North Wales Forensic Psychiatric Service, Llanfairfechan, Conwy, UK.
J Med Ethics. 2018 Nov;44(11):729-733. doi: 10.1136/medethics-2017-104698. Epub 2018 Jun 29.
Compassionate care is a foundation of the National Health Service (NHS). However, several high-profile inquiries into healthcare failures in the NHS suggest compassion is often absent in our hospitals. Ensuing policies mandate healthcare professionals to 'show more compassion' but, as the psychological evidence-base indicates, this instruction neglects the complexity of this social emotion. This paper applies the psychological research on compassion to modern healthcare settings with the aim of creating a better understanding of the pathways leading to uncompassionate care. A review of the empirical evidence suggests a range of psychological factors modulate compassion. In particular, the psychological literature indicates the human compassion system is adaptive, highly attuned to its environment. As such, a healthcare professional's ability to experience and display compassionate behaviour will be, in part, determined by the environment in which they practise; that is, aspects of the organisational environment will either facilitate or inhibit compassion. This paper argues that the typical organisational set-up of a modern healthcare setting seriously undermines compassionate care. Organisational features frequently associated with uncompassionate care include the understaffing of hospital wards, excessive working shift patterns and the dogged focus on achieving service efficiencies-each has been identified as contributing to the alarming breakdown of compassionate care at the centre of several healthcare failings. Policies focusing on culture change in the NHS neglect the growing psychological evidence base on compassion, but by applying a psychological understanding of compassion to healthcare settings, we can begin to adequately understand and address the real causes of uncompassionate care.
关怀是英国国家医疗服务体系（NHS）的基础。然而， NHS 中几起备受瞩目的医疗失误调查表明，关怀在我们的医院中常常缺失。随后的政策要求医疗专业人员“表现出更多的关怀”，但正如心理学证据基础所表明的那样，这一指令忽略了这种社会情感的复杂性。本文将心理学对关怀的研究应用于现代医疗保健环境，旨在更好地理解导致缺乏关怀的途径。对实证证据的回顾表明，一系列心理因素调节着关怀。特别是，心理学文献表明人类的同情心系统是适应性的，高度适应其环境。因此，医疗保健专业人员体验和表现出同情心的能力在一定程度上取决于他们所处的环境；也就是说，组织环境的某些方面将促进或抑制同情心。本文认为，现代医疗保健环境中典型的组织设置严重破坏了关怀。与缺乏关怀相关的组织特征包括医院病房人手不足、工作轮班模式过于频繁以及对实现服务效率的顽强关注——这些都被认为是导致几起医疗失误中关怀彻底崩溃的原因。 NHS 中关注文化变革的政策忽视了日益增多的关于关怀的心理学证据基础，但通过将对关怀的心理学理解应用于医疗保健环境，我们可以开始充分理解和解决缺乏关怀的真正原因。
