Does Obliging Compassion in Medicine Actually Work? And for Whom? An experimental study

Abstract

Compassion is central to effective medical practice. However, in contemporary healthcare systems, a lack of compassionate medical care has been frequently remarked upon. Despite a strong research base, compassion in medicine remains understudied. Of particular note, although compassion is a professional requirement under the codes of medical ethics, the question of whether this ethical and professional mandate actually enhances compassion has not yet been answered. The current study experimentally investigates whether making obligations more salient impacts medical compassion, as well as whether it interacts with physician and patient variables in predicting compassionate responding. Eighty-eight medical trainees aged 18-27 recruited from the University of Auckland completed an online baseline questionnaire assessing demographics, cultural orientation traits including vertical collectivism, and social desirability. Participants then attended a 20-minute laboratory session in which they were block-randomised by gender and ethnicity (Asian/European) to experimental conditions designed to enhance (obligation prime) or reduce (autonomy prime) the salience of obligation. After the primes, participants read four hypothetical patient vignettes systematically varying in patient presentation and responsibility before making ratings of patient liking, caring, desire to help, and closeness for each. A donation paradigm provided a behavioural measure of compassion. As expected, ‘desirable’ patient characteristics, in particular, positive patient presentation elicited greater compassion. However, lower patient responsibility only elicited higher compassionate ratings for positively presenting patients. While participants in the obligation condition donated a greater portion of their study remuneration, there was no main effect on self-report ratings. However, the effect of the experimental condition varied across different medical trainees. Specifically, those with higher vertical collectivistic cultural orientations were more compassionate towards the ‘difficult’ patients when the salience of obligation was highlighted (versus reduced). This complexity is broadly consistent with assertions from the Transactional Model of Physician Compassion (Fernando & Consedine, 2014) and highlights the ongoing need to test whether obliging compassion in medicine is beneficial and for whom. Data underscore the complexity of the influences of contextual, physician, and patient factors impacting medical compassion. Specifically, while compassion is obliged under codes of ethics in medicine, it impacts various medical trainees differently depending on other physician and patient factors. For future research, medical compassion needs to be viewed and empirically investigated by taking into account the contextual factors, in addition to the personal and interpersonal factors.