1st June 2021

On excellence, empathy and compassion

Dictionary definitions of excellence (e.g. “the quality of being outstandingly good”) tend to overlook the degree of subjectivity behind the definition.  Much of what we see as “excellent” is intangible, and “in the eye of the beholder”. What is excellent to me might not be excellent to you.  With this in mind, I considered my own view of excellence in healthcare, some of which stems from my experiences as a patient several years ago.  I realised that I tend to think of excellence as a balance of competence and compassion.

Whilst competence is easy to understand, the quality of compassion is a bit more complicated.  Do we all mean the same thing when we talk about compassion?  This is an important question, because it is a key component of healthcare, clearly referenced as a core value in the NHS constitution:

From the NHS Constitution for England:

“We ensure that compassion is central to the care we provide and respond with humanity and kindness to each person’s pain, distress, anxiety or need. We search for the things we can do, however small, to give comfort and relieve suffering. We find time for patients, their families and carers, as well as those we work alongside. We do not wait to be asked, because we care.”

So what do we mean by compassion?

Compassion is often confused with empathy, but they are not the same thing.  Empathy is the ability to ‘feel’ what someone else is feeling.  Whilst it is essential to maintain healthy relationships, it is possible to have too much empathy, especially when working in healthcare.  How could we possibly tolerate the combined suffering of all of our patients?  This would be a fast-track to burnout.  Empathy needs to kept at bay to some degree, to minimise our own trauma.  Compassion, on the other hand, is the desire to relieve the suffering of others.  To be compassionate, we don’t need to feel the suffering of others, but we do need to recognise it.

There is an emerging literature on this topic in the world of neuroscience.  Whilst social pscyhologists have recognised the distinction between empathy and compassion for some time, evidence from neuroscience is a relatively new area.  This (full text) paper is a good introduction to the topic, describing the differences between empathy and compassion in terms of linguistic definitions, psychology and neuroanatomic correlates.  Interestingly, distinct networks in the brain are active during the two different processes, illustrating that these are indeed different concepts, all the way down to neuronal networks.

This idea is potentially very valuable for those of us working in healthcare:  when facing the suffering of others (e.g. as healthcare professionals) it may be prudent to monitor one’s own empathy and compassion responses – the former may lead to burnout.  But, what can we do if we are too “empathetic”?  Can we learn to choose between the two responses?  It seems that we may indeed be able to learn to choose compassion over empathy through training. The paper (and a growing body of related research) points to compassion training as a method to help us modulate our responses to the suffering of others.

The commonest form of compassion training is “loving kindness meditation”, or “Metta” meditation.  It might sound a bit fluffy, but I can speak from experience that it is easy to do and is a good introduction to the practice of meditation. I can recommend the Metta “track” in the Waking Up app; a meditation app from the neuroscientist, philosopher and public intellectual, Sam Harris.  Here is a sample if you are interested in giving it a go.

Let me know what you think in the comments below, or feel free to contact me directly via the website.


Thoughts on “On excellence, empathy and compassion

  1. I am currently embarking on a PhD looking at excellence in palliative care. Nurses often interchange quality with excellence and vice versa -I believe they may be similar but maybe characteristically different and wonder if we believe we have given excellent care it helps us cope with loss

  2. I’d be interested to hear your perspectives on staff with high affective empathy due to autism/neurodiversity and how compassion training can be neuro-informed. There’s been some exciting research published recently which highlights how some autistic folks like myself experience high affective empathy. Previously, this has always been minimised due to the double empathy problem. At work, we also have the phenomena of emotional contagion/projective processes occurring in dyads but also manifesting more widely/maladaptively in organisations; and whilst I have been given some training on how to remain grounded and body scan during interpersonal episodes, generally they occur quickly, and all of us as humans are prone to communicating our own trauma non-verbally. And it is very easy then, to become part of a re-enactment of either our own or the other person’s history.

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