As a young doctor working in the E.R. my capacity for compassion, and that of my colleagues, was often stretched; this was particularly the case when my patients could be said to have brought misfortune on themselves. I saw drug addicts suffering overdose, teenagers retching after self-poisoning, thieves injured through being arrested, all treated more brusquely than other theoretically more blameless patients.
I tried hard to maintain empathy, reflecting that the overdosed, self-poisoned and criminal may no more have brought their problems on themselves than those with skiing or horse-riding injuries or heart palpitations through overwork. But it's complicated: I've stitched up many slashed wrists cut not through willfulness but as a release from intense anguish; I've attended alcoholics for whom alcohol was clearly a substitute for love. I may not have always succeeded, but I always hoped that my humanity, or my professional duty to provide a high standard of care, would step in when my compassion was running low.
Compassion means "together-suffering" or "fellow-feeling" — a sense of identification we feel when imagining another's pain. The word "patient" means "sufferer," and at its most basic level the practice of medicine could be described as the attempt to ease mental and physical pain. If physicians have a surfeit of compassion — if they're too sentimental, or too thin-skinned — they do their jobs slowly, even less effectively. I've worked with colleagues like this: They don't last long in the pressurized environment of the E.R. or the primary care clinic.