Compassion [kuhm–pash-uhn] noun
A feeling of deep sympathy and sorrow for another who is stricken by misfortune, accompanied by a strong desire to alleviate the suffering.

Compassion Corner is a series from Patient Worthy that will focus on the subject of compassion in the healthcare and rare disease space. In this series, we explore the role of compassion in this field and what it means for caregivers, patients, and others.

Medical ethics view compassion as a virtue that involves a regard for a person’s welfare together with deep sympathy towards that person’s suffering. There is evidence that compassion in medicine improves care.

Oxford Academic Family Practice reports that doctors are conflicted about delivering compassionate care. Many medical students leave school with less compassion than they had when they began their studies. Why?

Zaira Chaudhry at Geisinger Commonwealth School of Medicine writes about her transition from pre-clinicals to clinicals. Zaira felt privileged to finally participate with her healthcare team and interact with patients. She also noted that if a physician views a patient strictly through the lens of a clinician, that physician might overlook the fact that the patient is not an object but a human being.

Feedback

According to some proponents of compassion, it is worth giving the topic priority. Many doctors agree that patients are not only grateful when they are treated with compassion, but they tend to follow their doctor’s medical advice more often.

The naysayers wonder if compassion is a virtue, an emotion, or is it a personal trait. Is it too complicated? Can a person learn to be compassionate?

The answer may lie in a combined effort. Empathy in psychology is characterized as the understanding of another person’s emotions. Yet, following along these lines, we see no reference to alleviating another person’s suffering nor a moral obligation to that effect.

Compassion, taken from the Latin words ‘to suffer with’, is characterized by a person’s suffering, and another person’s sincere desire to relieve it.

In medical literature, the concepts overlap because empathy has been expanded to include ‘a moral imperative to relieve suffering’. Here, the divide between empathy and compassion narrows. To acknowledge someone’s suffering (compassion) an element of empathy should be present. Researchers tend to choose compassion rather than empathy.

Yale Psychology Professor Paul Bloom in his recent book ‘Against Empathy’, calls for ‘The Case for Rational Compassion’. He describes empathy as not inherently good but having the potential to be good. And regarding compassion, Professor Bloom says it is more complicated than we assume.

The work of physicians is based on their relationship with their patients and admittedly relationships can get very complicated. It is difficult to deal with suffering and even more difficult to watch or alleviate. Yet this is an important aspect of dealing with illness.

In this regard, empathy is necessary in order to understand, diagnose and treat a patient’s illness. Physicians can create empathy by:

• Letting patients know the doctors care
• Reading a patient’s narrative
• Teach the patient to inquire generally about other patient’s ideas, concerns, and expectations

Ready to Start Treatment? Not yet

Does a physician have any obligation to the patient other than using the latest technology to ease the patient’s suffering and treat a certain disease? Or does the physician take it to the next level and attempt to find a cure? And if so, does the physician’s responsibility end when a cure is found?

If compassionate care is absent from a job description, then the attending physicians may not engage compassionately with their patients.

In his podcast, Compassion and Courage, professional speaker Dr. Marcus Engel asks physicians if at times they feel that humanity is missing at their hospital or clinic.

Many med students develop a ‘hero-healer’ complex after graduating. They believe that their role is to control disease and cure patients. The young physicians soon learn that there are many diseases they cannot cure or control. This puts them at risk of dissatisfaction and disillusionment.

A compromise to consider is a transformation from the hero who fixes patients to a more spiritually driven physician who serves patients with compassion and therefore greater satisfaction.

The Difficult Patient

Proving that patients have different reactions to their illnesses, we must acknowledge that their emotions can range from depression to anger. A physician’s ability to be compassionate is challenged by patients who are abusive or simply angered by the severity of their illness.

Although physicians may not expect to be showered with gratitude, they are also human. After a hectic day of rounds, an abusive patient can be especially challenging.

Walk in Their Shoes

One possible solution is to find out where the patient’s behavior originated. Having a better understanding of a patient’s suffering and where it originated is vital.

Eric Cassell, in his book The Nature of Suffering, articulates the knowledge physicians must have in order to understand the patient predicament. This knowledge helps the physician understand the patient’s medical history with an eye toward the future.

Setting Boundaries

Revisiting the above, if a physician believes that he or she is unable to handle the suffering of a patient, the physician will experience distress, not compassion. There are many questions the physician may ask of themselves:

• Does the physician feel he or she has the expertise to cope with the problem?
• Does the physician’s schedule allow enough time to handle the issue?
• Is the physician aware of the emotional as well as the mental capacity required to address these issues?
• Has the physician factored in the effort required to balance other aspects of his or her life such as home and personal health of the physician and family?