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Academic Medicine:
doi: 10.1097/ACM.0b013e31829ef1d8
Letters to the Editor

Compassion: Necessary but Not Sufficient

Longmaid, H. Esterbrook III MD; Branch, William T. Jr MD; Rider, Elizabeth A. MSW, MD

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President of the medical staff and chair, Department of Radiology, Beth Israel Deaconess Hospital–Milton, Milton, Massachusetts; helongmaid3@gmail.com.

Carter Smith, Sr, Professor of Medicine, Emory University School of Medicine, Atlanta, Georgia.

Assistant professor of pediatrics, Harvard Medical School, and director of academic programs, Institute for Professionalism and Ethical Practice, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts.

To the Editor: Fan and Lin1 recently addressed the decline in students’ and residents’ empathy during their training, noting that while “there are many efforts to preserve and promote professionalism,” something was missing from “the discourse about improving humanism in medicine.” We agree, but suggest that their recommendation to include the teaching of compassion in medical training, while vital, is only part of the solution.

The physician–patient relationship, which underpins health care, has been buffeted by the changes in care systems, payer methods, and regulatory encumbrances and will continue to erode unless we find ways to reframe and make primary the central task of health care: the care of the patient. We must create means to support practitioner–patient relationships as the foundation for care regardless of whatever technical advances, regulatory requirements, and payment reforms evolve.

During the past several years, we have asked health care experts, educators, researchers, clinicians, and patients from around the world about the human dimensions of health care. That is, what are the core human values that should be present in every health care interaction? Participants identified the capacity for compassion, including the component of empathy, as one fundamental value. We found international agreement about additional fundamental values essential to health care, including commitment to integrity and ethical practice, respect for persons, commitment to excellence, and justice in health care. From this work, an international working group developed the International Charter for Human Values in Healthcare,2 the purpose of which is to articulate and promote these fundamental values and to restore them to health care.

It is time to incorporate all of these human values into conversations about medical training, health care delivery, and any comprehensive assessment of the quality of care physicians provide.

H. Esterbrook Longmaid III, MD

President of the medical staff and chair, Department of Radiology, Beth Israel Deaconess Hospital—Milton, Milton, Massachusetts; helongmaid3@gmail.com.

William T. Branch, Jr, MD

Carter Smith, Sr, Professor of Medicine, Emory University School of Medicine, Atlanta, Georgia.

Elizabeth A. Rider, MSW, MD

Assistant professor of pediatrics, Harvard Medical School, and director of academic programs, Institute for Professionalism and Ethical Practice, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts.

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References

1. Fan VY, Lin SC. It is time to include compassion in medical training. Acad Med. 2013;88:11

2. International Charter for Human Values in Healthcare, Human Dimensions of Care Working Group. . The International Centre for Communication in Healthcare. http://charterforhealthcarevalues.org. Accessed January 16, 2013

© 2013 by the Association of American Medical Colleges

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