Welcome to PracticeUpdate! We hope you are enjoying access to a selection of our top-read and most recent articles. Please register today for a free account and gain full access to all of our expert-selected content.
Already Have An Account? Log in Now
Importance of Compassion in Healthcare
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersPURPOSE
To summarize the scientific evidence that compassion can measurably improve patient outcomes, healthcare quality and safety, and the well-being of healthcare providers, and to consider specific strategies for cultivating compassion and better communicating it to patients.
DESIGN
Perspective
METHODS
We selectively review the literature on compassion in health care, including obstacles to its expression and the demonstrated effects of provider compassion on patient outcomes, healthcare quality and cost, and provider well-being. We also review evidence regarding the trainability of compassion, discuss proven methods for cultivating individual compassion, and recommend strategies for incorporating it into routine medical practice.
RESULTS
Compassion is the emotional response to another's pain or suffering, accompanied by a desire to alleviate it. Review of the literature shows that compassionate health care measurably improves physical and psychological patient outcomes, increases patient adherence, improves healthcare quality and safety, increases financial margins, and prevents physician burnout. Psychophysiological research demonstrates that empathy and compassion can be actively cultivated through intentional practice. Validated models of compassion-based interactions can facilitate the consistent expression of compassion in daily medical practice.
CONCLUSIONS
Given its many proven benefits to patients, healthcare organizations, and providers, compassion should be cultivated by healthcare providers and systems, and considered an essential component of optimal medical care.
Additional Info
Disclosure statements are available on the authors' profiles:
Compassionomics: The Science and Practice of Caring
Am J Ophthalmol 2023 Nov 01;[EPub Ahead of Print], I Lains, TJ Johnson, MW JohnsonFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
This week, during our review of articles for PracticeUpdate Eye Care, we came across an article that our editorial board considers to be relevant to the entire spectrum of healthcare services.
In this article, the authors selectively reviewed the literature regarding compassion in healthcare, including obstacles to its expression and the effects of provider compassion on patient outcomes, healthcare quality and cost, and provider well-being. The latter issue has become a widespread concern in counteracting physician burnout. The authors also reviewed the current evidence regarding the trainability of compassion, discussed proven methods for cultivating individual compassion, and recommended strategies for incorporating it into routine medical practice.
You might be wondering where the term "Compassionomics" originated. It is a term coined by Stephen Trzeciak, a physician and co-author of a book published in 2019 titled Compassionomics: The Revolutionary Scientific Evidence That Caring Makes a Difference. A useful companion to the book is a video of a riveting TED talk delivered by Dr. Trzeciak. The impetus for that talk was a question posed to him by his 12-year-old son. We trust that you will enjoy watching the talk and find its content useful when applied to your practice environment.
If someone is in the medical field and lacks compassion toward their patients, they are in the wrong line of work. Did we not choose to go into the medical field because we wanted to make a difference in the lives of the patients under our care? With the shortage of oncology specialists, the increased volume of newly diagnosed patients with cancer, financial institutional pressures, and the challenges of balancing work and family life can result in compassion fatigue or, even worse, burnout among physicians.
In order to accommodate the increased volume of patients newly diagnosed with cancer, we have to transfer the follow-up care of our patients to nurse practitioners and physician assistants, thereby removing from our schedules patient appointments that are essentially social visits. That is, the patient is doing well; during the visit, she will probably thank you for taking care of her and say that she prays for you every night, give you a hug, and even leave chocolate chip cookies on your desk. We must remove all those warm and fuzzy visits and replace them with visits to patients with newly diagnosed breast cancer who are in shell shock, have a ton of questions, and, if they have stage IV disease, can barely listen to what we are saying, realizing that a grim reaper at some point may appear at their bedside.
During the pandemic, we were mostly seeing patients via MyChart telemedicine visits. This took away the opportunity to hold the patient's hand and lean in as we talked. Even I felt depressed. It seems that I was failing my patients because I could not give them a farewell hug.
Currently, I am working on a series of accredited continuing medical education short videos that are focused on communicating with patients who have metastatic breast cancer (or other types of advanced cancers). The communication skills training is intended to provide tools and tips on how to deliver bad news (because there is actually an art and science to doing this), be compassionate, provide patient-centered care (because our patients are far more than their pathology and staging workup results), and prevent compassion fatigue. Patients want us to be honest with them, and this is where we can stumble right from the start, for instance, trying to avoid telling them too much or, worse, sugarcoating the truth. We may be our own worst enemies because physicians are trained to focus on treating the disease, and as long as there is another available treatment option, it will be offered until we run out of options or the patient becomes too sick to continue. This is undeniably bad medical practice and not something to take pride in. I have heard doctors tell their patients: "I am sorry I have failed you; I have to enroll you in the hospice program now." Well, that sounds like the doctor and the patient failed something. What if we worked alongside patients, having them share in the decision–making about their care, including having them develop criteria as to what condition they would foresee themselves in that would want them to stop treatment and regain control of their lives by enrolling in the hospice program, even enrolling earlier rather than later, as we know that those who do live longer have improved quality of life. We must work with patients to embrace the nine elements needed to be fulfilled in order for anyone, including ourselves, to experience and achieve a good and peaceful death. Furthermore, we must not abandon patients after getting them enrolled in the hospice program, but instead, offer to remain in touch with them and their families as they continue their journey to the end of life, and really do so. Many patients decline hospice care owing to concerns of being abandoned by their healthcare providers (so please do not do it). Moreover, enrolling patients in the hospice program does not mean giving up but, instead, allowing patients to regain control over how they want to spend their remaining time. I stopped saying, "I am so sorry...," approximately 25 years ago when I realized that it was not helping the patients or myself. When I realized how to truly engage with my patients, such as by knowing their upcoming milestones so that we can reserve those days for a drug holiday or delaying the start of a new treatment so the patient could attend her son's graduation or her daughter's wedding and enjoy the day, I then truly understood what it meant to be compassionate and provide holistic care to my patients. We can help patients develop alternative ways to fulfill life goals that seemed far too distant for them to reach; for instance, providing the patient's 10-year-old daughter with cards to be opened upon reaching significant milestones in her life after her mother's passing, which could include messages the patient wishes to convey to her daughter when she gets her first menstrual period, obtains her driver's license, graduates from high school and college, get married, or has her first baby, and so forth. These words of motherly love, wisdom, and advice can be written in these cards for this specific purpose. I know someone who actually does calligraphy and watercolor painting to create a special card for our patients with stage IV breast cancer, intended to be opened by their daughters when they experience their first romantic breakup. The front of the card reads: "For the first time that your heart is broken." Certainly, a daughter would have wanted her mother to tell her on that day that she deserved someone better who cared about her and was thoughtful, smart, caring, and so on. Reading those words from her mother is very powerful.
I believe that if we can change our approach with our patients, although it does require getting to know them better, we can come away with less guilt from losing another patient of ours and, instead, we can take pride in having helped them fulfill their hopes, putting them in a good place mentally, allowing hospice care to be engaged earlier rather than at the last minute, and ensuring that both the patient and their families were prepared for the patient's end of life.
I have received 62 awards for my work in the field of cancer, specifically breast cancer. One of these awards was from the American Cancer Society, called the Lane Adams Award (a national award). It is quite unusual and not something framed or made of crystal. It is a 24-karat gold pin that depicts one hand holding someone else's hand, symbolizing "Compassion."
Compassion affecting outcomes? How could that be? Compassionate people put the interests of others before their own. They can't help it. They are driven to do it. It becomes a part of their culture. What could a focus on the interests of others portend?
Is it possible to teach compassion? The University of Mississippi Medical Center has embraced this idea. They have embarked on a "Communicate with H.E.A.R.T." ( Hearing, Empathy, Apologize, Respond, Think) program, which requires 4 hours of interactive training by each of the 9000 employees of the medical center. It is designed to improve service excellence by integrating compassion into the university culture in an effort to produce exceptional patient and employee experiences at every point of interaction by helping employees understand their roles in creating positive patient experiences. It espouses a culture of empathy. Will it work? How could it hurt!
The authors of this paper are right in their focus, and we are genuinely pleased to feature the article this week. Compassion in work and life has so many benefits that can be measured, but surely (and, perhaps, more importantly) benefits that can be felt. We believe that the basic rule of "do unto others as you would wish for yourself" is part of every major religion and almost all secular cultures. Jon Bastiste's new album has a song titled "Worship" that begins with "We are born the same. Return to that place." In dermatology, we see skin of all shades and textures and ages, but it's all skin; however, it's the person inside that we may help and even make that person's day with a little bit of compassion, which they might then pass to someone else.