Definitions
- “Compassion is the character trait that shapes the cognitive aspect of healing to fit the unique predicament of this [particular] patient.”
What is Efficiency and Compassion?
- Compassion is a virtue essential to the good practice of medicine.
- “To be compassionate is to be disposed to see, as well as feel, what a trial, tribulation, or illness has wrought in the life of this person's here-and-now suffering.” (Pellegrino)
- There is a huge emphasis in medicine to do everything efficiently, that is, without wasting time, energy, or resources.
- This emphasis on efficiency can cause pressure that drives physicians away from compassion.
Why should we practice the virtue of Efficiency and Compassion?
- Why Do We Need to Balance Compassion and Efficiency?
- The good of the patient consists not only in his medical good, but also his personal and spiritual good.
- Efficiency itself is a good thing. But when efficiency supersedes all other ideals, it can be damaging to the good practice of medicine, as well as to physicians themselves.
- Efficiency is not necessarily opposed to compassion, but its importance seems to be emphasized for more than that of compassion.
- This ultimately leads to physicians losing sight of the ideal of compassion.
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
You are on your Family Medicine rotation as a third year medical student. Your precepting attending Dr. Swift runs a busy practice, and he double-books his appointments, so he often sends you to see a patient on your own while he sees a different patient. He then has you present the patient you saw to him, so that he can zip into the room and wrap up the visit while you write the note for the encounter.
An older patient, Mr. Jimmy, is coming in with the chief complaint of a new mole on his back. As you are heading to the patient’s room, Dr. Swift lets you know that if you think the mole looks suspicious, the plan will be to do a biopsy in the procedure room as part of today’s visit. Dr. Speed hands you a procedure consent form, instructing you to get consent for the procedure while you’re in the room.
You go into Mr. Jimmy’s room and start taking his history. Mr. Jimmy tells you he recently retired from a very busy career. You attempt to direct the conversation to the suspicious mole that brought him in, and he shows you a spot on his upper back which looks completely normal to you. Mr. Jimmy is relieved to hear that you don’t think it looks like cancer, and as you’re trying to politely exit the room, he shares with you that his work kept him feeling like he had a sense of purpose after his wife died a few years ago, but now that he is retired, he feels like he is mourning her loss all over again, and he’s starting to ask himself what his life has meant, whether God exists, and other big questions. You decide that as a medical student, you can take a few extra minutes with Mr. Jimmy to talk to him about these big questions, so you sit back down and have a thoughtful conversation. When you get up to leave the room again, Mr. Jimmy tears up. He thanks you for being a good listener and tells you that you’re going to make a great doctor.
You walk out of the room and find Dr. Swift pacing outside the door. He looks at the blank consent form in your hand and shakes his head in frustration, exclaiming, “Are you kidding me? You just spent half an hour in that room, and you’re going to tell me he doesn’t need a biopsy? I set up the procedure room while you were in there!”
Discussion Questions
- What lesson do you think the medical student will learn from this episode? Is it a good/correct lesson? Why or why not?
- Why do you think Dr. Swift puts such an emphasis on efficiency? Is this a good thing?
- Can a busy physician afford to listen to patients about even non-medical issues? Why or why not?
- Do you think it is more important to be efficient like Dr. Swift, or compassionate like the student? Is there a realistic compromise or a happy medium?
- Compare and contrast the benefits of Dr Swift’s approach and the student’s approach.
- Is either person going too far in their approach?
- If the student had not taken the time to converse with Mr. Jimmy, how would that affect the patient? Would this effect be significant? Why or why not?
How do we foster Efficiency and Compassion?
- It is important to fight against the idea of efficiency as the end-goal.
- It is also important not to see efficiency as always “competing” with compassion, but rather, that we are pursuing the ideal of efficiency alongside other ideals. If you recognize an imbalance in your ideals, strive to correct it.