Compassion as our core in the ED
He’s screaming. Half-naked. Covered in sweat. Thrashing against the stretcher - a young man in the grip of drug-induced psychosis.
Security has been called. The waiting room is full. You’re down two staff. Five ambulances ramped, two more on the way. The whole shift is slipping sideways.
You hesitate. Just for a second.
““Compassion isn’t an optional extra - it’s the delivery system. It’s how care gets through when everything else is falling apart.””
Do you call for backup - a flurry of hands, a knee on the bed, the quick descent into chemical restraint? Do you let the muscle do the talking, move fast, keep the line moving? Or do you pause - even briefly - and say something steadier?
Maybe something that starts with, ‘You’re safe’. Something that reminds you that he is still a person, not a problem.
Because here’s the truth. In moments like this, compassion isn’t an optional extra - it’s the delivery system. It’s how care gets through when everything else is falling apart.
This isn’t a piece about being nice. It’s about choice, about what it means to care when it is hard to care. Not when things are calm, but when someone’s screaming, the phone won’t stop, and another trolley rolls in. Because this is where it matters most. And this is where it’s most at risk.
Compassion as a clinical skill
The ACEM 2025 Strategy states it plainly: ‘Compassion is at the heart of the care we provide.’ But saying that is the easy part. The harder question is, ‘What does it look like in practice?’.
““The ACEM 2025 Strategy states it plainly: ‘Compassion is at the heart of the care we provide.’””
Because compassion isn’t a soft skill, it’s a clinical one. It draws on clarity, courage, and presence - the ability to stay with suffering. Not to solve it, but to witness it without flinching. It’s not just feeling. It’s action. And it’s measurable.
The evidence is clear[1]:
A Canadian study found that when homeless patients received usual care plus compassion, ED return visits dropped by 33 per cent within 30 days.
Patients who feel seen and heard require up to 50 per cent less pain relief after surgery.
Acts of compassion improve diagnostic accuracy because patients share more, and clinicians listen more closely.
They reduce anxiety, because feeling seen helps people feel safe.
In team settings, even brief incivility can increase medical error rates by over 50 per cent.
““We’ve got the strategy. We’ve got the science. What we need now is a culture that treats compassion not as a luxury, but as a baseline expectation.””
Clinicians benefit too. Compassionate action activates reward pathways in the brain. It reduces burnout, buffers moral injury, and builds connection. Whole departments function better, with fewer complaints, fewer sick days, and less reliance on short-term staffing[2].
We’ve got the strategy. We’ve got the science. What we need now is a culture that treats compassion not as a luxury, but as a baseline expectation.
What it looks like under pressure
It’s easy to talk about compassion during grand rounds, in policy documents, or at committee meetings. It’s harder on a Wednesday night, with no psych reg, three agitated patients, and a team nearing collapse.
But this is when it matters most. Not as performance, but as orientation.
A kind word at the right moment. A pause to explain, even when you’re stretched. An ED consultant who de-escalates with tone and posture, not just orders. A registrar who walks a patient back to their bed - and gives them a cup of tea.
““Compassion under pressure doesn’t mean doing more. It means responding with intent. It means eye contact that says, ‘I see you’.””
Compassion under pressure doesn’t mean doing more. It means responding with intent. It means eye contact that says, ‘I see you’. It means clarity and kindness in a chaotic resus. It means asking yourself (even for a moment) ‘What does this person need most right now?’ and sometimes, ‘What does this team need?’
Because when everything is urgent, it’s easy to default to speed and control, to narrow our focus to the immediate and the measurable. But the work that stays with us - the work that matters - is almost always slower. Quieter. Human.
When compassion is absent
You can feel it when it’s gone. The tone shifts, patience thins, language hardens. Compassion fatigue fuels cynicism. A missed moment becomes a missed diagnosis. A patient becomes a problem, and a colleague does too.
When compassion is absent, it’s not just the patient who suffers. Clinicians do too. Momentary acts of incivility can reduce clinical performance by more than 60 per cent[3]. Not because people stop caring, but because their working memory, diagnostic reasoning, and situational awareness all take a hit.
The absence of compassion leads to defensive medicine, depersonalisation, and burnout. It drives good people to the edge - or out of the profession altogether. And it corrodes trust - between teams, between staff and patients, and between who we are and who we meant to be.
We talk about systems thinking, about flow, about safety. But no system built on fear, fatigue, and control can be truly safe. And no culture that turns away from suffering - in others or in ourselves - can call itself compassionate.
How do we build it into culture
It starts small…a quiet check-in at the end of a shift. A senior who asks, ‘What’s the most compassionate thing we can do right now for them, and for us?’ Culture isn’t a memo. It’s what we tolerate. What we model. What we multiply.
‘The standard you walk past is the standard you accept.’ Lt General David Morrison AO, Australian Army (ret)
““If compassion is to survive in emergency medicine, it must be deliberate. Built into handovers. Baked into debriefs. Spoken aloud in moments of tension, not just in moments of calm. We need to train for it the way we train for trauma.” ”
If compassion is to survive in emergency medicine, it must be deliberate. Built into handovers. Baked into debriefs. Spoken aloud in moments of tension, not just in moments of calm. We need to train for it the way we train for trauma. Not just technical skill, but relational skill. Not just protocols and pathways, but uncertainty, distress, and emotional labour.
Author Mary Freer calls this muscular compassion - brave, boundaried, and willing to act. It means asking better questions: What are we hoping to build here? What if we did it differently? Who’s not in the room? How can I help?
And it means resisting the drift into learned indifference. The minute we start believing that efficiency is more important than dignity, we lose more than time. We lose each other.
What compassionate care looks like
We’ve talked about compassion in moments. But zoom out and it becomes more than that. It’s not just a choice in crisis. It’s a posture, a principle, and a promise.
So, let’s be explicit. For patients, compassionate care is safety. It’s being seen and spoken to with dignity, not just as a case or a task. It’s care that softens fear, reduces pain, and restores a sense of control. It’s the difference between being treated and being cared for.
Compassion as our core in the ED
For teams, compassionate care is connection and protection. It buffers burnout and strengthens morale. It turns transactional environments into human ones. It’s the invisible scaffolding that keeps people grounded, shift after shift. Not with perfect calm, but with enough steadiness to weather the storm.
And for the College, compassionate care is credibility. It is how values become visible. How strategy meets the shop floor. It’s the kind of leadership that shapes culture from the inside out. Not with platitudes, but with presence, investment, and follow-through.
The work that matters most
We began with a man in the grip of psychosis. You might still have called security. You might still have reached for sedation. But the difference is everything. Did you see him as dangerous… or afraid? Did you ask yourself, ‘What does he need from me right now?’
This is the work. Not kindness instead of competence, but kindness as competence. The work of medicine, done well, by people who still remember why they showed up.
Let that be what defines us.
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[1] Compassionomics: The Revolutionary Scientific Evidence That Caring Makes a Difference, by Stephen Trzeciak and Anthony Mazzarelli, Pensacola, Studer Group, 2019
[2] ibid
[3] Riskin, A., Erez, A., Foulk, T.A., Kugelman, A., Gover, A., Shoris, I., Riskin, K.S. and Bamberger, P.A., 2015. The impact of rudeness on medical team performance: a randomized trial. Pediatrics, 136(3), pp.487-495.
