title: Smiling through clenched teeth: why compassion cannot be written into the rules.
abstract: The discourse on the failings of the National Health System often cites lack of compassion as an important factor. This has resulted in proposals to enact rules which aimed at enforcing compassion in healthcare workers so as to improve the quality of healthcare and avoid future scandals. This paper argues that compassion cannot be enforced by any rule. Moreover, the contractual nature of the current doctor-patient relationship does not foster it. Experience from other service industries shows that attempts to enforce compassion in workers are futile. Rather than improving service, these attempts result in a culture of perfunctoriness and cynicism.
authors.affiliation: Correspondence to Dr Yinchu Wang, Barts and the London, London, E1 2AD, UK; y.wang@smd11.qmul.ac.uk.
authors.forename: Yinchu
authors.initials: Y
authors.lastname: Wang
mesh_terms: D000574:American Medical Association; D002055:Burnout, Professional / Q000209:etiology / Q000523:psychology; D032781:Codes of Ethics; D003695:Delivery of Health Care / Q000941:ethics* / Q000592:standards / Q000639:trends; D004644:Emotions; D004645:Empathy; D004739:England; D006282:Health Personnel / Q000941:ethics* / Q000523:psychology* / Q000592:standards / Q000639:trends; D006761:Hospitals / Q000941:ethics; D006801:Humans; D009723:Nurse-Patient Relations / Q000941:ethics; D015279:Organizational Culture; D010817:Physician-Patient Relations / Q000941:ethics*; D012904:Smiling; D012918:Social Alienation / Q000523:psychology; D035502:Trust; D014481:United States
keywords: Codes of/Position Statements on Professional Ethics; Education for Health Care Professionals; Health Workforce; History of Health Ethics/Bioethics