Compassion

Definitions

1. Compassion is sympathy for another's suffering, coupled with a desire to alleviate it
2. A feeling of deep sympathy and sorrow for another who is stricken by misfortune, accompanied by a strong desire to alleviate the suffering
3. The virtue by which we share in the suffering of others and are moved to help them

What is Compassion?

Compassion is the cornerstone of excellent medical care. It means seeing our patients as whole people, not just their diagnoses, and treating them with kindness and empathy. Compassion moves us beyond mere clinical competence to genuine care for the patient's total well-being.

In medicine, compassion manifests as the ability to perceive and respond to a patient's suffering—physical, emotional, and spiritual. It requires both emotional attunement and practical action to relieve distress.

Why should we practice the virtue of Compassion?

Compassionate care has been shown to:

• Improve patient outcomes: Studies demonstrate that compassionate care leads to better adherence to treatment and improved health outcomes
• Increase patient satisfaction: Patients who feel their physicians are compassionate report higher satisfaction with their care
• Reduce physician burnout: Practicing compassion can paradoxically protect against burnout by fostering meaningful connections
• Strengthen the doctor-patient relationship: Compassion builds trust and facilitates open communication
• Uphold the dignity of the patient: Compassion recognizes the inherent worth and humanity of each person

Aristotle's Doctrine of the Mean

Compassion represents the mean between:

• Excess (Sentimentality): Being so overwhelmed by patients' suffering that one cannot function professionally
• Deficiency (Callousness): Becoming hardened to suffering and treating patients as mere cases or objects

The virtuous physician cultivates compassion that is:

• Balanced: Acknowledging suffering without being paralyzed by it
• Professional: Maintaining appropriate boundaries while remaining emotionally present
• Sustainable: Practicing self-care to avoid compassion fatigue

How do we foster Compassion?

Practical strategies for developing compassion:

1. Practice active listening: Give patients your full attention; listen to understand, not just to respond
2. Cultivate empathy: Try to imagine the patient's experience and perspective
3. Acknowledge suffering: Verbally recognize what the patient is going through
4. Take small actions: Simple gestures—sitting at eye level, offering tissues, explaining clearly—demonstrate care
5. Reflect on your practice: Regularly examine how you're showing compassion and where you can improve
6. Maintain self-compassion: Be kind to yourself to sustain your capacity to care for others
7. Seek inspiration: Read stories of compassionate physicians and reflect on what moves you to practice medicine

Clinical Case

“Trauma team to the trauma room” blares over the hospital PA system while simultaneously a chorus of trauma pagers echoes around the surgical call room. You hear your team groan collectively while someone exclaims “Another gunshot” and another follows up with “why can’t those gangs take the night off?” You have seen the north end of the 80-hour resident call week for months and you were really hoping for a “quiet” night prior to a well-deserved day off. Your team meets the attending surgeon in the emergency room and go to work. It’s a young adult male with a gunshot wound to the abdomen. You stabilize him and take him to the operating room where you find a shattered spleen and additional bowel injury. A splenectomy and diverting ostomy follow and then you transfer him to the ICU.

You think afterwards that you’ve just been going through the motions for some time especially on the trauma service where your Level I trauma center has a very active “knife and gun club.” You have been briefed about burnout in medicine and especially in residents, but you don’t think the long hours have unduly affected your performance as your attendings routinely cite your surgical skills as above average.

After rounding on your patient, the next morning, you overhear your team’s medical student say that the patient was not a gang member but rather a pastor who was shot trying to break up a fight.

Alternative Case

You are taking care of a mother of three children who is admitted for a pain crisis because she has multiple myeloma and had a recent compression fracture. You are trying to manage her pain with titration of opioids. You notice, however, that she continues to have a lot of pain despite very high amounts of pain medications. You explore a bit at bedside and find that she's also suffering deeply from feeling like she is always away from her children and that she is therefore a bad mother.

You step out of the room to overhear the nurse saying, “she's suffering so much. If I were her, I'd ask them to just put me to sleep permanently.”

Reflection Questions

1. When have you felt most compassionate toward a patient? What enabled that response?
2. What barriers to compassionate care do you encounter in your practice?
3. How do you balance compassion with professional boundaries?
4. In what situations do you find it most difficult to feel compassion? Why?
5. How can you cultivate compassion when feeling overwhelmed or burned out?