Integrating compassion to clinical care: a review of an emerging ‘science’

Sympathy, empathy and compassion are a family of connected mental states or emotions that relate to understanding and responding to another’s feelings. Compassion can be defined as a feeling that arises when witnessing another’s suffering, and motivates a desire to help. It differs from empathy, which is experiencing another’s feelings, and sympathy (a feeling of sorrow and concern to another’s pain or suffering). There is a public demand for health workers to demonstrate more compassion. This is reflected in compassion being stressed in mission statements of health institutions, and in the goals of regulatory organizations and medical councils. Increasingly, compassion and technical competence are both considered as integral elements of quality care. Despite their acknowledged importance in health care, empathy and compassion are rarely researched or taught explicitly. Measuring compassion is difficult and there is a need for psychometrically validated instruments. As a result, most research is on empathy. Empathy improves diagnostic accuracy, patient satisfaction, drug compliance, and lead to better outcomes (e.g. improved glycaemic control in patients with diabetes). Studies have found a rapid decline in empathy during the undergraduate medical course, believed to be due to poor role models, students experiencing harassments by senior staff, confronting clinical realities that counter student idealism, higher workload, and poor psycho-social support. Facing distressing situations with little support leads to empathic distress. The intensity of the latter is reduced by functioning as teams, listening to each other’s concerns non-judgementally, self-reflection to understand one’s own emotional reactions and cultivation of self-compassion. Skills of self-compassion and compassion towards others may be learnt through contemplative approaches and certain religious meditation techniques (e.g. ‘Metta’ meditation in Buddhism). Sri Lanka could also draw on these indigenous cultural and religious practices and take a lead role globally in the emerging interdisciplinary ‘science’ of compassion and health.