The term ‘compassion’ is widely used, but what it requires is rarely analysed. It has been defined as understanding another’s suffering, combined with commitment to doing something to relieve this. It involves an emotional component – a personal reaction to the plight of another – and sensitivity to the personal meaning a condition may hold for the individual. An emotional response to tragic circumstance is by nature spontaneous. But compassion also requires deliberate responses – respect, courtesy and attentive listening. The human brain is hard-wired with the capacity to share the experience of others, including their emotions. So the potential for empathy and compassion is innate. However, this can be limited by repeated exposure to suffering, when the neural networks involved become down-regulated. In addition, an organisational culture geared to performance targets with diminishing resources can lead to exhaustion and burnout. This results in reduced capacity to attend to the needs of patients. The traditional solutions of education and further research may not be sufficient. A framework is proposed for doctors to contribute to compassionate medical care, taking account of organisational factors. The key elements are: awareness; self-care; attentive listening to patients; collaboration; and support for colleagues.