Compassion: what it is and why it matters in medicine

'Many medical students are demoralised by an impersonal system before they even begin'

Mara Fiorese
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If you were to comb through scientific literature, you may notice that there’s something capable of reducing post-operative pain, boosting the survival chance of cancer patients, lowering the mortality rate in high risk cardiac patients and cutting the hospitalization rate for diabetics. As if that wasn’t enough, it also boosts the immune system.

So what is this mysterious substance? It’s compassion, or better still, compassionate doctors. Before you stop reading, don’t make the mistake of confusing compassion with pity or commiseration.

Compassion isn't a single, sympathetic utterance, but is rather made up of presence and engagement that suffuses an entire conversation.

The importance of compassion may unsettle doctors who think their duty is to be technically proficient and up-to-date, those who think that it’s a natural quality you either have or don’t have, as well as certain ethicists who think that doctors need to maintain a professional distance from their patients.

But it is central to the welfare of patients. Dr. Robert Youngson, an anaesthesiologist, has launched a campaign to make healthcare more compassionate. According to his research, there are two type of doctors who fit the profile:

1) Empathetic doctors: those who naturally grasp that the whole point of empathy is to focus attention on the patient.

2) Doctors who have successfully attended a doctor patient communication skills course. Communication skills can be taught.

For example, a good technique for showing compassion, is simple: 3 T’s. Talk or listen, take time and touch. Merely taking the time to talk and listen to patients is comforting, as is a doctor’s touch.

Moreover, we must leave our empathetic abilities to guide us through our work, we should develop our compassion as a gift everyone can use.

How many doctors have become cold and distant after losing their freedom and being forced to work as small cogs in a big machine? How many students have become unenthusiastic or demotivated before even getting their medical degree? This is a pedagogical mistake due to a depersonalizing education system: unconcerned and unable to give full support to students, leaving them alone and without a role model.

Scientific literature proves that this argument can be applied both to single professionals and organisations. Personality, values and behaviour reflect individual performances, which are the road to failure or success for each organisation. The doctor-patient relationship is part of the healing process.

Biologically speaking, empathy can be explained by "Mirror neurons." These are a type of brain cell that fires when someone performs an action, and also when a person watches someone else performing the same action.

They were discovered back in the 90s, by a team of Italian researchers who found individual neurons in the brains of monkeys that fired both when the monkeys grabbed an object and also when the monkeys watched another primate grab the same object.

But mirror neurons also exist in the brain areas that are in charge of emotions.

This means that we are able to recognize other people’s emotions simply by observing them. When we observe someone, these mirror neurons are activated and allow us to at least partly feel the emotions that the person we are observing is feeling.

These “empathic” mirrors are triggered both when we experience an emotion and when we observe somebody who is experiencing the same emotion. This extraordinary achievement provides the neurophysiological grounds for empathy.

“It’s the relationship that heals”, says Dr. Irvin D. Yalom, Psychiatry professor at Stanford University; he underlines the importance of qualitative relationships over theory. A relationship is strictly personal, a good relationship is based on care and the will to relieve patients’ suffering.

According to the American psychologist Carl Rogers, there are three main ingredients to a good doctor-patient relationship: empathy, honesty and genuineness.

Rollo May, psychologist and theologian, applies the Greek word “agape” or the Latin “caritas” to compassion to underline what is essential in a therapeutic relationship: an emotion of regard and affection (it applies to both “agape” and “caritas”). He shares the Royal College of General Practitioners’ (RCGP) point of view, whose motto is: “Cum Scientia caritas - Compassion with Knowledge”. It all seems to fit.

If we work on patient-centered care, if the patient himself feels that he’s taken seriously and the doctor addresses his needs, this will lead to reduced healthcare waste.

Our purpose is to stimulate a debate on how to improve medical training, given the positive results of the researches; a debate on being both up-to-date and compassionate.

At the edge of the Fourth Industrial Revolution, a wave of digital-era change, compassion is still a valuable tool for those who want to shape innovations rather than being overwhelmed by them.

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