Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Cultivating Compassion


Compassion—acting on the desire to relieve suffering—is central to giving clinically excellent care to those in need.

We often hear of the importance of compassion in giving clinically excellent care. However, the term “compassion” is often over-sentimentalized or reduced to “being kind” to patients. It can sometimes be viewed as helpful but not essential to clinical practice. In my research internship with the Hillebrand Center for Compassionate Care at the University of Notre Dame, I’ve learned that the new science of compassion—grounded in biology, neuroscience, and psychology—shows that compassion should not be merely tangential, but rather central to medical practice.


The difference between compassion and empathy

Compassion isn’t the same as empathy—they involve different neurological networks. Compassion can be defined in four parts: (1) noticing the suffering of another; (2) being moved by it; (3) experiencing a desire to relieve it; and (4) acting on this desire to relieve it. Thus, compassion is more than “feeling with” another. Empathy, or “empathic resonance,” is captured in step two of the four-step compassion process, being moved by suffering. Compassion thus contains a conscious motivational and behavioral component, while empathy is simply a neurological response to the suffering of another through the firing of mirror neurons and activation of the pain matrix.



The zone of balanced compassionate caring

The “zone” of balanced compassionate caring lies between the two extremes of emotional detachment and emotional over-involvement. This distinction is critical—rather than being emotionally detached from patients, it’s important for clinicians to remain optimally emotionally involved through strategies of emotional regulation. These strategies may include vocalizing emotions, cognitive reappraisal, or other techniques to regulate emotional involvement. Emotional regulation has been shown to have health benefits for clinicians in terms of gaining fulfillment and reducing stress and burnout.


The benefits of optimal emotional involvement

Compassion and an optimal level of clinician emotional involvement also have benefits for patients beyond patient satisfaction. More than just “being nice,” true compassion—noticing and being moved by the suffering of another and acting on a desire to relieve it—increases the accurate delivery of care from diagnosis to treatment. Taking the extra time to hear the patient’s full story and to allow oneself to be moved by their suffering can prevent unnecessary and costly tests or prescriptions. If the patient doesn’t understand why they’re taking a certain medication, or if the clinician and patient are not aligned on the patient’s goals and values, then care can be misguided.


Giving care within the clinician compassion mindset and the zone of balanced compassionate care can make a substantial difference in a patient’s health outcomes. As medicine becomes increasingly specialized and technology-driven and physicians are often constrained by the boxes of EHRs and insurance billing, it’s important to re-center our practice on compassion in order to mitigate burnout and enhance patient care.


Here are three ways to cultivate compassion:



1. Self-reflection

The practice of self-reflection, whether through journaling or talking with colleagues, can open doors to self-awareness. This can help clinicians discern why they may experience over-involvement with some patients and emotional detachment with others.


2. Reclaim emotion’s role in clinical practice

Rather than immediately suppressing automatic emotional responses, explore why you’re experiencing these emotions and how they can be channeled to the benefit of the patient’s healing. Emotional resonance carries biological significance —it can be a driving motivational factor in engaging compassionately with patients to promote healing.


3. Concretely express caring intent

As Dr. Dominic Vachon writes in his book How Doctors Care, “It is not enough to care about a person in your mind and heart. You have to show that you care.” Practices for expressing compassion involve striking a balance between introversion and extraversion by purposefully creating time to listen as well as time to converse. One thing you can consider saying is, “Your illness must be challenging for you—recognize that it affects your mental and emotional well-being. I promise to accompany you though it with my expertise and desire to do the best I can for you as a patient and as a fellow human being.”