How do we deliver compassionate care?

The Francis report asked probing questions about the provision of compassionate care within the NHS. Responses from the Care Quality Commission (CQC) and The King’s Fund have focused on promoting ‘well-led’ care. From a psychological point of view we might also raise questions about role of emotion in compassionate care. In an organisational culture that privileges emotional distance, and provides little space for doctors or patients to acknowledge their distress, what are the consequences for delivering compassionate care?

Illness as an emotional experience

The experience of serious illness is rarely an emotionally neutral event. People who are ill or dying understandably become distressed. Cancer blogger and author Sophie Sabbage describes how emotional expression by people who are ill is sometimes discouraged by NHS staff, who engage patients with a ‘please don’t be vulnerable’ appeal. This seems like a lost opportunity for compassionate care.

Distressed doctors

It’s not just patients who may be distressed by suffering, as was so eloquently described by Dzeng and colleagues in their recent paper. For physicians, witnessing suffering in others—particularly when it appears unnecessary—can be deeply distressing. Some doctors become less empathetic, not more, as they struggle to articulate the unthinkable ‘we torture our patients before they die’.

In this situation, doctors may be encouraged to adopt a dispassionate or ‘objective’ viewpoint and to value emotional distance. Perhaps this helps to explain why some trainee physicians develop detached and dehumanising attitudes as a coping strategy when experiencing moral distress.

Responding to the call for compassionate care: Where to from here?

Where the emotional sanitisation of medicine leaves little space for doctors or patients to acknowledge suffering and distress, and privileges emotional distance over a need to be emotionally present, compassionate care is surely compromised.

It doesn’t have to be this way. If the organisational culture promotes open discussion and normalisation of emotional issues—for example, the interestingly named ‘death rounds’ described by Dzeng’s participants – this seems to offer much benefit. Such environments are the exception rather than the norm. Should they be?

Acknowledgement

This blog is linked to a related letter in the Journal of General Internal Medicine.

Interested to learn more?

Related CCHSR blog here.

  1. Dzeng E et al. Moral Distress Amongst American Physician Trainees Regarding Futile Treatments at the End of Life: A Qualitative Study. Journal of General Internal Medicine 2015.
  2. Dzeng E et al. Influence of Institutional Culture and Policies on Do-Not-Resuscitate Decision Making at the End of Life. JAMA Internal Medicine 2015; 175: 812-9.
  3. McVeigh, T. Cancer blogger tops ebooks chart by making peace with her illness. The Observer.       Sunday, 18th October, 2015.
  4. Francis R. Report of the mid Staffordshire NHS foundation trust public inquiry. London: The Stationery office; 2013.

 

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  • The Cambridge Centre for Health Services Research (CCHSR) is a thriving collaboration between the University of Cambridge and RAND Europe. We aim to inform health policy and practice by conducting research and evaluation studies of organisation and delivery of healthcare, including safety, effectiveness, efficiency and patient experience.