November 19, 1999 (Ira Pilgrim)


The value of compassion cannot be over-emphasized. Anyone can criticize. It takes a true believer to be compassionate. No greater burden can be borne by an individual than to know no one cares or understands.

- Arthur H. Stainback

I just watched the video of the movie Patch Adams. It was about as miserable a film as I have ever seen. It was as bad as some of the Saturday matinees that I saw when I was a kid. However, the theme is one that interests me: compassionate medicine.

My dictionary defines "compassion" as "Pity for the suffering or distress of another, with the desire to help or spare." It is a good thing for a person to have, provided that it doesn't interfere with a person's ability to do what has to be done to help that person. A doctor who is so compassionate that he won't cut into human flesh obviously doesn't become a surgeon. A psychiatrist without compassion is worthless in a field where compassion itself can sometimes be therapeutic.

I remember a Peanuts cartoon that featured Linus and Charlie Brown. Charlie says to Linus, "You can't be a doctor, you don't love mankind," to which Linus replies, "Of course I love mankind; it's people I can't stand."

Pathologists, radiologists and other kinds of docs who never see a patient don't need compassion. Compassion can be a decided asset for doctors who deal with people, especially those who deal with serious, painful, or life threatening illnesses. It is a fact that everyone who visits a doctor for something other than a routine physical is afraid. A perceptive physician is aware of this and considers it when dealing with his patient. If the compassion interferes with logical thinking, it is a good idea to put the compassion on the back burner when making decisions about the diagnosis and treatment of diseases. The best physicians do that very well. A competent surgeon can be compassionate when talking to a patient in pain, but when his patient is anaesthetized on the operating table, he might as well be a computer: a logic machine like Startrek's Mr. Spock.

Physician-scientist Michael B. Shimkin said that "Compassion without competence is crap," and I agree with him. I can get compassion from my wife and friends. I want competence in my doctor. It is a plus if he is also compassionate; but competence comes first. Not only can incompetence in a physician be hazardous to your health, but it can put you in an early grave.

Unfortunately most people mistake compassion for competence. I suspect that there is more money made, and less accomplished, by people who can fake compassion. Maybe I am being too harsh. Perhaps those who peddle compassion are truly compassionate. However, the results are the same; the patient either gets well by himself, stays the same, or gets worse. Sometimes he dies of a condition that could have been cured. I know for sure that I would prefer a physician who is both competent and compassionate. However, If I were forced to make a choice between a competent SOB and a compassionate incompetent, I would take the SOB every time. My health and life are important to me.

Many people have no idea how to recognize competence and assume that if a doctor is nice and kind that he knows what he is doing. Those people would be better off not relying on their instincts. Instead, they should ask someone who might know whether a doctor is competent, such as another physician. While doctors are reluctant to pan a fellow physician, you should be able to distinguish between "he's okay" and "he's very good," or "he's the best."

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