Understanding Compassion in Family Medicine: A Qualitative Study

Dr. Jane Uygur, BA, MD, CCFP, MClSc Dr. Judith Belle Brown, M.S.W., PhD Dr. Carol Herbert, BSc, MD, CCFP, FCFP, FCAHS, FRCPS (Glasg), FRACGP (Hon)
Department of Family Medicine, Western University, London, Ontario, Canada
Study Purpose To examine family physicians perceptions, experiences and ideas about factors which influenced their capacity for compassion at various phases of training and practice. Methods Methodology: - phenomenology - in-depth interviews Participant recruitment: - family medicine residents at Western - family physicians in Ontario Collection: - 22 in-depth interviews - semi-structured - open-ended questions - 2 investigators reviewed transcripts - immersion and crystallization Motivation Capacity Connection Results A major theme emerging from the data was The Compassion Trichotomy which describes three interrelated developmental areas that determine the evolution or devolution of compassion in family physicians: 1) motivation ; 2) capacity ; and 3) connection.

Discussion
The three areas of The Compassion Trichotomy parallel appraisals described in emotion research. These appraisals track an individuals interaction between the self and the environment and give rise to emotion. The appraisals pertinent to compassion are as follows:
Relationship
Skill to Connect

Core Values
Physician effectiveness

Patients want compassion

Empathy

Time
Self-Care

1. The relevance of sufferer to the self - motivation

2. The individuals ability to cope with the situation at hand capacity

Energy
open Participants identified three major areas that affected their capacity for compassion: 1. The development of emotions and empathy during their early years 2. The factors that impacted their emotional and mental energy and 3. Their ability to cultivate compassion by learning to care for themselves. available understanding supportive human

3. The sufferers deservingness of help connection.

Participants identified three major areas that impacted their motivation for compassion: 1. Their core values, exemplified by the The Golden Rule, treat others as you want to be treated 2. Their belief that patients wanted compassionate physicians and 3. Their experience that compassion made them more effective in their work.

Participants illustrated the central role that connecting with patients played in compassion. They described: 1. The skills required by physicians to demonstrate compassion; 2. How compassion impacted the patient-doctor relationship and vice versa and 3. How, although time restraints impeded connection with their patients, compassion could be demonstrated in little time.

Conclusions Compassion plays an important role in physician job satisfaction but the three areas of compassion must be developed and kept in balance to prevent compassion

Analysis:

The Compassion Trichotomy

Be Human
Motivation

Balance & Boundaries

Be Professional Maintain Objectivity Encourage Independence Compassion

Compassion Over Career

fatigue and burnout. Understanding the development required in these three areas also provides an approach for teaching compassion in medical education. Contact

Trustworthiness and credibility: - field notes - verbatim transcriptions - reflexivity - member checking - peer audit - independent & team analysis

Engage Emotionally Provide Support

Connection Capacity

training Participants observed that the human connection they experienced through compassion further motivated them to be compassionate. This motivation energized them and fed their capacity for compassion. Finally participants articulated how their capacity for compassion built on experience and empathy enhanced their skills to connect with their patients thus creating a virtuous cycle. Participants described boundaries they put in place to keep compassion in balance and prevent burnout. There were distinct areas of balance within each of the three areas of The Compassion Trichotomy. For example, in the area of motivation, participants believed compassionate physicians must be supportive while encouraging independence. This balance could be upset by physician motivations based on needing to be needed rather than helping the patient.

Career

Final Sample and Demographics: - age range of participants 26-64 - 9 men, 13 women - broad range of religions, practice types
RESEARCH POSTER PRESENTATION DESIGN 2012

Participants described how compassion evolved over their careers. Most described how compassion diminished during training and increased with experience. The differences between compassion in training and later career was described within the three areas:
Motivation: focus change from biomedical to holistic, cure to care, control to support Capacity: culture of detachment diminished empathy but life experience increased empathy Connection: distracted in new physician role but clinical experience increased ability to connect

Dr. Jane Uygur 330 Harolds Cross Road Harolds Cross Dublin 6W Ireland

353 85 1185562

jane_uygur@hotmail.com

www.PosterPresentations.com