Our good friend and colleague, Dr. Robert Sanet, spends a considerable amount of time during his seminars addressing the importance of compassion in patient care. In the course of working with Bob on commentary to his seminar series, I was touched by the extent to which compassion plays a role not only in patient care outcomes, but in the perception of optometrists and therapists about their own work/life balance.
There is now a book on the subject of compassion as essential to health care, co-authored by two New Jersey physicians, Stephen Trzeciak and Anthony Mazzarelli. These two authors present the case forcefully that to downplay the role of compassion in patient care actually goes against the grain of evidence-based medicine. As background, have a look at this TEDx video by Dr. Trzeciak.
Consider the following from page 58 of Trzeciak and Mazzarelli’s insightful book on Compassionomics: “The data we’ve reviewed so far has laid an important foundation, a starting point to begin to open our minds to the possibility that how we relate to one another – how we connect or fail to connect – can, in fact, impact one’s health in meaningful ways. For good health, human connection matters. That’s powerful. And it is obviously rooted in very rigorous scientific evidence. It’s not mushy. It’s not soft. It’s science. It’s part of that overlap between both the art and science of medicine, areas that previously were believed to be completely distinct and separate.”
Compassion science is a relatively new field, such that anyone doing a search for pertinent research will find there isn’t any single best term to use. In conducting a systematic review of the literature, here are terms that the authors considered:
Yet there are important distinctions to be made, foremost being the working definition of compassion which is: “an emotional response to another’s pain or suffering involving an authentic desire to help”. Empathy is the feeling or understanding of another’s challenges or struggles, and compassion is that action that flows from empathy. So by definition, anytime a study examines health care provider behavior toward a patient, the study must involve compassion.
Systematic review of the literature shows positive scientific evidence of the effects of compassion that can be grouped into four categories:
- Physiological Effects
- Psychological Effects
- Enhanced Patient Self-Care
- Increased Quality of Care
Physiological effects have been documented in biomarkers that range from cortisol levels as related to stress, to functional indices of the immune system. Psychological effects are equally wide-ranging, with multiple studies showing an association between better patient experiences and outcomes and connecting with or trusting the provider. As Trzeciak and Mazzarelli note: “When seeking health care, most patients confer trust in physicians, nurses, and other caregivers when they make the choice to place their health and well-being in their hands … But here is the catch. Trust is not automatic. A health care provider must build that trust, and one of the ways to rapidly build trust is through compassion. There is ample evidence on this in the biomedical literature.”
A representative study cited shows a high level of correlation between scores on the CARE measure and the extent of pain or discomfort experienced with migraine headaches. The Consultation and Relational Empathy (CARE) Measure is a consultation process questionnaire has that been developed by Dr Stewart Mercer at Glasgow University.
There is impressive research on the impact of compassion on functional impairment for reasons other than pain or discomfort. Trzeciak and Mazzarelli share a synthesis of data on the topic of the therapist-patient relationship in physical rehabilitation research showing that a therapeutic alliance that includes an affective (i.e. emotional) bond is associated with better functional rehabilitation outcomes for patients. Here is a link to the systematic review demonstrating the importance of the therapeutic alliance.
Can compassion on the part or a provider be developed? Compassionomics shows that the concept of neuroplasticity extends not only to patients being able to develop new skills or recapture functions lost, but to providers remodeling themselves. It can take as little as 40 seconds for providers to exhibit the type of compassion that makes a difference in the therapeutic alliance. In his optometric seminar series, Bob Sanet references the work of Carol Dweck regarding the power of the learner’s mindset as applied to patients, originally introduced to him by our colleague, Dr. Nancy Torgerson. Compassionomics extends this power to the provider: “Growth mindset is crucial for becoming a more compassionate health care provider, or more broadly, a more compassionate person.”
A final, powerful message in Compassionomics is that historically physicians-in-training have been taught: “Don’t get too close to patients”. The thinking was that keeping a safe distance from patients – at least emotionally – would protect the caregiver by preventing emotional overextension and thus reduce the risk of getting burned out. But the problem with that historical thinking is that it’s actually not evidence-based. In fact, the available scientific evidence tells a very different story. “There is abundant data in neuroscience and psychology research showing that compassion for others promotes well-being for the giver of compassion.”