Beyond Compassion: Replacing a Blame Culture With Proper Emotional Support and Management; Comment on “Why and How Is Compassion Necessary to Provide Good Quality Healthcare?”

Document Type : Commentary


University of Bath, Bath, UK; University of Lund, Lund, Sweden


The absence of compassion, argues the author, is not the cause of healthcare failures but rather a symptom of deeper systemic failures. The clinical encounter arouses strong emotions of anxiety, fear, and anger in patients which are often projected onto the clinicians. Attempts to protect clinicians through various bureaucratic devices and depersonalization of the patient, constitute as Menzies noted in her classic work, social defences, aimed at containing the anxieties of clinicians but ending up in reinforcing these anxieties. Instead of placing additional burdens on clinicians by bureaucratizing and benchmarking compassion, the author argues that proper emotional management and support is a precondition for a healthcare system that offers humane and effective treatment to patients and a humane working environment for those who work in it.


Main Subjects

  1. Fotaki M. Why and how is compassion necessary to provide good quality healthcare? Int J Health Policy Manag. 2015;4(4):199-201. doi:10.15171/ijhpm.2015.66
  2. Hochschild AR. The Managed Heart:  Commercialization of Human Feeling. Berkeley: University of California Press; 1983.
  3. Craib I. Experiencing Identity. London: Sage; 1998.
  4. Bolton SC. Who cares? Offering emotion work as a 'gift' in the nursing labour process. J Adv Nurs. 2000;32(3):580-586.
  5. Meerabeau L, Page S. Emotion management and cardiopulmonary resuscitation in nursing. In: Bendelow G, Williams SJ, eds. Emotions in Social Life: Critical Themes and Contemporary Issues. London: Routledge; 1998.
  6. Theodosius C. Emotional Labour in Health Care: The Unmanaged Heart of Nursing. Abingdon: Routledge; 2008.
  7. Bone D. Dilemmas of emotion work in nursing under market-driven health care. International Journal of Public Sector Management. 2002;15(2):140-150.
  8. Theodosius C. Recovering emotion from emotion management. Sociology. 2006;40(5):893-910. doi:10.1177/0038038506067512
  9. Menzies I. A case study in functioning of social systems as a defence against anxiety. Hum Relat. 1960;13:95-121.
  10. Menzies Lyth I. Containing Anxiety in Institutions: Selected Essays. London: Free Association Books; 1988.
  11. Klein M, Mitchell J. The selected Melanie Klein. 1st ed. New York: Free Press; 1987.
  12. Bauman Z. Modernity and the Holocaust. Cambridge: Polity Press; 1989.
  13. Menzies Lyth I. Changing organizations and individuals: psychoanalytic insights for improving organizational health. In: de Vries MFRK, ed. Organizations on the Couch. San Francisco: Jossey-Bass; 1991.
  14. Lökman P, Gabriel Y, Nicolson P. Hospital doctors' anxieties at work: patient care as intersubjective relationship and/or as system output. International Journal of Organizational Analysis. 2011;19(1):29-48.
  15. Obholzer A. Managing social anxieties in public sector organizations. In: Obholzer A, Roberts VZ, eds. The Unconscious at Work: Individual and Organizational Stress in the Human Services. London: Routledge; 1994:169-178.
  16. Obholzer A, Roberts VZ, eds. The Unconscious at Work: Individual and Organizational Stress in the Human Services. London: Routledge; 1994.
  17. Fotaki M. Why do public policies fail so often? Exploring health policy-making as an imaginary and symbolic construction. Organization. 2010;17(6):703-720. doi:10.1177/1350508410366321
  18. Gabriel Y. The caring leader – What followers expect of their leaders and why? Leadership. 2014. doi:10.1177/1742715014532482
  19. Gabriel Y. Psychoanalytic approaches to leadership. In: Bryman A, Collinson D, Grint K, Jackson B, Uhl-Bien M, eds. The SAGE Handbok of Leadership. London: Sage; 2011:393-405.