Compassion and Competence In Medical Practice

Although I am not sure why, I have observed that some health care professionals tend to be profoundly uncomfortable with subtleties, and so their thinking is often very much “either–or” in nature. My sense is that “either–or” thinking tends to naturally exclude or denigrate many things that are more about “and-or-both.” Certainly, I have known of many conversations in which people argued for compassion in clinical practice but were either strangely silent or dismissive about a physician being extraordinarily skilled and knowledgeable. Also, I have heard many people argue solely for competence (or skills/knowledge) in clinical practice. Unfortunately, these arguments often rely on narrow and/or artificial parameters that obscure more than illuminate important clinical and human realities. Naturally, I have little sympathy with either approach, because these unfortunate positions tend to undermine the pursuit of better outcomes.

Contrary to what some physicians or other health professionals assert, it is not a case of one speciality needing compassion and others not needing compassion. While it may be accurate to suggest that there are specific steps or procedures that would be no better with compassion, it is bordering on disingenuous to suggest that, because of this, compassion can serve no earthly purpose in producing clinical results or in affecting real-world clinical practice. In my estimation, all of medicine would be better if physicians learned to diagnose, treat, and follow-up with compassion.

While a patient does not need compassion during certain stages of a procedure or technical intervention, this simply is not the case in a great many other aspects of acute or chronic health issues. For instance, accurate diagnosis and/or a fuller sense of risk factors or other potential issues may certainly be more likely to be revealed when a patient is more comfortable trusting a physician who is going to be performing surgery or an invasive procedure. The person doing the invasive procedure or surgery may be more cognizant of what he or she (and support staff members) can do actively to prevent or minimize postprocedure acute or chronic iatrogenic effects if measures are taken preprocedure and postprocedure to reduce the chances of these things happening greatly. Someone approaching the same procedure or surgery without adequate compassion, may easily have a very different understanding of what constitutes a job well-done, whether the procedure in itself represents that person's entire responsibility of care and whether difficult acute postrecovery issues have anything to do with the medical personnel, let alone chronic issues that develop as a result of a specific surgical intervention (for example, chronic pain may follow a surgical procedure). What I am suggesting is that, even in specialties that people often regard as not needing compassion, any specialty can benefit from compassion being used, because it can benefit the patient and improve the practice of medicine. When compassion is combined with skill, knowledge, and competence, physicians really do the best thing for patients. I have purposefully used surgical interventions as one of the examples above, because it is important to use an example that is not a “soft” kind of intervention, and also to suggest that, just because compassion does fit into various specialties in various ways, this does not mean it is any less important or applicable in areas that appear not to require it.

In my view, any physician that has anything less than top-flight skills, knowledge, or competence, is simply destined to make more medical mistakes, cause more suffering, and do considerably more harm to patients. There is something almost surreal about the notion that physicians will be doing outstanding work, as long as these doctors are compassionate. Deep skills, knowledge, or competence should never ever be dismissed as a luxury—nothing could be further from clinical truth and true healing. Thoroughness, relevant big-picture issues, and tiny details all matter if a physician is going to make the most accurate diagnosis, offer the best treatment(s), and have the best follow-up for optimum short- and long-term outcomes.

The founder of hospice and palliative care Dame Cicely Saunders was adamant in arguing all patients deserved “efficient loving care” ¹ or “compassionate evidence-based care.”* The incomparable Robert Twycross (BM, BCh, MRCP, DM) had mentioned in his eulogy about Saunders that she was very impatient with the notion that love and tenderness (alone or in themselves) could be defined as being appropriate care. ¹

Clearly, our dear patients deserve both compassion and competence. Diagnosis, treatment, and healing are all improved when every physician truly understands this to the depths of his or her soul. William Osler stated: “The good physician treats the disease; the great physician treats the patient who has the disease.” ² Without competence and compassion, medical practice is sadly diminished. Also, as many experienced clinicians know, competence and compassion together can make a huge difference in cases, but especially in the difficult ones, because it helps the physician really listen to the patient, while making it easier for the patient to speak more openly. Some physicians fail to listen deeply and consistently, and patients suffer as a result. By emphasizing consistent and genuine listening, it is possible to elevate both compassion and competence.