The treatment of a disease may be entirely impersonal; the care of a patient must be completely personal.

Francis Peabody (1930)

Compassion means co-suffering and reflects the physician's willingness somehow to share the patient's anguish and understand what the sickness means to that person. Compassion is an attempt to feel along with the patient. Pellegrino (1979, p. 161) said, "We can never feel with another person when we pass judgment as a superior, only when we see our own frailties as well as his." A compassionate authority figure is effective only when others can receive the "orders" without being humiliated. The physician must not "put down" the patients, but must be ever ready, in Galileo's words, "to pronounce that wise, ingenuous, and modest statement—'I don't know.'" Compassion, practiced in these terms in each patient encounter, obtunds the inherent dehumanizing tendencies of the current highly institutionalized and technologically oriented patterns of patient care.

Figure 1-1 "The Doctor" by Sir Luke Fildes, 1891. © Tate, London, 2005.

The family physician's relationship with each patient should reflect compassion, understanding, and patience, combined with a high degree of intellectual honesty. The physician must be thorough in approaching problems but also possess a sense of humor. He or she must be capable of encouraging in each patient the optimism, courage, insight, and the self-discipline necessary for recovery.

Bulger (1998) addressed the threats to scientific compassionate care in the managed-care environment:

With health care time inordinately rationed today in the interest of economy, Americans could organize themselves right out of compassion. . . . It would be a tragedy, just when we have so many scientific therapies at hand, for scientists to negotiate away the element of compassion, leaving this crucial dimension of healing to nonscientific healers.

Time for patient care is becoming increasingly threatened. Bulger (1998, p. 106) described a study involving a "good Samaritan" principle, showing that the decision of whether or not to stop and care for a person in distress is predominantly a function of having the time to do so. Even those with the best intentions require time to be of help to a suffering person.

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