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Culture of Empathy Builder:  Antonio Fernando

Beyond Compassion Fatigue:
The Transactional Model of Physician Compassion

Antonio Fernando and Edwin Rutsch

Antonio (Tony) Fernando is a medical doctor and Senior Lecturer at the School of Medicine in the University of Auckland located in Auckland, New Zealand. His research interests include diagnosis and treatment of insomnia and other sleep disorders. He is currently working on a PhD on compassion in healthcare.


Tony wrote an article titled;  Beyond Compassion Fatigue: The Transactional Model of Physician Compassion.  He writes, "Paradoxically, despite being central to the practice of good medicine, the bulk of studies across the past two decades have been focused not on compassion, but on compassion fatigue....


Anatomy of the heart - Enrique Simonet  (Wikipedia)


We have suggested that the scientific study
of compassion in medicine may be enhanced
when conducted within a transactional framework...

"We have suggested that the scientific study of compassion in medicine may be enhanced when conducted within a transactional framework in which compassion is viewed as stemming from the dynamic interactions between physician, patient, clinical, and institution/environment factors. The Transactional Model of Physician Compassion offers a framework within which to identify and organize the barriers and facilitators of physician compassion and thus better inform future interventions aimed at enhancing physician compassion."
Sub Conference: Health Care



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Beyond Compassion Fatigue: The Transactional Model of Physician Compassion
"Physician compassion is expected by both patients and the medical profession and is central to effective clinical practice. Yet, despite the centrality of compassion to medical practice, most compassion-related research has focused on compassion fatigue, a specific type of burnout among health providers.


Although such research has highlighted the phenomenon among clinicians, the focus on compassion fatigue has neglected the study of compassion itself. In this article, we present the Transactional Model of Physician Compassion. After briefly critiquing the utility of the compassion fatigue concept, we offer a view in which physician compassion stems from the dynamic but interrelated influences of physician, patient and family, clinical situation, and environmental factors. 


Illuminating the specific aspects of physicians’ intrapersonal, interpersonal, clinical, and professional  functioning that may interfere with or enhance compassion allows for targeted interventions to promote  compassion in both education and practice as well as to reduce the barriers that impede it. "

Potential areas for physician intervention include;

  • "education on the nature of compassion "

  • education on " the benefits the doctor, the patient, and their families can derive from compassionate clinical care."

  • "training doctors how to manage their expectations of patient behavior and outcomes"

  • "eight-week program on mindfulness meditation, self-awareness, and communication found sustained improvements in physician empathy."

  • "helping patients to see situations from the perspective of the medical professional"

  • "limiting unnecessary interruptions during the consultation and providing adequate privacy"

  • "work environments should encourage togetherness, collegiality, and mutual support among different disciplines and within the medical hierarchy "