Understanding compassion in family medicine: a qualitative study

Abstract

BackgroundPatients and physicians have traditionally valued compassion; however, there is concern that physician compassion has declined with the increasing emphasis on science and technology in medicine. Although the literature on compassion is growing, very little is known about how family physicians experience compassion in their work.AimTo explore family physicians’ capacity for and experiences of compassion in practice.Design and settingThis was a qualitative study designed using a phenomenological approach in rural and urban Ontario, Canada.MethodIn-depth interviews were audiotaped and transcribed verbatim, followed by independent and team coding. An iterative and interpretive analysis was conducted using immersion and crystallisation techniques. Purposive sampling recruited 22 participants (nine males and 13 females aged 26–64 years) that included family medicine residents from Western University (n = 6), and family physicians practising <5 years (n = 7) or >10 years (n = 9) in Ontario, Canada.ResultsFrom the data, the authors derived the Compassion Trichotomy as a theoretical model to describe three interrelated areas that determine the evolution or devolution of compassion experienced by family physicians: motivation (core values), capacity (energy), and connection (relationship).ConclusionThe Compassion Trichotomy highlights the importance and interdependence in physician compassion of motivation (personal reflection and values), capacity (awareness and regulation of energy, emotion, and cognition), and connection (sustained patient–physician relationship). This model may assist practising family physicians, educators, and researchers to explore how compassion development might enhance physician effectiveness and satisfaction.

Predictors of Physician Compassion, Empathy, and Related Constructs: a Systematic Review

“…Greater coherence was evident in studies of attitudes and values; positive judgment or non-judgment 98 , 138 and respect 87 , 89 predicted greater ECRC, while prejudice and negative judgment predicted lower ECRC 80 , 98 , 146 . Having empathy and compassion as a value predicted greater ECRC 98 , 131 , 147 .…”

“…The presence of cross-cultural differences predicted lower ECRC 55 , 94 and the association of ECRC with cultural beliefs and cultural knowledge was observed 50 , 125 – 127 . Personal illness experience 45 , 78 , 128 – 132 , experience with illness among relatives or one’s own children 45 , 113 , 132 – 134 , or caregiving experiences 45 , 113 , 131 , 135 predicted greater ECRC. Finally, a small number of predominantly qualitative studies showed spirituality 89 , 136 , meaning 136 , and religiosity 137 to predict greater ECRC, although there was no effect of religion 39 .…”

“…Finally, a small number of predominantly qualitative studies showed spirituality 89 , 136 , meaning 136 , and religiosity 137 to predict greater ECRC, although there was no effect of religion 39 . The evidence regarding factors such as living situation 39 , 42 , 72 , 82 , upbringing 98 , 113 , 131 , siblings 64 , 76 , having children 39 , 41 , 49 , 64 , 77 , 111 – 113 , 138 , 139 , the number of children 72 , 82 , 84 , 140 , and marital status 43 , 47 , 49 , 50 , 63 , 64 , 72 , 76 , 77 , 83 , 84 , 86 was conflicted and, hence, inconclusive.…”

“…In terms of dispositional factors, pro-social traits/dispositional compassion (e.g., empathy, compassion, altruism, humanism) 47 , 52 , 70 , 73 , 89 , 93 , 116 , 141 , 142 and the ability to recognize and deal with emotions 38 , 70 , 76 , 82 , 106 , 116 , 131 , 143 , 144 predicted greater ECRC, whereas higher emotionality (both positive and negative) 93 and idealism predicted lower ECRC 145 . The individual constructs underlying this evidence, however, were scattered and highly heterogeneous with more than 30 personality traits examined.…”

“…Positive beliefs about the importance of ECRC in medical care 38 , 50 , 87 , 89 , 90 , 131 , 147 and the motivation to maintain good standards of care 89 , 90 , 148 , 149 and to obtain higher job satisfaction by practicing compassion 89 , 131 , 136 , 148 predicted greater ECRC. On the contrary, beliefs that ECRC negatively affects objectivity 98 , 107 , 147 , 150 predicted lower ECRC.…”