On Technology, Bullying and Compassion Fatigue

Technology has been described variously in theological terms (a “qualified blessing” from a God who gives of grace creatively) and ethical terms (generally neutral of itself, with potential for good or bad outcomes, depending on how it’s used). Most medical professionals (at least those who cling to some moral and ethical footing in their view of such things) hold certain technologies in high regard, like therapeutic tools that allow their patients to live longer, healthier lives. Yet they struggle with those things that push the envelope, which may sacrifice the judicious for the temporal.

It’s not these ethical dilemmas of which I speak. Technology has the ability to be a tremendous force for democratization of everyday life. People have access to information that is unfiltered, and can express themselves with a freedom that goes beyond even the seeming anonymity of road rage. The past few weeks have shown me the challenge that this technology creates for those in medicine, both human and in my own veterinary medical professions.

I am entering an unlikeable phase in life where I will start to lose friends and contemporaries to cancer and heart disease and strokes. I attended the funeral of a friend that left this life sooner than many of us felt ready. We know the right theology, we face reality, but it still stings. One of our other friends, who has lost a parent in recent years, commented that, near the end, there seems a need for blame to be assigned. She had maintained vigils at her own mother’s side as she slipped away, and still felt herself recoiling from the sight of hospital beds and fluid pumps. She remembers how she almost hated the nurses and doctors that couldn’t fix her mother, and who seemed almost as baffled at the deterioration of their patient as she did. All she could see was her mother worsen with no apparent plan by her caregivers to turn things around. That anger, fully known to be irrational in hindsight, is no less real in her memories.

As a veterinarian, I also know of another very sad case, this time of a colleague in New York. Her story can be found here, but it is heart-wrenching to hear its specifics. Briefly, this doctor had done what many veterinarians before her have done, which is to avoid the personal and professional pain of what is called “economic euthanasia,” where a pet is taken in by the doctor after the individual bringing it to the office expresses a financial inability (or unwillingness) to have treatment performed that would save its life. Dr. Shirley Sara Koshi successfully nursed a cat back to health, on her own time and at her own expense, after it had been turned over to her in such fashion by an individual who brought various cats to Dr. Koshi after they were removed from a New York City park. After its recovery, the individual attempted to reclaim the cat and was rebuffed unless and until the medical expenses were paid. Legally, the cat had been relinquished to Dr. Koshi and there were no ethical obligations (and, indeed, should have generated ethical objections) to return the cat to the individual who brought it to her in the first place.

Technology and emotion can supplant when legal options are scant. Enter social networking, specifically a pair of Facebook pages. The first, called “Regret-a-vet,” offers disgruntled consumers of veterinary services a forum to air their grievances, complete with lots of “Likes” and supportive comments. The second, and more venomous, is called “Veterinary Abuse Network,” and, in this case, ratcheted things up a bit. A full-tilt assault on Dr. Koshi ensued. The veterinarian did respond, regrettably pulling herself into the same mud as her opponents, but the social networking diatribe continued, unabated, for weeks and weeks.

When the body of Dr. Sochi was discovered after her suicide, a brief note on the “Veterinary Abuse Network” page found justice in the freedom that the cat had won, free of this imperialistic animal doctor. There was cheering at the death of this veterinarian. The Facebook destruction of a medical professional was complete.

Now to be sure, I don’t know all the specifics of this case, nor do I know all the factors that led to the suicide of a 55-year old veterinarian. But I do remember the brute honesty of my friend who admitted that her family needed a scapegoat when her mother died, and medical professionals served that role. The freedom to “rate” our physicians and veterinarians and others, via the anonymity of the Internet, is a technology that is fearsome to me and, I suspect, some of my friends in human medicine. The narcissism fueled by Facebook and other venues can destroy someone, and fast. I have never had to deal with it; someday I surely will.

Jean Bethke Elshtain once wrote that we must think of our political figures as being made of “flesh and bone,” not just as unfeeling figureheads in a political system. I think this relates to our medical professionals as well, a staggering percentage of whom are still (and often inexplicably) idealistic and face emotional and ethical issues head-on, and who must maintain a deep compassion for their patients and family members (and, yes, this means veterinarians as well as physicians; as one of the former, I can tell you how the short lifespan of my patients and their role in the family make my job and the job of my staff that much more exhausting). This compassion is exhausting, and we all seem to take it personally when a patient dies, no matter the reason. Jesus modeled well how to get away to a “lonely place” to regroup in communion with the Father when acts of compassion could be so, soulfully tiring. We have no room for that in medicine. The standard for an online review of a physician ought to differ from one made for an Italian restaurant or a carpet cleaning service, but the democratization of the Internet lumps them all together.

What a shame. What a tragic story. What a reminder that technology can be our friend, and can be used to bully us all. And that bullying can hit us in our weakest place—the place that says we just don’t care. Be ready.

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Sharon

Wow… Great blog, Jerry! I had a patient trash me on Facebook, but I chose not to respond and let it go. Of course no one knew of my side of the story, but me responding would have only fueled the fire. I am glad I resisted even if my staff felt otherwise. We will see if she ever tries to return with a toothache one day! Right now my aunt Kelley is in the last hours of her terminal ovarian cancer. They gave her three months left, but things have sped up in the last day or two due… Read more »