One: The Variable Medicine Leaves to Chance.
Updated: Sep 30
The Paradox of Clinical Precision.
Article 1 of the Compassionate Competency series.
There's a paradox built into medical training.
To earn the title of doctor you need diagnostic precision, procedural skill and judgement grounded in evidence. Then, for many, come years of specialty training on top. I can't think of another profession that demands as much.
Despite that, across all those years, one thing goes largely untaught. It's the thing that decides whether clinical expertise is translated into medicine, whether capability grows into leadership, and whether caring for other people ends up feeding the doctor's own wellbeing, or draining it.
I call it compassionate competency.
What's happening in every interaction
All healthcare happens inside relationships between clinicians and patients.* Something is going on in every one of those interactions, with patients and with colleagues, that very few clinicians have been provided with a systematic way to work with.
Things like:
• how psychological safety gets built, or broken
• how understanding and capability move from one person to another
• how clarity and commitment to a plan is crystallised
• how two people work along the journey between where things are and where they want them to be
This isn't a side issue: the evidence points to the way we relate to one another, shaped by mindset and non-technical skills, as the main variable in whether clinical expertise turns into medicine.
By mindset I mean the beliefs we hold about ourselves, other people and our environment. It’s easy to lose sight of how malleable those beliefs are, and the impact they have on our behaviour. They shape what we notice, how we make sense of it and what we choose to do next. Mindset affects health so strongly that medicine now uses it on purpose. We call it the placebo. Its shadow, the nocebo, is what happens when negative expectations cause real harm.
Patient and clinicians walk into a consultation already moving. The patient is already trying to get well. The clinician is already working toward a good result: a full clinical picture, and the satisfaction of seeing their expertise pay off. Every exchange either moves them both along or slows them down. That's really all placebo and nocebo describe. Good expectations help a journey that's already underway. Poor ones add friction, and can work against what both people want. In simple terms, I am describing whether the conditions we experience support clinical excellence.
Non-technical skills (communication, collaboration, leadership, empathy, managing stress) are how clinical expertise gets into the room. They shape the patient's experience and outcomes. They shape how well teams work. Over a career, they shape the clinician's success and wellbeing.
Compassionate competency is the practice of setting up conditions where people can work through hard things together and get the most out of those moments. Now, and over the long run.
Still, it's one of the few things modern medicine leaves to chance. No medical training program in Oceania makes mindset and non-technical skill development compulsory, and the clinicians we work with overseas describe the same gap.
Individual clinicians haven't failed here. The system has a hole in it.
Stuck between good medicine and wellbeing
The gap turns into a trap in a few ways. That happens when a clinician can't bring their clinical excellence to a patient because a misunderstanding or a conflict has already got in the way. A trainee and supervisor can't build the safety, capability and consistency a training program demands. A patient leaves less likely to follow the plan or return, and the clinician moves on to the next thing without the satisfaction of having really connected, or of seeing their expertise become care.
"It's when you have no good moves. But you still have to move."
I think there's another option. Clinical excellence and compassionate competence don't have to compete. You need both to turn expertise into medicine that works. Mindset and communication are already happening in every interaction. The job is ensuring they help patient and clinician get where they're trying to go.
Clinicians who build compassionate competence on top of their clinical skill bring something different into the room. Their consultations:
• affirm each person's value and create safety
• affirm that people can learn and grow, so both sides come to see the gap the same way
• affirm shared responsibility, so what doctor and patient commit to actually happens,
And they manage it without getting bogged down in resistance, fear or resentment.
The difficult moments become part of the work, and the consultation stays on a therapeutic path. In teams, the same skills mean supervision builds capability, and hard conversations bring people closer instead of pulling them apart.
What's at stake
The evidence is strong. Some of it may still surprise you.
When clinicians develop compassionate competency, clinical outcomes improve. Patients turn up more, tell you more of what matters clinically, and stick with treatment. Requests for second opinions and extra diagnostic tests go down. So do complaints. Patient safety improves. The clinician's diagnostic skill hasn't changed.
The interaction has, and that changes what's possible.
The flip side is just as well documented. Several longitudinal studies have followed clinicians through medical school, internship, residency and early career. The pattern holds every time. If mindset and non-technical skills aren't supported, empathy, self-regard and emotional intelligence drop at each transition.
Left alone, that trajectory doesn't reset. It steepens. You see it first in job satisfaction and a sense of meaning. Later it shows up in error rates, complaints and how long people last in medicine. One 25-year study found academic performance, the very thing the training system is built around, predicted later exam results. It didn't predict career satisfaction, burnout or quality of life.
What did predict them were the human capabilities medicine has mostly left to chance.
Clinical outcomes and clinician wellbeing are tied together. The whole system does better when clinicians are properly supported to give good care and to find satisfaction in it. We still leave the main lever for that to luck.
So this is more than a philosophical point. Compassionate competency measurably affects outcomes, patient safety, clinician wellbeing, careers and how the system performs.
Clinical outcomes and clinician wellbeing are tied together.
You can learn this
The same research that maps the gap also shows how people can traverse it.
Structured development of compassionate competency produces real, lasting change. When medical students had training grounded in mindset and their own autonomy, their trajectories shifted. Another study, of a structured emotional intelligence and resilience curriculum, found the gains held at one-year follow-up. 91% of participants were still using what they'd learned in their next clinical year.
Compassionate competency isn't a personality trait you either have or you don't. Like clinical expertise, it grows through deliberate practice inside a framework built for the job.
At 700, that framework rests on Compassionate Accountability®. It's approved by RACS and ANZCA for healthcare education, and approval with European medical authorities is underway. 700 led the development of Compassionate Accountability's healthcare-specific resources. Put simply, compassionate competency is the capability clinical training has left undeveloped, and Compassionate Accountability is a proven way to build it.
Trajectories set early tend to stick, at least until action is taken to establish a new one. Without support, the distance between where a clinician starts and where they end up keeps growing – perhaps more meaningfully, the gap between where a clinicians wants to be right now, and where they find themselves grows. So the earlier the work happens, the bigger the payoff. For the clinician's career and wellbeing, for every patient they'll see, and for the teams they'll one day lead.
For many senior clinicians in 700's workshops, often nearing the end of their careers, two things often surface at once. The first is grief, for the harm this gap has caused that didn't need to happen. The second is relief. Changing it doesn't need a redesign of the system. It needs a different approach to the next interaction, and the one after that.
This doesn't need to be one more thing on an already full plate. It's about providing clinicians the tools for something they are already doing, every day.
The gap is the opportunity
If you've read this far, you've probably felt it. The distance between what you know is possible and what actually happens for you, your patients, and your colleagues.
Now we have a name for it. Compassionate competency: the mindset and non-technical skills that turn clinical expertise into effective medicine, capable leadership and a career that stays meaningful.
Modern medicine accounts for nearly everything else. It's rigorous, it follows the evidence and it's committed to improvement. The one variable it has left to chance is, by its own research, among the biggest influences on outcomes, patient safety and clinician wellbeing.
That can be fixed. The rest of this series looks at each part of it: what the research shows in more detail, how it is experienced by clinicians, what compassionate competency looks like day to day, and what it takes to develop.
If any of this matches what you've seen in your own practice, your team or your training, I'd love to hear from you. You can get in touch below to arrange a conversation, or to access a copy of our research white paper, Communication as Care.
If you're wanting to explore how compassionate competence is showing up for you, you can take our free assessment, Healthcare's Hidden Variable, here. You'll also receive a copy of Communication as Care in your inbox.
* All healthcare happens within relationships between clinicians, patients and their carers. That includes clinical teams and the organisations they work in.
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