Compassion and empathy are two of the most commonly recurring terms used to describe the character traits of a physician. These terms are often used interchangeably, but in a profession like medicine, setting a boundary between the two is essential.
In a 2016 article titled, ““Enhancing compassion in general practice: it’s not all about the doctor”, The British Journal of General Practice (BJGP) highlights an interesting distinction between these terms.
According to the BJGP, empathy refers to an individual’s ability to think of and feel others’ emotions whereas compassion saddles with itself a desire to help (Fernando et al., 2016). Critical to building an understanding of empathy and compassion is recognizing that it is the difference between thoughts and actions that sets these two terms apart.
Fernando et. al further supplements these definitions by providing some situational examples to contextualize how empathy and compassion work in medical settings. Take for instance a physician who may acknowledge and understand the pain of a child suffering an asthma attack but may not necessarily stop to act upon it because they have other pressing responsibilities to consider. In this situation, does the physician exhibit empathy or compassion or both? The answer is clear – although the physician is empathetic, they do not show compassion (Fernando et al., 2016).
This precise scenario is used by Fernando et. al to introduce the discussion on the dangers of empathy without compassion. If the physician feels empathetic but the ‘feel good factor’ that arises from acting in a compassionate manner is missing, it can actually lead to the arousal of negative feelings in the physician. This negativity stems from an acknowledgement of patient suffering but inability or helplessness to act against it. This negativity can spiral into “serious emotional fatigue and breakdown”(Fernando et al., 2016). Thus, it is highlighted that a lack of compassion from physicians is detrimental not only to their work and patients but also for themselves and their mental and emotional well-being (Fernando et al., 2016).
If increased physician burnout is the cost of empathy without compassion, then why are barriers to practicing medical compassion not highlighted and discussed through medical education and in research literature?
Most of the literature that discusses the issue tends to attribute empathy without compassion to ‘compassion fatigue’, a phenomenon that professionals working with traumatized individuals often face (Cocker, 2016). It highlights how constant exposure to trauma leads to burnout and stress for physicians, and can gradually cause reduced compassion overtime. While compassion fatigue remains a valid component of the issue, it is one of many factors that heavily influence the emergence of compassion in healthcare providers.
The Barriers to Physician Compassion (BPC) is a questionnaire which provides unique insights to understand these factors (Fernando et al., 2014). The questionnaire was administered to 372 physicians in the Philippines and controlled rigorously for demographics, education, and other factors. After analyzing the findings, four components were highlighted. Physician burnout and overload remained the number one variable in physician compassion but was closely trailed by external distractions, patient and their family’s attitude, and the complexity of the clinical cases (Fernando et al., 2014).
By recognizing the various factors that lead to decreased compassion in physicians, we understand that physicians themselves are not a unique component in the problem. The issue arises from multiple contexts, the situational factors playing a major role in physicians attitudes and actions. By understanding and acknowledging these factors, the problem of empathy without compassion can be approached from different perspectives, the solution targeting not only the physician but the external variables that influence them.
Cocker, Fiona, and Nerida Joss. “Compassion Fatigue among Healthcare, Emergency and Community Service Workers: A Systematic Review.” International Journal of Environmental Research and Public Health, MDPI, 22 June 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC4924075/#__ffn_sectitle.
Fernando, Antonio T, and Nathan S Consedine. “Development and Initial Psychometric Properties of the Barriers to Physician Compassion Questionnaire.” Postgraduate Medical Journal, The Fellowship of Postgraduate Medicine, 1 July 2014, pmj.bmj.com/content/90/1065/388.info.Fernando, Antonio T, et al. “Enhancing Compassion in General Practice: It’s Not All about the Doctor.”
The British Journal of General Practice : the Journal of the Royal College of General Practitioners, Royal College of General Practitioners, July 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC4917021/#__ffn_sectitle.