I had just finished a teaching session in Albania. The topic for the morning was ‘The neurobiology of compassion.’ We spent some time discussing where compassion comes from and where it goes to. Failure of compassionate behaviour in healthcare workers is an active topic of research and public concern in the UK at the moment. The very professionals that people look to for sensitive personal care are failing to provide it. Even worse than that, patients are being actively mistreated by healthcare professionals. One particularly distressing piece of evidence is the fact that medical students tend to lose their sense of compassion as they progress through the course(1). What is happening here? Are medical teachers training it out of them?
After the session a young medical student came up to me and asked me somewhat anxiously,
‘How can I prevent myself from losing compassion?’
My reply that time was rather brief, but her question has prompted me to write 10 tips to keep yourself compassionate.
- 1. Stay away from cynics. Keep away from people who are always grumbling, criticising and pessimistic about the fundamental goodness of human nature. If you stay with them, you risk becoming like them.
- 2. Stay close to your patients. Listen to them and try to understand their sufferings so that it is easy to identify with them. One of the major causes of lack of compassion is a sense of distance between yourself and the sufferer. This may be caused by differences in race, language, religion, cleanliness – or just about anything . If you find yourself without compassion for a patient, ask yourself what is causing the distance. To remain fully present in the face of suffering requires maturity and both internal and external resources. These are provided by the three ‘F’s – faith, family and friends.
- 3. Remember your wounds. There is a saying ‘never trust a doctor who does not bear a wound.’ How often have you had people say ‘I know just how you feel.’ and you have thought ‘Oh no you don’t. You have never experienced what I’m going through right now.’ Although your physical, mental and spiritual wounds will cause you to suffer, they are a valuable cause of compassion for your patients. They will help you reduce the distance.
- 4. Stop for the one. You can always make a difference to someone; you can never make a difference to everyone. It’s tempting to rush on by and be overcome by business. Time pressure often has a devastating effect on altruistic behaviour which may only be shown when social norms permit. This is illustrated by a nice experiment on the failure of good Samaritans.(2)
- 5. ‘Weep with those who weep and mourn with those who mourn.’(3) Don’t be afraid to express your emotions. That is what makes you human and not a machine. Patients want to be treated by humans. The evidence suggests that patients feel supported by displays of emotion by their doctors, especially anger if it is on the patient’s behalf.
- 6. But remember their suffering is not your suffering. Compassion fatigue is a real problem for the empathic doctor who becomes overwhelmed with the suffering of his patients and cannot escape. Make sure that you are well resourced and exercised both physically, mentally and spiritually.
- 7. Be thankful for all the blessings you have. This will help keep you both compassionate and content.(4) Some people write a short note to themselves at the end of each week simply listing the things for which they are thankful in their lives.
- 8. Work closely with good role models for compassionate relationships, both medical and non-medical. It seems likely that a combination of your mirror neurones activity and neuroplasticity will gradually alter the way your brain is structured and the way it works. Both good and bad attitudes can be learnt in this way. In the same way, if you practice compassion yourself, the structure of your brain will change and so will you as a person and as a doctor.
- 9. Make conscious judgements of which actions show compassion and which do not, both in yourself and in others. This use of your emotional intelligence keeps you alert and tuned in to what is happening and keeps you on track.
- 10. Admire what is good; oppose what is bad. You have the power and the responsibility to develop a caring environment where you are. You are a role model and an influence for good, not just with your students and your peers but also those who are senior to you. Several times in my life my students have set me straight when my attitude was not as it should have been.
David Chaput de Saintonge
- 1. The Devil is in the Third Year: A Longitudinal Study of Erosion of Empathy in Medical School. Academic Medicine: September 2009 : 84;1182-1191. http://journals.lww.com/academicmedicine/Fulltext/2009/09000/The_Devil_is_in_the_Third_Year__A_Longitudinal.12.aspx#
- 2. Rachlinski J. The Limits of Social Norms. Chicago-Kent Law Review, 74: 1537-1567 (2000). Full text at http://www.rasmusen.org/w/04.02.01a.htm
- 3. Holy Bible. Romans 12;15
- 4. McCullough ME, Emmons RA, Tsang J-A. The grateful disposition: a conceptual and empirical topography. Journal of personality and social psychology 2002;82;112-127. http://www.psy.miami.edu/faculty/mmccullough/Papers/The%20Grateful%20Disposition_JPSP.pdf