Is compassion an optional extra?

A debate article by Professor David Haslam was published in Journal of Compassionate Health Care on 13 July 2015. The article puts forward a passionate viewpoint about the importance of being kind in healthcare. Here, Editor-in-Chief of the journal, Sue Shea, tells us more.

It was a pleasure to receive the debate article from Professor David Haslam, Chair of National Institute of Health and Care Excellence (NICE).

Professor Haslam puts forward a passionate viewpoint regarding the importance of the concept of compassion in healthcare, beginning with reference to the devastating events at Mid-Staffordshire recorded in the 2013 Francis Report.

A perceived lack of compassion

There is international concern about the perceived lack of compassion in health care and this is sometimes thought to be the result of the modern day technical/scientific training of doctors and nurses, coupled with the large amounts of paperwork that staff are expected to deal with in recent times.

In his article, Professor Haslam refers back to four decades ago whereby in his early days in the medical profession he witnessed care carried out with great compassion, but also care that was ‘anything but compassionate’, concluding that ‘the good old days’ were not automatically good at all.

Thus, if there were signs of a lack of compassion in the past, when society was less technically orientated and pressures were not so high, can we expect compassion to form a crucial part of health care today?

The answer is surely yes – it can and it should. Compassion should not be an ‘optional extra’, and indeed there is evidence to suggest that even small acts of kindness and understanding, and attention to basic needs, results in faster recovery and less patient anxiety.

After all, we are all potential patients and how would we want to be treated when we are at our most vulnerable?

What is compassion?

The concept of compassion and its associated virtues are certain to be very much in place when an individual first enters the medical profession, but might become lost or hidden due to a number of factors.

As Professor Haslam reminds us, there are many definitions of compassion and the concept might be difficult to describe. However, many of us would be in agreement to the virtues included within the concept, and most importantly the fact that compassion implies taking some kind of ‘action’- even it that action is only small – to help to relieve the suffering of another.

The concept of compassion and its associated virtues are certain to be very much in place when an individual first enters the medical profession, but might become lost or hidden due to a number of factors.

Some potential reasons for this, put forward by Professor Haslam include: shortness of available time to develop caring relationships; loss of sense of personal responsibility if many team members are involved; rapid access rather than continuity (in General Practice); and ‘sheer busy-ness’.

But as Professor Haslam further states, the above cannot account for the whole explanation. He goes on to draw attention to the fact that the ability to emphasize might become lost in clinical training, and that healthcare professionals might fear that demonstrating too much compassion could lead to compassion fatigue.

Compassion fatigue and burnout are of course increasingly common and important factors to take into consideration. Thus attention needs to be paid to the care of healthcare professionals themselves with awareness from each member of the organization in recognizing symptoms of potential burnout in their colleagues.

So what is the solution?

Should courses on compassion be introduced to the curricula in terms of medical/nurse training, and if so how? Debate as to whether or not compassion can be taught has existed for some time, and as far back as 1983, Pence raised this question in a well-cited essay, utilizing the differing views of ancient philosophers.

Pence drew on the opinions of Socrates (who claimed that virtues cannot be taught), and Protagoras (who claimed that everyone teaches virtues), concluding that compassion can be taught if medical education systems reward this virtue alongside other medical virtues.

As such, there is possibly ‘extraordinary potential for blending the best of evidence-based medicine with real patient centredness’, and as Professor Haslam points out, we should cultivate self-reflection, and ways of encouraging and sustaining compassion could be activated through learning from humanities such as literature, film, theatre, poetry which help us imagine the lives of others.

It is also important to learn from patient and healthcare professionals’ personal ‘stories’, and to learn from examples of ‘what goes right’, and not just ‘what goes wrong’.

Developing a ‘compassionate culture’

In the final section of Professor Haslam’s paper, he refers to the important role of leaders, and team-work. It is important when considering the concept of compassion, to look at the organization as a whole and to consider to what extent we can develop a ‘compassionate culture’.

My own view is that to develop a compassionate culture, any on-going training in the field of ‘compassion’ should be delivered to all involved within the health care setting, including managers, administrative staff, auxiliary staff, and policy makers, so that the needs and well-being of both staff and patients can be recognized.

Thus, compassion should not be seen as an optional extra, and the organization itself should demonstrate ‘compassion’, in order to cultivate and sustain the concept in individuals working within the healthcare setting.

As Professor Haslam concludes “…in the end, it all comes down to patient-centredness. And it takes every single person involved in healthcare – from Governments all the way through to the frontline – to remember this’.

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