Abstract
Compassion is a cornerstone of healing, and a compassionate clinician has the power to significantly impact a person's life and health for the better. In fact, research has demonstrated that compassion in clinical practice may improve doctor–patient relationships, health outcomes, and quality care measures and reduce malpractice suits. Still today, however, there are many factors that create obstacles to compassionate care, and stories abound of less than inviting clinical encounters. The good news is that the capacity for caring can be expanded in each of us and fortunately, increasing number of innovative programs are helping to strengthen compassion in health care settings.
What Is Compassion?
Compassion is described as a “sympathetic consciousness of others' distress together with a desire to alleviate it,” according to the Merriam-Webster dictionary. 1 In a study examining the root of what compassion actually embodies, Strauss et al. found that specific elements of compassion included “recognizing suffering in others; understanding the common humanity of this suffering; feeling emotionally connected with the person who is suffering; tolerating difficult feelings that may arise; and acting or being motivated to act to help the person.” 2
In an article comparing empathy and compassion, Singer and Klimecki pointed out that the sharing of suffering can be difficult and especially challenging for those in the helping professions. 3 They stated, “In order to prevent an excessive sharing of suffering that may turn into distress, one may respond to the suffering of others with compassion. In contrast to empathy, compassion does not mean sharing the suffering of the other: rather, it is characterized by feelings of warmth, concern and care for the other, as well as a strong motivation to improve the other's wellbeing. Compassion is feeling for and not feeling with the other.” 3
The embracing of these qualities of compassion by clinicians and health care organizations has been shown to yield improved outcomes on a number of fronts. Sinclair et al. stated, “Studies have reported that patients and family members consistently identify components of compassion, such as receiving care that is person-centered, responsive, and dialogic, as indicators of quality care, with healthcare providers and institutions characterized as compassionate being less likely to receive patient complaints and malpractice suits.” 4
Obstacles to Compassion
In fact, best practice guidelines and principles of medical ethics within major health care organizations such as the American Medical Association call for clinicians to provide compassionate medical care. Unfortunately, that charge does not always translate into practice, and there are many factors that may contribute to a lack of compassion in the clinical setting. The Schwartz Center for Compassionate Healthcare stated on its website that “the stresses of today's healthcare system threaten the delivery of compassionate care” and cited financial pressures and administrative demands as leading to less time with patients. 5 Consequently, less time with patients may cause clinicians' to narrow their focus on making a diagnosis and as a result spend less time processing the actual impact of illness with the patient, according to The Schwartz Center.
The rigors of clinical training and toxic working environments may also limit a clinician's capacity for compassion, according to James R. Doty, MD, professor of neurosurgery and the founder and director of The Center for Compassion and Altruism Research and Education (CCARE) at Stanford University School of Medicine, Palo Alto, California. Dr. Doty commented in an interview, “The reality is that our baseline as a species is to care, and this certainly is the case with most individuals who go into the caring professions. Unfortunately, often the nature of clinical training has a tendency to diminish one's empathy and compassion.”
Clinicians, however, are often as frustrated as the patients that the medical system does not allow time and space for a more compassionate and less hurried pace. The Schwartz Center reported that “many caregivers today are anxious, frustrated and under pressure with no structured outlet for expressing their feelings and little preparation for the difficult communication issues that are an inevitable part of patient care.” 5
Clearly, the ability to offer compassionate care must be aided by environmental support, according to Dr. Doty who stated, “If a healthcare provider is suffering, in pain or attempting to function in a toxic environment, this has an impact on their ability to perceive the suffering of another, to be present and to care appropriately.” He recommended that health care organizations ensure that their providers feel that they are cared for and that their working environment is one that nourishes the spirit. Dr. Doty said, “Once this happens, healthcare providers can be their best selves for their patients. Compassion training and mindfulness programs are all helpful in this way and give both physicians and patients tools that support health and healing.”
Enhancing Our Capacity to Care
Both clinical experience and research findings demonstrate that the pursuit of compassionate care must continue, and many organizations, programs, and trainings have been created to help expand the capacity for compassionate care in the health care setting. Here are a few examples: The CCARE at Stanford University School of Medicine, Palo Alto, California, has a vision that ultimately, the practice of compassion will be appreciated as being as important for health as physical exercise and eating a healthy diet.
6
To that end, CCARE investigates and provides means to cultivate compassion and altruism through research, events, conferences, collaborations, and educational trainings. Among their offerings, CCARE provides compassion cultivation training, an eight-week course that through instruction, daily meditation, mindfulness, and in-class interactions helps health care professionals, educators, and many others learn how to train their minds to intentionally choose more compassionate thoughts and actions.
7
Specifically, the course aims to help people develop the strength to be present with suffering, the courage to take compassionate action, and the resilience to prevent compassion fatigue. CCARE has a comprehensive website ( The Schwartz Rounds program is a unique forum for health care providers to meet with colleagues to discuss “social and emotional issues they face in caring for patients and families.”
5
The Schwartz Center for Compassionate Healthcare website commented on Schwartz Rounds, which occur in hospitals around the globe, and stated, “In contrast to traditional medical rounds, the focus is on the human dimension of medicine. Caregivers have an opportunity to share their experiences, thoughts and feelings on thought-provoking topics drawn from actual patient cases. The premise is that caregivers are better able to make personal connections with patients and colleagues when they have greater insight into their own responses and feelings.”
5
Caregivers who participated in The Schwartz Rounds have reported increased feelings of compassion toward patients, increased readiness to respond to people's needs, less stress and isolation, and improved communication with team members.
5
Serving as a form of the environmental support that Dr. Doty noted the need for above, this popular program demonstrates that when clinicians are able to openly process the difficult things they see, feel, and experience on a daily basis, they are more freed up to be present for patients and offer compassionate care. Loving kindness meditation and/or compassion training emphasize the expansion of compassion in personal and daily life and can increase a person's capacity to care. Weng et al. in a research article about compassion training stated, “In compassion training, compassion is cultivated toward different people, including loved ones, strangers, and difficult persons, as well as toward the self.”
8
They reported, “Compassion training can improve personal wellbeing, including stress-related immune responses, positive affect, and psychological and physical health.”
8
Singer and Klimecki commented on loving kindness training, and said, “This form of mental practice is carried out in silence and relies on the cultivation of friendliness towards a series of imagined persons. One would usually start the practice by visualizing a person one feels very close to and then gradually extend the feeling of kindness towards others, including strangers and, at a later stage, also people one has difficulties with.”
3
These authors reported that “several weeks of regular compassion training can have a beneficial impact on self-reported feelings of positive affect, personal resources, and well-being during everyday life.”
3
Loving kindness meditation and compassion trainings are increasingly offered in many health care settings, community settings, and by individual practitioners. Clinicians should be aware of such resources.
When it comes to compassionate care, on a practical and immediate note, Dr. Doty said that clinicians can start where they are and remember that for many people, the very nature of seeing a physician or other health care practitioner results in anxiety and fear. He emphasized the importance of creating a clinical space that promotes a sense of calm and where a patient feels safe. Dr. Doty commented, “From a patient perspective, the physician often appears rushed and aloof. This is especially true when the physician instead of being present is focused on a computer screen during the interview.” He continued, “First, I would suggest greeting the patient, smiling and not giving the patient the feeling that you are rushed or that they are simply another diagnosis versus a unique individual. During the interview and examination, one should give the feeling that the person in front of them is the most important thing in the world and that what they say is important.” Dr. Doty relayed that physical/nonverbal communication is important in the conveying of compassion and stated that maintaining eye contact and leaning forward toward the patient during a visit, for example, are important nonverbal cues that one is being present with the patient. Dr. Doty said, “All of these actions diminish anxiety and fear while creating a space of psychological safety. By doing so, the patient truly is able to listen, and research has shown that their blood pressure, stress hormones and even inflammatory proteins decrease in a compassionate setting. The executive control area in the brain is functioning at its best allowing for them to be present for thoughtful and discerning decision making.”
Conclusion
Anyone who has ever visited a doctor or other health care practitioner knows that a compassionate clinician makes all the difference in how one feels and how that appointment unfolds. Now, research affirms that compassion is a necessary ingredient for optimizing health and that it can be expanded and strengthened through unique forums, educational activities, trainings, and meditation. Clinicians and health care organizations must commit and recommit to the importance of compassion in the clinical setting by addressing obstacles and providing the resources to expand our capacity to care.▪