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.