Opinion by Robin Youngson.
This interesting viewpoint from Tom Shakespeare, writing in the BBC News Magazine, asks whether a focus on compassion is costing us attention to other, more important technical aspects of care?
Rather than emphasising compassion, many medical educators would say that their priority is to ensure that professionals have sound medical knowledge. After all, when it comes to heart surgery, most of us are less concerned about whether a doctor is kind and more worried about whether they know what they are doing and have great outcomes statistics. In a crowded medical school curriculum, ensuring that doctors learn the core clinical skills comes first.
I would also add that in the disability movement, we are rather suspicious of compassion. Activists sometimes wear T-shirts with the slogan “Piss on Pity”. Disabled people do not want people to feel our pain, we want them to get off our backs. Another relevant motto is that professionals should be “on tap, not on top”.
Non-disabled people may imagine what it’s like to have an impairment, thinking how dreadfully tragic it must be. But, actually, they are just projecting their own fears and ignorance, letting their moral imagination run away with itself. The evidence proves that most disabled people are well-adjusted and report a good quality of life.
Empathy and compassion are only good up to a point. The health professional who feels our pain most is likely to be the one who burns out first.
Shakespeare makes a number of very valid points in his article, which is engaging and well written. But he repeats a number of common myths about compassion and makes some assertions that are just plain wrong. His article elicited many comments and it’s worth reading the discussion that follows. Here’s my view on some of the issues.
Compassion OR technical skills?
It’s a curious feature of Western culture that we unconsciously construct our thinking in terms of arguing opposite points of view and then settle on the one that ‘wins’. It’s how we conduct our politics, our legal system, and many of our daily choices. I have never heard anyone argue for compassion AND technical skills, it’s always one or the other. Western medicine does not tolerate ambiguity! But the evidence is really clear: compassion and mindfulness greatly enhance the application of our clinical skills.
I’m an anaesthetist. I do highly technical work and sometimes I have only minutes to make the right decisions and take the right action to save a patient’s life. But then I may have only five minutes to greet and assess my next patient before administering anaesthesia, so I need the highest level of skills in empathy and connection to elicit the patient’s fears, build a bond of trust, make a plan together, and have a patient feel confident coming into the OR.
For me the key skill is mindfulness, the ability to be consciously aware of how I am directing my attention and what is needed in each moment. Your consciousness is like a searchlight, it can only focus on one thing at a time. Indeed research shows that focusing on analytical thought, suppresses the circuits that enable empathy. Without mindfulness, the technical expert may come across as cold and detached while the caring practitioner may fail in the application of clinical skills.
Confusing empathy, compassion and pity
Shakespeare, in common with many other writers, uses a number of terms interchangeably. Compassion is a complex construct, including elements of empathy, sympathy, sensitivity, non-judgment, a tolerance of distress, and a motivation to relieve suffering.
Empathy is not enough. Empathy is the capacity to perceive and understand the emotions, feelings and circumstances of another person. It’s not always a force for good. Both conmen and torturers use skills in empathy to increase the harm they do to others. The simple definition of compassion is “the humane quality of understanding suffering and wanting to do something about it”. It’s a motivation, not just a feeling.
Empathetic caregivers feel the pain of their patients. You cannot sustain compassion unless you have the internal resources and resilience to tolerate that distress in yourself and still be fully present to the patient. Empathy alone can lead to burnout. But compassion is self-sustaining. Every act of compassion toward another is also an act of compassion to self. The practices of compassion: kindness, caring, appreciation, gratitude, and non-judgement are sustaining. It’s not true to say, “The health professional who feels our pain most is likely to be the one who burns out first.” Caregivers with the deepest compassion feel their patients’ pain most acutely but they also have the most joyous and satisfying practice.
What is needed, is to provide an emotionally supportive environment for our your doctors and nurses so that they can survive the terrors of early practice while still keeping an open heart and developing the personal practices that are self-sustaining.
Anyone with illness or disability is right to feel suspicious of ‘compassion’ if it’s really pity in disguise. Pity is a form of judgement, it’s an assertion of superiority – oh, you poor thing! Pity is no part of compassion. Compassion always brings deep respect and non-judgement.
Shakespeare does indeed attend to a number of these arguments:
We need health professionals who are technically competent, but who can also demonstrate the virtues of compassion and empathy. In most of medicine, technical versus caring skills is a false dichotomy. Changing a bed pan or taking a blood sample are not simply objective tasks. You can do them in ways which are empowering and soothing, or you can do them in ways which are demeaning and disrespectful.
It’s worth reading the full article and reflecting on all the points he makes – and also exploring the many comments posted by others. This is healthy debate and it’s wonderful to see the issue of compassion in healthcare receiving so much attention. Five years ago, a Google search for “Compassion and healthcare” yielded almost no results. Today we are beginning to realise that compassion and caring are as important as all the technology and bio-medicine.