6.2 - Compassion

In this episode of The Hippocratic Society Podcast, Michael and Dr. John Rhee dive into the essential role of compassion in medicine. Building on their previous discussion with Dr. Kristen Collier, they explore how true compassion goes beyond emotion—it is an intentional act rooted in wisdom. Through a compelling patient story and reflections on suffering, virtue, and moral imagination, they offer insights into cultivating compassion even in the most challenging clinical situations. Tune in for a thoughtful conversation on how to grow in empathy and care for patients with greater depth and purpose.

16 minutes • Published Mar 24, 2025 • Download • Transcript

Recommended readings

Are You Experiencing Compassion Fatigue, Rebecca A. Clay (2020), American Psychological Association
Compassion in Healthcare: An Updated Scoping Review of the Literature, Malenfant S, Jaggi P, Hayden KA, Sinclair S (2022), BMC Palliative Care, 21(1):1-28
The Anfortas Question, M.S. Sanatani (2010), Canadian Medical Association Journal, 182(11)
The Philosophy of Medicine Reborn: A Pellegrino Reader, Edmund D. Pellegrino (2008), University of Notre Dame Press
The Rebirth of the Clinic: An Introduction to Spirituality in Health Care, Daniel P. Sulmasy (2006), Georgetown University Press
The Tamworth Reading Room (from Discussions and Arguments), John Henry Newman (1841), Longmans, Green & Co.
Physician Burnout: Its Origin, Symptoms, and Five Main Causes, Dike Drummond, MD (2015), Family Practice Management, 22(5):42-47
Practicing Medicine and Ethics: Integrating Wisdom, Conscience, and Goals of Care, Lauris C. Kaldjian (2014), Cambridge University Press
Resident and Fellow Well-Being: Everything You Need to Know About Resident and Fellow Burnout, My Well-Being Index (n.d.), MyWellBeingIndex.org
The True Value of Reframing, OptimalWork

Transcript

[Intro music]

Hi, and welcome to the Hippocratic Society Podcast. This podcast is a project of the Hippocratic Society.

In the podcast, we aim to reflect on deeper questions in medicine, all with the aim of rediscovering the ideals that brought us to medicine in the first place in order to better serve our patients and colleagues.

Thank you for joining us and we look forward to engaging with you through this podcast.

Hi, and welcome back. My name is Michael and I'm joined again by Dr. John Rhee. Today we would like to talk about compassion.

This episode follows our interview with Dr. Kristin Collier about medical wisdom and the humanities.

During that episode, we talked about compassion in medicine and how it is both necessary to develop medical wisdom, but also itself must be developed by something other than hard science.

And with that, we'd like to dive a little deeper into compassion and how we can use wisdom to practice compassion fully in clinical practice.

Thanks, Michael. Looking forward to it.

Great. So why don't we start with the story?

Stacy had been in the hospital for months.

She seemed to be homeless, and after being discharged months ago, she was quickly brought back in need of medical attention.

Currently, she was in an intermediate care unit on isolation precautions and was monitored 24. 7 by a sitter.

She was extraordinarily demanding and vocal and had earned herself a reputation of being a particularly difficult patient.

She was constantly told rules or denied requests just to continue making the same requests until she could find someone willing to do what she asked.

Anyone who approached her with a new sensitivity and empathy found themselves taken advantage of and manipulated. Shortly thereafter,

the nursing team had to put on a coordinated front to decide what she could and couldn't do,

setting boundaries in the name of care and for the sake of all the staff.

In addition to her disposition, she had bouts of intense pain, which she described as a 10 and for which medication had been almost entirely ineffective in her suffering. She was insufferable,

and it was clear that her pain was more than just physical.

And so, Joan, with patients like Stacy,

these situations truly show us the depth of our character.

And in the face of her suffering, we want to be able to practice true compassion despite all the obstacles.

But before we get into the how, why don't we start talking about compassion itself?

So what is compassion?

Great. Thanks, Michael.

Yeah, you know, it's a story that I reflect on a lot because these are rare patients, but then patients that I think remain in the lives or the minds. Sorry.

Of a lot of us who practice medicine and that it could be really hard to live compassion with patients, especially when we feel this conflict within ourselves in terms of just how we feel like we are also treated by the patient,

and also interior feelings of how we want to also be appreciated, perhaps by patients or for the work that we do.

And so with compassion,

it literally means compassio, to suffer, with *** being.

Perhaps some of you have taken Spanish or Latin, but with. And the passio meaning to suffer.

And,

you know, we often think about the word passion in terms of things that we feel really strongly about.

Perhaps we even associate the word passion with a negative emotion like anger, when somebody is very impassioned or.

But actually, the original word passion comes from suffering.

And the place that it is still used as suffering is in a religious context,

specifically in a Christian context, where there was a movie, the Passion of Christ.

And in that sense, the word passion there is not being used as some deep feeling, but rather the suffering, the suffering of Christ. And so that's the etymology of the word compassion, which I think is an important word to reflect on because of the fact that perhaps we could contrast that with what we've been talking just now as just a feeling.

So just a feeling, perhaps more closely aligned with the word empathy, this feeling that surges out of our hearts.

But that compassion is therefore not just a feeling, but actually it is an action of responding to another person's suffering.

And so what that means is that because actions, all actions are human actions, right? Are the decisions that we make to act,

and therefore all have moral aspect and character.

And I think that that's also important because as we act, we also then want to reflect on what is the object of our act, what are our intentions of the act itself.

And this is the same in compassion, that we act towards a particular good that we see for a particular patient,

and therefore is an integration of. Of our senses,

our reason that come together,

that move forward with the will in a particular act.

Thank you, John. I think that made it very clear that compassion is really coming from our soul, coming from a decision that we make, more so than just feeling sorry for the patient or a sort of pity.

And so clearly, it's very relevant to medicine and may even be the virtue most commonly practiced by clinicians.

But why is it necessary?

What is so important about compassion?

If I can act and heal others just as effectively,

maybe without it.

Yeah, great question, Michael. And a lot of our work in the Hippocratic Society is based on the work of Dr. Edmund Pellegrino, who was a physician, but also a philosopher. And he would say that, quote, first, seeing and knowing the need Is essential to then responding with care.

So compassion is essential to the healing aspect of our patients. Because even when we cannot perhaps physically heal more through compassion, we can still do continue to accompany the patient in their suffering and therefore be able to still provide healing interiorly.

In fact, studies show that being compassionate and empathetic towards our patients Facilitates healing in patients in more ways than just physical.

But I think there's also this important aspect just to go back to this idea of feeling versus the act of our will,

right?

Because we can empathize with a patient, for example, who is suffering.

But if we only base it on a feeling,

without this direction of what the good is for the patient,

then in a moment of intense suffering,

we may feel a lot of the patient's suffering.

And in an attempt to get rid of our own suffering that we feel by taking on the suffering of the patient,

we may think that just eliminating the suffering is sometimes the only thing that is necessary.

And we sometimes forget about the fact that suffering itself may be playing an important interior role in a patient,

and maybe even consider that suffering may be changing the patient's perspective or the way that they're interacting with their disease.

I think a lot of physicians know that in a patient's suffering, they often gain new perspectives.

And perhaps within our own lives, too, we too gain new perspectives in periods of trial or difficulties.

And to an extreme, I would even say that when we try to eliminate suffering at all costs in order to try to alleviate our own suffering from the patient, then sometimes we could even eliminate the patient, him or herself.

And so the other reason why I think the aspect of just not focusing on the feelings is important Is that virtues are the most noble and also helps us grow the most when we practice a virtue like compassion,

when we actually don't feel compassion, or when it is particularly difficult,

because, as you can imagine, that is when we are growing the most in compassion,

when we have our favorite patient come into the clinic to see them, it is not difficult to be compassionate. And so we're not actually stretching our ability to grow in that particular virtue.

But it is patient,

like Stacy, like the story that we had just heard,

where when we feel like it is very challenging to show compassion to this patient, that is actually when we are growing the most in compassion.

So I think that all of those things are just really important things to reflect on, because there's the theme here in the Hippocratic Society of this personal growth that is really important.

And also the theme of identifying the good and what that good is. That Is, I think, also very important.

And so compassion requires a deeper understanding, therefore, of that meaning and purpose of suffering.

And to also look towards in a patient's suffering,

what is perhaps the good in which my virtue or exercise of compassion can also do for the patient.

That is not just like a feeling based thing, but a movement towards healing for the patient, him or herself.

Thank you, John. That was a very beautiful reflection on compassion and how it helps both patient and clinician grow and virtue and understanding suffering and finding meaning even in their suffering.

And so how do we go about doing this? What are the ways we can actually bring this into practice? Especially,

as you were saying, when we're tired, when we don't feel like doing something that we know a patient needs, when we're annoyed at the patient,

when we're recovering from another patient who passed away an hour ago and haven't had time to process our emotions,

what do we do to grow in compassion? And how can we practice that?

Yeah, you know, a lot of these virtues, as perhaps the listeners have been recognizing,

have similar themes of how to grow in the virtues,

themes that we've talked about before.

This idea of presence and mindfulness, so being aware of our feelings and not just immediately acting on our feelings, which we often do, but being able to recognize first, and then seeing it from a third person view,

that itself is like a really important practice or exercise that mindfulness helps us with. So that we're not just constantly reacting to things as we feel them, but rather the feelings become one additional data point for us as we integrate that with our rationality, with our intellect,

and to combine that in the heart, to integrate, therefore, what is the good to pursue here?

So I would say that mindfulness,

at least is like a very important aspect of compassion. To see the emotion that we feel inside, to recognize it, to embrace it even,

but then to have an outlet that is not just reactionary.

I think that second point is a cultivation of a theme that we also talk about in the Hippocratic Society, which is this theme of moral imagination.

And why is the imagination so important in compassion?

I think especially in a case like Stacy's, it is because imagination helps us to expand our horizons and expand our sympathies.

John Henry Newman would say that the heart is commonly reached not through reason,

but through the imagination.

And Edith Stein, another philosopher that I really, really like,

would say that we can imagine ourselves as the other,

since we recognize what we share. Imagination makes us aware of values beyond the limits of our own experience.

So what do these two philosophers have to do with this particular situation.

In which we're trying to grow compassion. I think what they're trying to say is that imagination allows us to step into scenarios. That we may not be used to or we may not have had experience with.

But that by the use of the imagination, we could step into the shoes of, for example, the patient.

Or perhaps the way in which we see ourselves. As potentially interacting with this patient.

And in that imagination also to see ourselves living the good.

And when we exercise that imagination and see,

therefore, that which is good,

Then we could also practice that in person, right? And so that's the aspect of this prudence or practical wisdom. That we can cultivate through the imagination, right? Which is also another theme why we use clinical case scenarios in the Hippocratic Society.

Because that imagination can be exercised through that clinical case. Even if we're not experiencing it directly.

And so that becomes a way for moral deliberation. Through this rehearsal in this imagination.

Where we try out different alternatives and different lines of action.

And therefore, with that imagination, come to that which is the best decision and way to act. For this particular circumstance and scenario for this particular patient.

And so, in this way, we could care for patients much more deeply at an individual level. When we cultivate this moral imagination. So moral being because of the acts in which we are living or doing or carrying out in the care of a patient.

And then we could also ask patients themselves more deeply about their suffering. By practicing this aspect of imagination. In which we could see ourselves in the patient's shoes as well.

What would it be like to be a father of three.

And to be going through this particular cancer diagnosis?

It awakens in us a deeper sense of closeness,

of relationality,

of vulnerability, fragility.

But also the shared humanity with the patient.

I think the other way that that happens Is oftentimes through studies of the humanities, right? Literature, narrative philosophy,

religious studies. These all are ways in which we gain different perspectives than our own. And therefore can further expand our ability in this exercise of the moral imagination.

And then lastly, I would say this aspect of reframing, which we also talk about.

But that in these interactions with patients where compassion is challenging.

We can still find ways in which we could both recognize the feelings to still act and say, what is good for this patient right now.

Is for me to still show utmost compassion and love.

And within that context, we could still see a way for us to grow in a particular virtue.

Whether it is compassion itself.

Or whether it's a particular approach of patience.

Or whether it's a particular way in which we still maintain our sense of stability as we talk and gentleness as we talk to the patient.

So these ways in which we could reframe and then find an opportunity for growth within that particular interaction.

Thank you, John. I think that gave some very practical and clear tips on how we can grow in compassion. And I love the idea of almost deciding how you're going to act before with moral imagination,

like a pre reflection really,

and then sort of being mindful of the feelings as they come up, but not letting those take over your actions and choosing what's best for the patient regardless of the feelings.

So thank you very much, John. I learned a lot and I hope our audience did the same.

And we'll see you all next time on the Hippocratic Society.

Thanks, Michael. Thank you very much for joining and reflecting with us today.

Keep up with new episodes by subscribing to the Hippocratic Society Podcast.

For more information on the Hippocratic Society,

visit us at hipsoc.org. The Hippocratic Society is a 501(c)(3) and depends on the generous support of its listeners.

And as always, we'll see you next time on the Hippocratic Society Podcast.

Loading...

0:00 / 0:00

Loading...

0:00 / 0:00