The column I wrote last month called "The Courage of Kindness" described a report in Health Affairs that called for providers to be more compassionate in caring for patients. In a follow-up, I shared responses from some readers who took issue with the premise of the report and with my comments — and those responses generated a whole new wave of reader reaction. Among the edited samples that follow, one reader debunks the idea that compassion takes too much time; others suggest ways to encourage more compassionate interactions with patients, and the last tells a personal story of how compassionate care works in real life and why it matters.

As a physician in practice for 21 years, having served as medical director at four different hospitals in three different states, I am dismayed by the responses you received in regard to your editorial on compassion in health care.

It does not take more time to be kind and compassionate; that excuse is simply that — an excuse. In our profession, isn't it our job to provide care and support for our patients and doesn't this responsibility remain no matter how we feel on any given day? Compassion and healing is why I went into medicine.

Fifteen years ago, I began a study of Buddhism, Shamanism and indigenous healing in an effort to learn more about the basis of healing. I found that focused interactions in which the healers make themselves fully present do not take more time. In fact, being fully present and compassionate increases the quality of the interaction so that time becomes less and less of a factor.

I would suggest that there is strong evidence that lawsuits are more likely to be pursued when the patient or family has felt ignored, not listened to, not understood, and simply not cared for.
Kurt Biehl M.D.
Boarded in General Psychiatry and Psychosomatic Medicine

Time spent counseling families and patients is given short shrift financially compared to procedures. Reimbursement changes properly compensating this time would quickly and easily result in behavioral changes. As in all else, you get what you pay for. Changes that have rewards attached are very quickly noticed. We providers are all too familiar with sticks.
Scott A. Joseph, M.D.

As someone once said about art: "I know it when I see it." Compassion is an experience rather than a surveyor's jot or tiddle; however, it can be measured in terms of patient and caregiver satisfaction. Compassionate behavior can be mandated in general terms that over time will result in a progressively improved and measurable "standard," much as anti-discrimination laws once set a moral tone that over time has actually made a difference in changing behavior and then reforming attitudes. People respect that which is subject to inspection and they respect striving for "the right thing" even if it initially looks like a distraction from other important and more measurable work.

As a former worker in an emergency room and 30 years in health care management I do see at least one problem for caregivers, and that is truly felt expressions of compassion can be exhausting. Compassionate behavior must be expected; however any well has only so much water in it and once fully drawn out, the well can become useless.
Lee Burkholder, BA, MBA, LNHA

I think compassion can be effectively introduced into more health care facilities if yoga classes were offered. Yoga classes bring awareness to ourselves and others in a very humbling way.
Kathy O'Malley-Gallagher

It is interesting to consider how to encourage and measure compassionate care. I wonder if a patient survey simply asked: Do you think any of your caregivers gave you compassionate care and/or considerate care? How many of your caregivers gave you compassionate care? If you have any specific examples, we'd like to know about them.

If I had been asked this question when I had my first daughter, I would have spoken of the nurse who cared for me two times: when I was hospitalized with preterm labor and came close to having our daughter at 24 weeks, and then when I finally delivered at 39 weeks. She truly took care of me in the most competent and caring way.

On the doctor side of my care, my obstetrician was great and her compassion came through as she became my cheerleader. A perinatologist told me that I'd be lucky if I made it to 27 weeks with my pregnancy. I followed the program and every week that I made it back to the OB, she gave me a "high five" and encouraged me to keep up the good work of doing nothing.

Had I been asked this question when I had my second daughter, I would have spoken about the nurse who gave me some of the best advice I have ever received. I had given birth to my second daughter late the night before and my husband and my first daughter were coming to visit me. Clare was just a bit over 2 years old at the time. When I told my post-partum nurse about the plan for the day, she wisely made a suggestion in the most unobtrusive way. She simply asked me to consider sending my newborn baby to the nursery and allow Clare and her dad to get Suzy from the nursery. She said that young siblings aren't always ready to walk into a hospital room and see a new baby occupying what was their place in their mother's arms. It was an amazing experience for Clare because the nursery gave her a baby whom she brought back and let her mother hold. From then on Suzy was Clare's baby and they have had one of the best sibling relationships I have seen.

I am a former hospital administrator and have been a health lawyer for over 20 years. The majority of my practice is health care regulatory and operational work for hospitals and health care systems. I love my practice because the people I get to work with really do care about the work they do and the patients in their care. On the extremely rare occasions I am asked to represent a health care provider who is not so inclined, I don't accept the representation.
Louise M. Joy
Joy & Young, LLP.
Austin, Texas

Bill Santamour is managing editor of Hospitals & Health Networks. Follow his tweets at www.twitter.com/hhnmag.