On Compassion

We have entered an era of evidence based medicine. So much so you can Google the phrase. So much so you get paid for doing it. So much so, soon a doc will be financially penalized for not doing it.

It's odd how we seem to have drifted into a model from industry that acknowledges and rewards production, objective results, measurable outcomes. And it's not just in medicine. It's really invaded the schools and is suddenly being used to justify school closings, charter school proliferation, and the purging of "ineffective" teachers. Not that there isn't some merit in all of this. Education and medicine have too long suffered from do littles and do nothings. (I wonder if priests and rabbis will be next? What will be the yardstick? Lives saved? Durable marriages? Congregational growth?)

In all of this the risk is the loss of compassion. Compassion takes time in a medical practice-- often unreimbursed unless you consider "patient satisfaction" as one of the tenets of pay for performance. But, then, compassion is often needed in circumstances when a patient won't be able to subsequently answer a phone call or fill out a survey. Likewise, compassion doesn't likely show up on state standardized tests that purport to assess both student knowledge and teacher competence. Compassion is not objective. The outcome of compassion is often very real but seldom measurable. Compassion may be the difference between dying at peace and dying in fear. Compassion may be the difference between trying to stay in school and dropping out entirely. But, perhaps unfortunately, compassion is usually doled out on a case by case basis and the outcome may not be measurable owing to the small "sample size."

In my work I don't save lives, fight cancer, or replace defective hearts. Even so, I try to always spend as much time with a patient as they need in order for them to leave with an understanding, with their questions answered, with an awareness of what's next, comfortable with the decisions being made, the choices offered. But I don't get paid for that. At least not enough to compensate for the volume I lose. Even so, I don't care. I think it's important and I sleep well at night.

In the not so distant future will compassion be quantified, objectified, measurable? Will it still be someone sitting and listening and touching and talking? When I read about all the change coming in healthcare and education I have to wonder-- will we still find genuine heartfelt compassion in the years ahead? I hope I'm wrong but I'm starting to think we'll be lucky if we do.