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Author: Robert A. Kalish, M.D.

Medical Interviewing and the Doctor-Patient Relationship
Fall 2011
R. Kalish, MD
Tufts University School of Medicine

Compassion in the Medical Interview

Introduction

Medicine is a field in which one devotes to the care of others. Compassionate care is an essential component of competent patient care. Compassionate care in medicine may be defined as the ability to recognize and be moved by a patient’s feelings and experiences, the capacity to show the patient that recognition and caring, and the desire to relieve the patient’s suffering or distress. It involves a focus on choosing the patient’s perspective and best interest over that of oneself or others. Some have described compassionate patient care as the deliberate participation in another person’s suffering. The benefits of compassionate care include a more effective patient-doctor relationship, increased patient compliance and greater satisfaction for both the patient and the physician; a growing body of evidence supports a positive influence of compassionate care on health outcomes. Compassionate care is central in such situations as breaking bad news to a patient or a loved one and in caring for the dying patient, but also should permeate routine interactions with patients since the care of patients involves an interpersonal connection and fears and other emotions that are not far under the surface. Debate has raged over whether compassionate care can be taught or is an innate ability that reflects deeper intrinsic qualities of temperament and communication. This lecture will explore the composition of compassionate care in the context of the physicians’ interactions and relationships with patients.

Learning objectives

By the end of the lecture, you will be able to:

  • Compare and contrast the definitions of sympathy, empathy and compassion and discuss their applicability and relevance to the patient-doctor relationship.

  • Recognize characteristics of compassionate care in the setting of the medical interview.

  • Identify techniques for providing compassionate care to the patient in the setting of the medical interview and the patient-doctor relationship in general

  • List the beneficial outcomes to both the patient and caregiver of compassionate care that have been reported.

Specific competencies students are expected to perform within the context of practice after this lecture.

  • Recognize the patient’s response to illness including stress, suffering, loss, and physical and emotional discomfort.

  • Demonstrate to the patient recognition and validation of these responses

  • Demonstrate the type of language, responses and gestures that comprise the characteristics of compassionate care during patient interviews.

  • Reflect on successes and areas for improvement in one’s compassionate interactions with patients.

Recommended Readings

  • Makoul, G. Essential Elements of Communication in Medical Encounters: The Kalamazoo Consensus Statement. (2001) Academic Medicine 76(4):390-393

  • Miller, S and Schmidt, H. The Habit of Humanism. (1999) Academic Medicine 74(7): 800-803
    Epstein, R. Mindful Practice. (1999) JAMA 282(9): 833-839

  • Sanghavi, D. What makes for a Compassionate Patient-Caregiver Relationship? (2006) Journal in Quality and Patient Safety 32(5): 282-292