Is there still room for compassion in emergency care?

At the recent Royal College of Emergency Medicine Annual Scientific Conference, I explored a more pressing question: Is there still room for compassion in emergency care? With the pace and pressures of emergency departments (EDs) today, it’s easy to lose sight of compassion, even though it’s at the heart of patient care. This blog post summarises that talk, digging into the reality of compassion fatigue, barriers to compassion, and what we can do to bring empathy back into our practice.

The Reality Check: How Hard Is Emergency Care Right Now?

Anyone working in emergency care knows it: the landscape is tough. Day in and day out, we deal with overcrowded waiting rooms, long shifts, staff shortages, and endless paperwork. These challenges aren’t new, but they seem to be getting worse. I opened my talk by asking the audience to think about how many times we’ve discussed these issues and how often they’ve felt overwhelmed at the end of a shift. Let’s face it—compassion can feel like a luxury when there are scores of acutely ill patients waiting to be seen.

Barriers to Compassion

So, what’s standing in the way of compassionate care? Some of the most significant barriers come from systemic pressures. Time constraints, heavy workloads, and understaffing make it hard to connect meaningfully with patients. Other important barriers are formed by the culture in our EDs. For example, a “target culture” may prioritise numbers and throughput targets over quality. Leaders have a hugely important role in setting the culture, emphasising the importance of compassion and ensuring that we focus on our patients.

There’s also what psychologists call the bystander effect. When everyone is swamped, we can assume someone else will deliver compassionate care. But often, this means it falls through the cracks altogether. The bystander effect, compounded by a high-stakes environment, is a huge barrier to consistent compassion. Research outside healthcare has shown that time pressure can be a significant contributor to the bystander effect, and in the ED, we are constantly working with time pressure. Could that be making us blind to the real human needs of our patients?

Reclaiming Compassion: Simple Steps and Personalised Care

Bringing compassion back to the bedside doesn’t have to be complicated. Based on my own research, I’ve found that even small actions can make a big difference in patient experience. Working with a hugely talented doctor called Ergul Kaide, who was then a medical student, we asked patients if and how they were suffering when they arrived in the ED. They gave a plethora of responses, ranging from the obvious ‘pain’ to ‘anxiety’, ‘nausea’, ‘vomiting’, and even basic human needs like hunger and thirst. We asked what they were hoping we’d do to ease their suffering. The most common responses weren’t about medical treatments – even analgesia. Even more important were simple human interventions – explanation, reassurance, closure. Before they left the ED, we asked what had been done to ease their suffering. Sadly, the most common response was ‘nothing’. However, of those who said something had eased their suffering, the most common responses were again to do with simple human interventions: patients valued explanation, reassurance, and friendly staff.

We summarised the approach to suffering by concluding that we need to pay attention to five things to address patient suffering:

Emotional distress
Physical symptoms
Information (provision)
Care (basic care)
Closure (whether that be knowing that they need hospital admission or being allowed to go home).

This spells out ‘EPICC’ – a simple evidence-based mnemonic that we could use in our everyday practice to address patient suffering in the ED.

Personalized care is another vital piece of the puzzle. Techniques like shared decision-making—where patients actively participate in their care choices—allow for more tailored and compassionate interactions. By involving patients directly, we show them their preferences are valued, even in a busy ED environment.

We can also start tracking compassionate care with Patient-Reported Experience Measures (PREMs), which offer insights into how patients actually experience their care. Tools like the PREM-ED 65, developed by Blair Graham, are designed to give us actionable feedback and can help ensure we don’t lose sight of compassion amidst the busyness.

Compassion is an Emotion—Not Just a Task

One problem with the solutions we’ve discussed so far is that they seem to reduce compassion to systems and checklists. However, true compassion requires us to feel, not just act. Compassion is an emotion, not a task, and to fully connect with our patients, we need to connect with our own emotions first. Developing emotional intelligence can help here, allowing us to recognize and manage our own feelings, which is key to understanding and responding to the emotions of others.

The Challenge of Compassion Fatigue and Burnout

A huge challenge relating to this is that emergency physicians often experience huge challenges in ‘feeling’ compassion. Compassion fatigue occurs when we become so overwhelmed and desensitised by the suffering of others that we simply can’t ‘feel’ compassion for others any more. Research shows that emergency physicians are disproportionately affected by compassion fatigue. Linked to that is ‘burnout’, which disproportionately affects emergency physicians. ‘Burnout’ comprises three key symptoms: emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment. Of these, ‘depersonalization’ is particularly relevant to compassion fatigue, as it involves a sense that we are not actually experiencing our thoughts, feelings, emotions and even our actions in the first person. It’s as though we’re an independent observer of our own lives – and with that comes a sense of emotional detachment, which can clearly get in the way of feeling compassion. These feelings harm our well-being and impact the quality of care we provide.

Building Self-Compassion: The Foundation of Lasting Compassion

If we want to sustain compassion for our patients, we have to start with ourselves. Self-compassion—treating ourselves with the same kindness we offer to others—isn’t just nice to have; it’s essential. Studies show that self-compassion can reduce burnout, helping us stay resilient in the face of relentless stress. Importantly, however, it can also increase our compassion for others. If we want to be kinder to others, it seems we ought to start by being kinder to ourselves.

So, what does self-compassion look like? It can be as simple as acknowledging that some days are hard, mistakes happen, and you deserve the same grace you give your patients. Learning to recognize our own emotional needs, take breaks, and avoid unnecessary self-criticism can go a long way in restoring our ability to care for others.

Redefining Compassion: Is It Just Easing Suffering?

As I wrapped up my talk, I shared a personal reflection. Coming from a Christian background, I initially saw compassion as “to suffer with” – as though true compassion required me to ‘suffer’ along with my patients. But over time, I’ve realized that true compassion in emergency care isn’t about suffering with patients; it’s about lifting their spirits, enhancing their well-being, and helping them feel heard and valued. This subtle shift in perspective raises a philosophical question: Is our purpose in emergency care merely to ease suffering, or is it to increase well-being?

This is a question we each need to answer for ourselves, but it has profound implications for the future of healthcare. How we define compassion—and our purpose in caring for others—will shape not just individual practice but also the direction of emergency medicine as a whole.

Final Thoughts: Yes, There’s Room for Compassion—and It Starts with Us

Despite all the challenges, I believe there’s still room for compassion in emergency care. But it starts with us. By caring for ourselves, fostering a culture that values empathy, and staying connected to our purpose, we can make room for compassion in even the busiest EDs. And who knows? Maybe by reclaiming compassion, we’ll not only improve patient care but also rediscover the joy and meaning in our work.