What does compassion sound like?

“Good to see you. I'm sorry. It sounds like you've had a tough, tough, week.”  Spoken by a doctor to a cancer patient, that statement is an example of compassionate behavior observed in a new study.

The researchers believe they are the first to systematically pinpoint and catalogue compassionate words and actions in doctor-patient conversations. By breaking down the dialogue and studying the context, scientists hope to create a behavioral taxonomy that will guide medical training and education.

“In health care, we believe in being compassionate but the reality is that many of us have a preference for technical and biomedical issues over establishing emotional ties,” said senior investigator Ronald Epstein, MD, of the University of Rochester Medical Center in New York. Epstein is a national and international keynote speaker and investigator on mindfulness and communication in medical education.

His team recruited 23 oncologists from a variety of private and hospital-based oncology clinics in the Rochester, New York area. The doctors and their stage III or stage IV cancer patients volunteered to be recorded during routine visits. Researchers then analyzed the 49 audio-recorded encounters that took place between November 2011 and June 2012, and looked for key observable markers of compassion. The study was published in Health Expectations (2013; doi:10.1111/hex.12160).

In contrast to empathy—another quality that Epstein and his colleagues have studied in the medical community—compassion involves a deeper and more active imagination of the patient's condition. An important part of this study, therefore, was to identify examples of the three main elements of compassion: recognition of suffering, emotional resonance, and movement toward addressing suffering.

Emotional resonance, or a sense of sharing and connection, was illustrated by this dialogue: Patient: “I should just get a room here.” Oncologist: “Oh, I hope you don't really feel like you're spending that much time here.”

Some doctors provided good examples of how they use humor to raise a patient's spirits without deviating from the seriousness of the situation. In one case, for example, a patient was concerned that he would not be able to drink 2 liters of barium sulfite in preparation for a CT scan.

Doctor: “If you just get down one little cup, it will tell us what's going on in the stomach. What I tell people when we're not being recorded is to take a cup and then pour the rest down the toilet and tell them you drank it all (laughter)… Just a creative interpretation of what you are supposed to take.”

Patient: “I love it, I love it. Well, I thank you for that. I'm prepared to do what I've got to do to get this right.”

Compassion unfolds over time, researchers concluded. During the process, physicians must challenge themselves to stay with a difficult discussion, which opens the door for the patient to admit uncertainty and grieve the loss of normalcy in life.

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