To the Editor: In his essay, “Can We Mandate Compassion?” (March–April 2011), Ron Paterson, a former health and disability commissioner in New Zealand, discusses the decline of physicians’ compassion—an issue that is receiving more attention in the media, and in our journals, hospitals, and medical societies, as well.
He decided—and I agree—that compassion should not be mandated. How could it be? After all, it’s unquantifiable; it’s not meted out in milliliters or grams. Compassion is a spontaneous emotion that arises from the individual caregiver’s spiritual reservoirs. Trying to regulate or mandate it would be absurd—the ultimate attempt at dehumanizing medicine. Giving students more exposure to the humanities, however, and teaching doctors what is not acceptable in “terms of conduct, attitudes, and behavior” may increase awareness of its importance. Putting that awareness into action is another thing.
Could it be that physicians are too hard-pressed for time and too overstressed with ordering and interpreting tests that they have little time and energy left for compassion? Has the threat of malpractice suits made physicians distrust patients, seeing them more as potential lawsuits than as suffering human beings, as horrible as that may sound to some? Or has the vast amount of new medical knowledge that rapidly reaches doctors given them an information overload so great that they have room only for cognition and none for emotion? When one adds the pressure physicians feel to control costs and to follow guidelines that often clash with their judgment, it becomes clear why compassion has declined.
As a primary care doctor, there are days when all I have to offer some patients is compassion. A divorce, problems with personal finances, depression, a recent death, a child in trouble with the law or with drugs, an unwanted pregnancy—these are some of the problems that are the most difficult and time-consuming for me. They do not require any new scientific knowledge. Like compassion, they are not quantifiable, and there are no board exams to test how well I help my patients cope with them. There is also no code that I can send to an insurance company that will accurately convey what I have done, or its value to my patients. Only my patient and I are aware of whether I was able to use compassion in a way that helped. How could it be otherwise?
It is much easier for me to treat a patient with pneumonia or conjunctivitis. I doubt that there ever will be a foolproof way to teach compassion to physicians. Perhaps performing psychological tests on incoming medical students may be the best way to determine which are most inclined to become compassionate physicians.
The Flexner Report of 1910, which contained many recommendations for improving medical education, may have overstressed the importance of science while neglecting the human dimensions of medical practice. The Carnegie Foundation, which funded the original study, has undertaken a second examining any unintended consequences of the first. Unlike the first, which was dominated by one man, the second comprises a broad team of educators, doctors, philosophers, and psychologists. Perhaps this broader approach will restore compassion to its rightful place.
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