Physician and Patient Factors Interactively Predict Medical Compassion An experimental study

Abstract

Compassion is a professional requirement of physicians and expected by patients. It is, however, challenging to sustain compassion over time and the question of how best to enhance medical compassion has not yet been answered. Although under-researched in the context of medicine, basic research suggests whether compassion emerges is a complex process involving both characteristics of the person in need (the patient), as well as personal characteristics of the physician. The current study investigates the contribution of physician trait, patient characteristics, and a state self-compassion manipulation on compassionate responding. Eighty-five medical trainees aged 18-30 recruited from the University of Auckland completed a baseline questionnaire assessing demographics and personality traits including physician empathy. Participants were blockrandomized by gender to receive self-compassion, objective, or self-critical manipulations before attending a 40-minute laboratory session during which they read four independently-validated patient vignettes varying in positive versus negative presentation and patient responsibility, and made ratings of liking, care, desire to help, and closeness. A test of compassionate donation behaviour concluded the session. The experimental manipulations temporarily changed self-compassion and state affect but did not predict compassionate ratings or impact donation behaviour as hypothesised. Instead, physician trait empathy and state interactively predicted both compassion in ratings and donations. Positively presenting patients, and to a lesser degree, less responsible patients elicited higher compassionate ratings, as hypothesised. Unexpectedly, low responsibility predicted higher compassionate ratings only among positively presenting patients. In line with expectation, more empathic medical trainees were less impacted by patient factors, consistent with suggesting compassion emerges interactively. The current study links trainee empathy with compassion, and suggests that self-compassion may reduce the impact of low trait empathy on noncompassionate responses and behaviour, particularly when caring for negatively presenting patients. Patient presentation was the most powerful predictor of all factors examined, possibly evidencing a staged decision-making process in which affective information is prioritized. Findings provide experimental evidence that the determinants of medical compassion are multifactorial and interactive, and that a self-compassion intervention may assist empathic and less empathic physicians alike in enhancing and maintaining professional compassion.