Compassion is central to the practice of medicine. At least it should be.
Most doctors and nurses began training with a pronounced desire to help, practising one’s craft compassionately is legislatively required in most contexts (including New Zealand), and evidence suggests compassion benefits patients. The culminating ritual in a new doctor’s qualifying ceremony – the Hippocratic Oath (or its variation) – emphasises confidentiality, integrity, commitment to patient care, and compassion.
And yet, compassion is recognised as lacking. Most famously brought to light following investigations into failures at the Bristol Royal Infirmary in 2001 and with the mid-Staffordshire Trust scandal in 2013, the difficulties in remaining compassionate are clear.
Research among physicians, nurses, and other health professionals has concentrated on compassion fatigue – the experience of feeling burnt out and unable to care – rather than studying compassion itself. However, recent work suggests that compassion must remain central to the practice of medicine and the provision of healthcare. Here’s why…
Patients expect compassionate care
First, compassion is expected by patients. When a patient seeks treatment, there is an expectation that a professional will kindly listen, look upon them tenderly, examine them gently, and seek to remove their distress. Unsurprisingly, patients do not like to be treated as symptoms, diseases, or organs, and their satisfaction with care, repeat business, and likelihood of making a complaint is almost certainly related to the extent they feel cared for.
Try thinking of it this way: patients remember the kind doctor or the caring nurse more than the actual procedure, expensive tests, and latest treatments. Unpleasant interactions are often unforgettable and there is a very practical reason that health professional education workshops focus on treating patients and families with care and compassion.
Compassion makes a clinical difference
That’s “all very well and good,” you say, but “I’m busy, I have more patients, I need to do some paperwork”. Fair enough. Time pressures are real and research conducted at the University of Auckland suggests time pressure may make compassion more difficult.
But compassion is not an optional extra we should deliver once we’ve finished the actual business of medicine. It is the heart of medicine. While medical knowledge and technical skill are important, empathetic and compassionate care itself predicts better patient health outcomes. And we’re not talking “warm fuzzies” here. Actual outcomes.
One large retrospective study of more than 20,000 diabetic patients in Italy found that those who saw their doctor as highly empathetic had fewer acute metabolic complications. Another study found that emergency patients randomised to receive compassionate versus usual care led to a one third reduction in subsequent visits across the next month. Other data show better medical outcomes, shorter and less severe colds and the like.
Caring is rewarding
Finally, our sense is that we spend excessive time “feeding” a narrative in which we deem caring for patients as tiring, or fatiguing, rather than also recognising it for the privilege that it is.
As the pendulum swings, a small body of research is beginning to examine compassion satisfaction.
Broadly defined in terms of the positive aspects of caring, compassion satisfaction predicts less irritability with patients and colleagues and greater adherence to standards of care as well as predicting lower burnout. Deriving pleasure and meaning from caring is central to why many of us “stick with it” suggesting that compassion may be important to the sustainability of our work.
So, yes, caring can be tough but it’s also rewarding and something that can be trained.
Recent studies at Auckland suggest that doctors report fewer barriers to compassion with greater experience. What are we learning? How can we leverage experience to teach compassion more effectively?
We can blame work demands and the nature of our patients, but we can also practise compassion and remember that it matters. For them and for us.
Not only are we mandated to deliver healthcare with compassion, but it may actually help our patients. It is central to the values of both our patients and our professions and most of us pursued careers in health because we care. It cannot be an optional extra.
The authors are organising New Zealand’s first compassion in healthcare conference in Auckland in March 2019.
About the authors:
Professor Nathan Consedine is a health psychologist in the School of Medicine at the University of Auckland.
Dr Tony Fernando is a sleep specialist, psychiatrist and senior lecturer in psychological medicine from the University of Auckland.