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Dr. Larry Dossey

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Bedside Manner: The Case For Compassion

Posted: 06/26/11 11:57 AM ET

We hear a lot about the importance of compassion -- and the lack of it -- in medicine these days. Compassion comes from Latin words meaning to "suffer with." If taken literally, compassion in healing seems irrational. Why would a medical professional want to suffer alongside his or her patient? Suffering with one's patient might cloud one's professional judgment. When sick, patients need the cool-headed objectivity of their doctor and nurse -- not co-suffering or sentimentality. But compassion means more than "suffering with." It involves entering the mind-space of other persons so completely that one senses what the experience of illness is like for them.

The reason why compassion matters in healing can best be seen at the bedside. My favorite example is an event from the life of Sir William Osler (1849-1919), who is often called the "father of modern medicine." At Johns Hopkins Hospital in Baltimore, he revolutionized the teaching of medicine by bringing students out of the lecture hall for bedside clinical training, and created the first residency program for the specialty training of physicians.

After revolutionizing how medicine was taught and practiced in the United States and Canada, in 1905, at the peak of his fame, he was lured to England where he became the Regius Professor Medicine at Oxford. One day he went to a graduation ceremony at Oxford, wearing the impressive academic robes that are a feature of the occasion. On the way he stopped by the home of his friend and colleague, Ernest Mallam.

One of Mallam's young sons was desperately sick with whooping cough. The child would not respond to the ministrations of his parents or nurses and appeared to be dying. Osler loved children greatly and had a special way with them. He would often play with them, and children would invariably admit him into their world. So when Osler appeared in his dramatic ceremonial robes, the little boy was captivated. Never had he seen a human like this! After a brief examination Osler sat by the bed, peeled a peach, cut and sugared it, and fed it bit by bit to the enthralled, speechless boy. It was his first nourishment in days. Although recovery was unlikely, Osler returned for the next 40 days, each time dressed in his magnificent robes, and personally fed the child. Within a few days the tide had turned and the little boy's recovery was assured.

That's compassion. Osler had the ability to enter so fully into the mind of the little boy that he knew how to entice him to take food. He made use of the boy's imagination and wonder with his dress. He understood how to evoke a healing response in someone who was dying, all without the use of drugs or high-tech interventions. Osler was the intervention. Only someone who understands compassion is capable of such things.

Osler was noted for his ability to convey caring at the bedside of his hospital patients on brief visits. He cared greatly not only for his patients, but also for the young physicians under his tutelage. He wanted his tombstone to say only, "He brought medical students into the wards for bedside teaching." His most famous saying was, "Listen to your patient, he is telling you the diagnosis."

Some say compassion is out of date. These days, physicians have only minutes to spend with patients in most medical settings. No physician can make a house call on a single patient for 40 days in a row, as Osler did. But that is not the entire story. Compassion can be conveyed in moments; it is not proportional to time.

Compassion is not antiquated. It remains a crucial factor in healing and will never go out of style. It is always available for any healthcare professional who is wise enough to claim it.


Sources:

Bliss M. William Osler: A Life in Medicine. Oxford, UK: Oxford University Press; 2007.

Golden RL. William Osler at 150. An overview of a life. Journal of the American Medical Association . 1999; 282(23): 2252-2258.

 
 
 
We hear a lot about the importance of compassion -- and the lack of it -- in medicine these days. Compassion comes from Latin words meaning to "suffer with." If taken literally, compassion in healing...
We hear a lot about the importance of compassion -- and the lack of it -- in medicine these days. Compassion comes from Latin words meaning to "suffer with." If taken literally, compassion in healing...
 
 
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07:13 PM on 06/28/2011
What a beautiful story of what's needed in health care today, by a visionary and man of great compassion who i am proud to call my friend. Dr Dossey has spent a career helping us rethink how we view medicine and the art of healing. This article is just the latest in many that should bring hope and deep value to the dialogue around health care transformation today.
06:59 PM on 06/27/2011
Thanks Larry! Love your article. More and more doctors are getting back to what brings them joy: the patient/physician relationship. Studies reveal that 61% of doctors say they derive their greatest satisfaction from that relationship. As more docs step off the assembly line we will all get better care.

Pamela Wible MD
http://www.idealmedicalcare.org/blog/
MommyMD
MD, Professor, Mom
08:23 PM on 06/27/2011
Unfortunately, I see my primary care colleagues losing their patient/physician relationships just to make ends meet. Since this is usually what called them to medicine in the first place, it is a shame and travesty for them and their patients. I do not know a single doc that can give comprehensive health care and maintain an authentic relationship in 5-10 minute visits. I assume that by "getting off the assembly line" you mean participating in alternatives to our broken medical system.
08:39 PM on 06/27/2011
Yes! MommyMD. We live in an era of disintermediation (removing the middle man) and transparency. It is time to remove no-value-added intermediaries from the patient-physician relationship and capture the sacred with one another again. There are a plethora of models. Here are a few:
http://www.youtube.com/watch?v=4YJz5wvt2bk
http://www.youtube.com/watch?v=dtEFIFqhw6I
http://www.youtube.com/watch?v=LoUfA2Yp8uQ

I am happy to help!

Blessings to you ~

Pamela

Pamela Wible, MD
3575 Donald St. #220
Eugene, OR 97405
www.idealmedicalcare.org
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Dana Ullman
Evidence Based Homeopath
01:45 PM on 06/27/2011
Dr. Osler's most famous prescription was "a mixture of hope and Nux vomica"...(Nux vomica is one of the most famous homeopathic medicines!)...so said WW Francis in the President's Address at the Osler Shrine, BULLETIN OF THE MEDICAL LIBRARY ASSOCIATION, October 1937.

In 1905, in Osler's farewell address to American physicians (as he left to teach at Oxford), he said, "It is not as if our homeopathic brothers are asleep: far from it, they are awake—many of them at any rate—to the importance of the scientific study of disease. … It is distressing to think that so many good men live isolated, in a measure, from the great body of the profession. The original grievous mistake was ours—to quarrel with our brothers over infinitesimals was a most unwise and stupid thing to do."
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drricklippin
physician-activist-poet
11:44 AM on 06/27/2011
Thanks Dr. Dossey

Without compassion the delivery of medical care is never complete and often not effective. Compassion was at the very core of "the former profession of US Medicine"

The great physician Dr.William Osler had it right in so many of his teachings and practices. So we need desperately to recapture Oslerian principles lest we continue our downward spiral into professional oblivion.

Dr. Rick Lippin
Southampton,Pa
11:34 AM on 06/27/2011
I have always found that nurses have a profound ability to have an impact on the patient. In today's fast paced world of medicine, they have more one on one time with the patient then most doctors do.
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thinkingwomanmillstone
My life is microbiodegradable.
09:18 PM on 06/27/2011
My family physician has no nurse. He has a receptionist but does everything else himself. He gives shots, takes weights, BP etc. He's lost just a little bit of his one on one with patients since he first opened his practice about 10 years ago but not much. He would recognize me on the street as well as every member of my family. If I am sick, I am seen on the same day. He treats my son with autism as if he is a thinking member of society. He has his faults but his good points far outweigh them.
03:50 AM on 06/28/2011
It sound like you have a wonderful doctor. I was not trying to say that there are not doctors like that but just to point out that a lot of nurses have stepped up to the plate and spend more one on one time with patients. My step-dad tries to spend as much time with his patients as he can but it becomes difficult. Does he see more patients in a day which mean spending less time with each patient or does he schedule people out three weeks? The doctor's staff can help to enhance the visit for the patient and create a more personal relationship, which leaves the doctor more time to make sure that everyone who needs medical treatment can be seen.
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BlackYowe
I am a classical- liberal woman and a Jeweler.
12:05 AM on 06/27/2011
Compassion does not have to be dripping outward emotion, a person who acts out of compassion be they reserved or forward makes a far more affective healer in my opinion.
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Levi Ben-Shmuel
Tai Chi & Kabbalah Teacher
08:57 PM on 06/26/2011
Regardless of how sophisticated and successful technology interventions are, there is no replacement for the heart-to-heart connection Larry writes about. As he also wrote, it might only take a moment to be effective. That is powerful medicine!
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pphhrogg
domestic clown goddess
07:47 PM on 06/26/2011
It is quite possible to be both cool and collected AND empathetic at the same time. I worked as an ICU nurse for 35 years, and I did it successfully for all of those years. Many doctors don't have the first clue about being compassionate. They don't teach them that in Med school.
07:22 PM on 06/26/2011
Compassion Compassion , Compassion, Compassion Compassion , Compassion, Compassion Compassion , Compassion, Compassion Compassion , Compassion, Compassion Compassion , Compassion, Compassion Compassion , Compassion, Compassion Compassion , Compassion!
I can not say this enough! Doctors have to stop acting like they are detached and with an attitude that they know more than their clients. They must remember people live in their bodies and the are of mind, body and spirit and all must be addressed when looking to healp and heal someone. Doctors are in a service profession and are there to service and help all who come to them to heal. In addition they are there to teach those to take responsibility for their healing and health. To do that, one must look in the eyes of their client and let them know they care.
12:06 PM on 06/26/2011
This happened to me:

About 12 or so years ago my blood pressure spiked unexpectedly and I was in the hospital. I was stressed due to a death in the family and other matters, and the efforts to control it were not going well.

There was a in-law who was a LPN who I actually totally detested. She came to visit me (why, I''ll never know, divorced her brother and we no longer speak) in the ER.

Even though there was what amounted to a blood feud between us, she lay her hand on my arm. Without my conscious assent or effort, my BP dropped like a rock.

Regardless of my relationship with the woman, being touched (gently) as she did calmed me in a way that, I believe, was truly healing.