or even in college as an undergrad?

No, actually, I discovered blogging in the mid two-thousands. So, I was a professional at that time. I’ve been out of my residency for about three or four years at that time. And the reason I got back into writing (blogging), and this is really important to the story, is that once you – this is a thing about professional school, there is a checklist of goals that you were supposed to attain. And, I figured once I had all of those things checked off, that once I entered professional life, everything would be in order, and I would be happy, and life would be fine, right? Happily ever after – that sort of thing. And about two years or so into my professional life, I just felt this void. There was a void, it took a little time to realize. That was around the time that the blogosphere was really emerging, was really becoming a thing.

So, as I was also a personal development junkie, I was consuming other people’s content. (I decided) I’m gonna get back to writing, and this is gonna be my entry, my regular sort of entry into it. And it was different for me because now my writing would be public. My writing had always been very, very, very private. So, that was how I started blogging. But because I still had this idea that I had to compartmentalize my personal from professional life I started blogging under my middle name, which is Emelia <laugh>. Now, I go by Emelia all the time. But at that time, everybody knew me as Fran, you know, my first name Francis, or Dr. Sam. and for several years nobody knew that Emelia was writing on the internet. So <laugh> that was another thing that, you know, I had to kind of converge.

I was wondering if you could just expand a little bit more on compassion. People think compassion and empathy are just things that you have or you don’t have, but in your book, you talk about them as competencies. So, could you elaborate a little bit more about what your thoughts are about that?

Yeah, so at the time I was on faculty, so of course I’ve seen many students come and go. And I was kind of observing how stressed they were, the difficulties that they had that they really didn’t tell people about that they were struggling with. I would also listen to patients whether there was something that wasn’t quite working for them. There was just this kind of disconnect because I think in healthcare we have this we have the idea that everybody who goes into it is compassionate. And healthcare spaces are compassionate spaces (but) patients don’t feel that for the most part. And I was also listening to colleagues and (hearing) their uneasiness with just feeling burnt out and not getting fulfillment from their profession as they thought they would have when they went into it.

So looking at this from all angles, I realized we were so focused on clinical competency, but where is the personal aspect of that in there? Where is not just the empathy or compassion for patients, but also the compassion for ourselves and our colleagues, the whole ecosystem? So that is when I really began to delve into the idea of compassionate competency. When we think of compassion, we think of it as being this mushy, esoteric sort of feeling. And I wanted to bring something practical, something actionable, something that was far more concrete that we could use in healthcare spaces. So that would be for the benefit of not just the patient but also for us as teams and also for us as individuals.

You see in the last few years, there’s been a lot of discussion and focus on wellbeing. And that’s for good reason. Because if we aren’t at our best, we can’t give our best. It’s a very simple concept. The other thing is that healthcare is personal. When patients come to you, you have information on them that the general public does not, things that they might not ever share with other people. So there has to be a safe space for them to be able to share that with you and be able to create that bond of trust. And what people don’t realize all the time is not only does that help the patient, but when you’re forming those connections, it’s also helping you.<laugh>. I know a lot of people are like, it sounds very (mushy), (but) actually, there is much evidence <laugh> to show that connection does make a difference on both ends.

(For students) there’s always the pressure to be quote perfect unquote, or to always deliver good news, or something like that…Talk a little bit about how…you’ve advised other students or residents about this?

Where do I start? First of all, you talked about the bulletproof exterior. So I think that goes back to training a lot. The idea of the hidden curriculum is usually used in the context of medical school, but it’s definitely applicable to dental school. And I would think really most of the healthcare training, right? There is this idea that in order to be professional, you must distance yourself, and you must (not) feel yourself, especially if you’re in a position of having to give bad news or what have you. It’s unspoken. A lot of the times, you know, it, and it’s in the little things. It’s about whether clinicians recognize patients as people or cases, right? So from your first time stepping into the clinic, whether your professor is making that distinction or not, you’re picking up what it is that they’re doing.

I studied oral surgery in Washington, DC, a metro area. We were dealing with a lot of of trauma, people who had been traumatized because of facial fractures and that sort of thing. And at the time, I couldn’t have articulated it, but there was a little bit of a disconnect because a lot of the time it was just about getting cases done, right? But all of a sudden, I was seeing patients whose cases, not them, but whose cases I might’ve seen on the news, but now they’re immersed in front of me. So that completely changes your perspective because it’s not about fixing a fracture or what have you. It’s also about dealing with somebody who’s suffered trauma, physical trauma, who’s been traumatized by the whole experience. And you don’t wanna further traumatize them within the care you provide, right? And I use that word care because sometimes it’s not care; it’s just management. We forget it’s supposed to be care <laugh>. This is how we came to the compassionate competency. I wanted to break that down. So I wanted to give people the skills and practices and ideals that a compassionate practitioner embodies. That’s how that came about.

I wanted to get your thoughts about how you can test for this competency.

This is where it gets messy <laugh>, and I think this is where we get uncomfortable with it. So a lot of times we place (compassion) to the side because it’s much easier to measure how well somebody did a particular procedure, right? Treatment, that sort of thing. But there are scales out there. We have the Jefferson scale of physician empathy and the version for students. I think that’s broadly used. But you know, that tends to be one dimensional ’cause it’s really only addressing say the physician-patient relationship. Empathy goes in all directions, not just in one. I don’t wanna say (it has) limited use. It’s been used so many times in a very useful manner.

But the other thing is it’s self-reporting. So I can say that I have all the empathy in the world, but if a patient doesn’t feel that, then there’s that disconnect, right? Which I kind of feel that the healthcare world has with patients, as it’s the idea of a grade for empathy. When we are looking for it in – what is it – OSCE (Objective Structured Clinical Exam)? Yeah, the OSCE. They grade empathy as far as has the student acknowledged the problem, listened to the patient, rephrased problem, (saying) what they think they heard, and then allowed the patient to extend, that sort of thing.

Those are shows of empathy, right? So when you’re grading that, we’re actually grading the performance. I can’t actually know what it is that you feel on the inside. I know you’re going through the motions. And I think those things are actually helpful for people who may not do those things naturally. They’re a start. I don’t know that you can gauge the intangible. There are cues, it looks good. It’s great. Like I said, it’s a start. But again, this is where we get a little uncomfortable because we like black and white, we like definitive margins, and yes, this is good. No, this is insufficient. That sort of thing. And empathy is not quite (concrete), you can’t do that with it. We can head in the right direction, but I don’t think we’re ever going to pinpoint “right” (or) an exact measure. I don’t think we can do that with aspects of humanity.

What’s making you happy now?

All my work right now is virtual. I have fallen into the role of caregiver. So this is where I wanna be. I lived in Washington, DC, for many, many years, and now I’ve moved back home, and this is where I want and need to be. So the work that I do is virtual, generally speaking, either to educators or student populations about compassion and giving them those practical tips that they can carry with them through their professional and personal life. So, a lot of it is virtual lecturing at this point.

Words of support for individuals?

As far as words of support, if anybody can learn anything from my story, it’s that whatever path you are on, we tend to be externally focused. We get focused on the checklist, what must I do, what is required of me? And, that sort of thing. But it’s so important to turn that inwards. Sometimes you have to check back internally because sometimes you just go so far down that list and you are so far removed from who you want to be or who you once were. So it’s just so important to feed that part of yourself. You know, understandably, these are tough programs. They require a lot of you, but it should never be to the point where you completely sacrifice the core of who you are.

So there needs to be those consistent check-ins. Because your wellbeing really is the foundation of everything else that you’re going to be able to provide. And if you have a faulty foundation, it doesn’t matter what you build on top of it, it will come crashing down at some point. So use the resources, do what you must, but like I said, keep checking back internally and find a way to feed yourself the things that you really, really need throughout your journey. And you’re just gonna be so much better for it, and that much stronger of a professional as well.

Dr. Sam can be found online at her website, http://www.compassionatecompetency.com/, and on LinkedIn.