Compassion isn't the key to NHS failings according to report

Compassion is not the answer to systemic failings within the NHS, according to a medical ethics expert from the University of East Anglia.

David Cameron has called for nurses to be hired and promoted on the basis of having in response to the Francis Report into failings at mid-Staffordshire NHS Foundation Trust.

But Dr Anna Smajdor from UEA's Norwich Medical School argues that the move could be "dangerous" in a paper published today in the journal Clinical Ethics.

She said: "It is wrong to think compassion is the answer to problems in the NHS, such as those displayed in mid-Staffordshire. If Cameron's ideas come to fruition – the compassion served up by healthcare professionals will be at best inauthentic and at worst dangerous.

"Healthcare professionals are responsible for many individuals, working to fulfil many tasks as efficiently as possible - often in situations where time and resources are limited. It would be very dangerous to rely on compassion as the motivation that ensures the necessary tasks are carried out. Reminders, routines and checklists ensure that crucial tasks are undertaken. But if hospitals are fundamentally under-resourced, they will fail to deliver the care that is required.

"Compassion is not a necessary component of healthcare - the crucial tasks can be carried out without compassion. One can remove an appendix without caring about the person from whose body it is taken, empty a bedpan without caring about the patient who has filled it, or provide food without caring about the person who will eat it."

Dr Smajdor's paper describes how the problems at Staffordshire were systemic through the entire institution and its culture. But she says that "it would be bizarre if that particular hospital had come to be staffed entirely by individuals who lacked compassion.

"In fact the report contains many accounts of healthcare professionals' distress – their feeling of depression and . If a lack of compassion was the root cause of the Trust's failings, there would be no reason for these uncaring staff to be suffering such distress."

Indeed, Dr Smajdor believes it can be damaging for healthcare professionals to feel too much compassion – because they may become deeply distressed by some of the things they see and do. They are at risk of suffering burn-out, fatigue, becoming de-sensitised and damaged.

"Imagine feeling the pain of compassion for every child suffering in the world, as if they were your own," she said. "We cannot do it, and if we tried, it would probably kill us. We cannot demand that guarantee an unlimited flow of compassion for each patient.

"David Cameron's plan to incentivise healthcare workers to display compassion is very problematic. Those that do not display it could be excluded from practicing medicine and we may lose many excellent healthcare workers.

"Good healthcare workers will ensure that the presence or absence of compassion does not interfere with their care."

'Reification and compassion in medicine: A tale of two systems' by Dr Anna Smajdor is published in the journal Clinical Ethics on Thursday, September 18, 2013.

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