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Compassion: hard to define, impossible to mandate

BMJ 2015; 351 doi: (Published 29 July 2015) Cite this as: BMJ 2015;351:h3991

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Re: Compassion: hard to define, impossible to mandate

Dear Editor,

We read Dr Chadwick’s article on compassion(1) with great interest. This is a word which is being frequently heard in connection with care provided by health and social care professionals but often without the thoughtful attitude seen in this article. Indeed, we have previously suggested that ‘compassion’ is in danger of becoming a jargon term and, as a result, losing some of its power.(2)

Frontline care staff need to have training and support in recognising and coping with the range of feelings – positive and negative – engendered by some people they are called upon to care for. It has long been recognised that these feelings are highly relevant to quality of care and are ignored at our peril.(3) People working in caring roles need to know that it is ok to feel powerful negatives such as disgust, impatience, and even hatred. However, it is essential to find strategies and resources within oneself not to act on them. Perhaps care teams could be encouraged to articulate such feelings – whether in Schwartz rounds as discussed by Dr Chadwick or in Balint groups familiar from psychiatry and general practice contexts(4) – and try to identify if there are individuals in the team who can carry positive regard to certain patients while others hold to the basic courtesies? We all know that our own personal reactions to other people are enormously varied and have their origins in our own stories.

We would like to promote a much more open dialogue about fostering caring compassion – as Dr Chadwick suggests, it can't be prescribed, but it isn't a happy extra which is wonderful when it happens. We believe that it can be learned and must be integrated into practice.

Yours faithfully,

Susan Maciver, Chris McGregor, Jenny Robertson, Tom C. Russ, and Christine Wilson
On behalf of the Working With Older People steering group, Human Development Scotland

Conflicts of interest: none

1. Chadwick, R. (2015). Compassion: hard to define, impossible to mandate. BMJ 351: h3991.
2. Maciver, S. & Russ, T. C. (2014). A plea to “see into the life of things”: thinking psychoanalytically about later life. In: Kate Cullen, Liz Bondi, Judith Fewell, Eileen Francis, and Molly Ludlam (Eds) Making Spaces: Putting Psychoanalytic Thinking to Work. London: Karnac.
3. Menzies, I. E. P. (1959). The functioning of social systems as a defence against anxiety: a report on a study of the nursing service of a general hospital. Human Relations, 13: 95-121. (Reprinted in Menzies Lyth, I. E. P. (1988). Containing Anxieties in Institutions. Selected Essays, Volume 1. (pp. 43-99). London: Free Association Books.)
4. Balint, M. (1957). The Doctor, his Patient and the Illness. London: Tavistock.

Competing interests: No competing interests

17 August 2015
Tom C. Russ
Honorary Consultant Psychiatrist
Susan Maciver, Chris McGregor, Jenny Robertson, and Christine Wilson
University of Edinburgh/NHS Lothian
Kennedy Tower, Royal Edinburgh Hospital, Morningside Terrace, Edinburgh EH10 5HF