To the Editor: There are many reasons for the decline of medical students’ and residents’ empathy as they progress through their clinical training,1 and there are many efforts to preserve empathy and promote professionalism.2 Yet it is important to pause and ponder: Is there something missing from the discourse about improving humanism in medicine?
Indeed, the concept of compassion has been noticeably absent from the literature, while concepts of empathy and professionalism predominate. Compassion is defined as a sympathetic consciousness of others’ distress with a desire to alleviate it—an “emotional reflex.” Empathy, on the other hand, is defined as the ability to understand the patient’s situation, perspective, and feelings and to communicate back that understanding.3 Thus, empathy lacks an internal motive to do something and is, instead, a technical ability. This is an important difference in these two concepts, which in many other ways are merely different ways to describe a wide spectrum of emotional experience.
The lack of discussion of compassion may also be (1) because compassion may have the ability to produce “compassion fatigue” and (2) because compassion may interfere with rationality or clinical reasoning. However, there is a lack of substantial evidence to support either claim.
It is time to incorporate compassion into the conversation about improving medical training, along with empathy and professionalism, since these three qualities of a physician may be more intertwined than previously thought. There has also been evidence suggesting that compassion helps counter a variety of negative emotions, bringing calmness to a physician’s practice.4 As a first step, it would be beneficial to develop a comprehensive measurement of compassion, as has been done with empathy.5 This may provide a new framework to help uncover subtleties of the caregiver experience previously overlooked, and may provide new approaches to current interventions in medical education aimed at producing caring physicians that remain humanistic throughout their careers. If compassion is considered an emotional reflex, then it is inherent in most individuals, and—like most reflexes—it can be honed, fostered, and exercised to its full potential.
Victoria Y. Fan, SM, ScD
Research fellow, Center for Global Development, Washington, DC; [email protected]
Steven C. Lin, MPH
Medical student, Boston University School of Medicine, Boston, Massachusetts.
1. Bellini LM, Baime M, Shea JA. Variation of mood and empathy during internship. JAMA. 2002;287:3143–3146
2. Neumann M, Edelhäuser F, Tauschel D, et al. Empathy decline and its reasons: A systematic review of studies with medical students and residents. Acad Med. 2011;86:996–1009
3. Mercer SW, Reynolds WJ. Empathy and quality of care. Br J Gen Pract. 2002;52(10suppl):S9–S12
4. Lutz A, Greischar LL, Rawlings NB, Ricard M, Davidson RJ. Long-term meditators self-induce high-amplitude gamma synchrony during mental practice. Proc Natl Acad Sci USA. 2004;101:16369–16373
5. Greif EB, Hogan R. The theory and measurement of empathy. J Couns Psychol. 1973;20:280–284