Definitions
- A feeling of deep sympathy and sorrow for another who is stricken by misfortune, accompanied by a strong desire to alleviate the suffering.
What is Compassion?
- “Compassion, since understanding and feeling something of the unique predicament of the person’s need, is essential to healing.” Edmund Pellegrino, MD (pg. 80)
- Encompasses empathy which is defined as “the psychological identification with or vicarious experiencing of the emotions, thoughts, or attitudes of another.”
- Goes beyond mere empathic feelings, but also embracing actions motivated by those feelings.
- “When compassion becomes a principle, it ceases to be a virtue. As a principle, all it means is the easiest way out.”
Why should we practice the virtue of Compassion?
- Helps both to understand ourselves, but also to have appropriate feelings towards our patients who are suffering.
- Being compassionate and empathic towards our patients facilitates healing in many patients.
- “Patients consistently identify compassion as a central feature of their overall experience of healthcare.”
- When compassion is seen merely as a principle it becomes expediency and is used to justify immoral acts done to decrease suffering at all costs. acts of kindness can boost oxytocin/ dopamine
Aristotle’s Doctrine of the Mean
Aristotle’s Doctrine of the Mean emphasizes balance as the essence of virtue, symbolized here by a mountain peak with a flag representing the ideal midpoint. Each virtue lies between two opposing vices—deficiency depicted on the left, and excess, on the right slope. For example, courage is the balance between cowardice (deficiency) and recklessness (excess). In a medical context, this principle guides healthcare professionals to strive for the peak of ethical behavior, avoiding the pitfalls of extremes to ensure thoughtful and compassionate care.
Case Studies
"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 gang bangers 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.
Discussion Questions
- How do you think you would feel differently towards this patient when you found out that he was a pastor rather than a gang member?
- Is compassion a required element in good medical care?
- Is compassion something that the patient earns or is it a gift that the physician gives?
- Why is the emotional nature of compassion important in our actions?
- Why is it more difficult to be compassionate to those who make foolish decisions such as smoking or drug use, not following doctors’ advice or participating in illegal activities?
- How can physicians regain compassion for these patients?
- How does compassion fatigue and burnout play an adverse role in the practice of good medicine?
- Compassion can be very difficult to sustain in certain environments. Can you name one? (Pandemics such as COVID or war zones are two).
- Lauris Kaldjian, MD wrote “Structural realities in hospital services and clinic schedules may teach trainees that efficiency and economic productivity are valued more than respect for patients’ questions, sensitivity to their anxieties, or compassion for their suffering.” In what ways does your medical institution reflect this statement?
How do we foster Compassion?
- Practice “small acts of kindness” or “go above and beyond.”
- Reframing: How will this opportunity for compassion make me a better physician, family member, friend?
- Avoid burnout
- Education: Humanistic studies, discuss “common humanity scenarios”.
- Create relational space in patient interactions