The Power of Compassion, Ritual and Belief in Healing: Part One

Compassion comprises less than 1% of all communications
by physicians to patients.

Stephen Trzeciak, MD

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This is the first a two-part series; the second will launch in June 2019

We’re writing this month having just completed a conversation with a colleague from Beaumont Health and the Beryl Institute about the impact of compassion on the economics of healthcare, and how it can play a role in enhanced outcomes as well as saving costs.

These posts are written in two parts, with related premises:

  1. That compassion is a learned behavior, and that it can benefit the person providing care, the patient receiving care, and the organization’s bottom line in measurable ways; and

  2. that compassion, ritual and belief play an outsized role in the healing process, the benefits of which have not yet been fully realized by the healthcare establishment. 

Our point of view is that these interactions happen by design, not by default. We believe that complex healthcare cultures can change over time if leadership adopts a Systems Thinking approach, co-designing actionable steps with staff and patients to build a resilient culture focused on optimizing healthcare experiences.

We call this discipline Healthcare Experience Design. The primary ingredient is effective communication; of all the elements that impact a caregiving culture, communication can be designed.

Part One: “The Compassion Crisis”

Thom Carroll/PhillyVoice

Thom Carroll/PhillyVoice

Stephen Trzeciak, MD, MPH is a physician scientist and Professor of Medicine at Cooper Medical School of Rowan University, and the physician leader of the Adult Health Institute at Cooper University Health Care in Camden, New Jersey. He’s concluded that the biggest problem in medicine is obvious: “We have a compassion crisis.”

Burnout, characterized by depersonalization of patients and emotional exhaustion, is rampant in medicine. It affects quality as well as how patients perceive their care. At its core, the problem starts with the emotional connection between health professionals and their patients. What was needed was for someone to bring science to the study of compassion and its impact on medical quality and cost.

“Why waste another moment of my career working on anything else?” Trzeciak thought. “This is what I need to do right now.”

A self-described “research nerd,” he has spent years poring over more than 1,250 research abstracts and papers, trying to answer the question “does compassion really matter?” The available evidence shows that it does and that there isn't enough of it in health care. 

Along with colleagues at Cooper University Health Care, he’s coined the phrase “Compassionomics.” It’s obvious that healthcare providers ought to be compassionate. That's a moral imperative rooted in the art of medicine. But the team hypothesized that compassion may also be “an evidence-based intervention with measurable beneficial effects belonging in the science of medicine.”

Cooper is just starting its first compassion studies. The team will look at how caregiver compassion affects PTSD among critically ill patients, at whether compassion training — yes, you can train people to be more compassionate — affects the development or course of provider burnout, and at how to model costs related to compassion training. 

James Doty, a neurosurgeon, founded the Stanford Center for Compassion and Altruism Research 10 years ago. He edited The Oxford Handbook of Compassion Science, which was published in late 2018.

Doty said compassion can have a powerful effect on both patients and medical professionals, but the roots of burnout and depression are deeply embedded in a system that can work against caring. The values of professionals, who entered their fields to help, often clash with those of the commercial, profit-seeking health institutions they work for.

“They feel that what they signed up for is not what they got,” he said.

When Trzeciak, 47, was in medical school, students were told not to get too emotionally invested in patients because it would raise the odds of burnout. “I can't find any data to support that,” he said. “But there is compelling data to the contrary.” 

Once he started diving into the data on compassion, Trzeciak had to admit that he needed to make some changes in his own approach to patients. He had been especially impressed by a 1999 Johns Hopkins University study on the impact that scripted, videotaped expressions of compassion had on cancer patients. If doctors spent just 40 seconds saying they and patients were on this difficult journey together, patients had less anxiety.

Trzeciak decided to do an experiment on himself. He would give his 40 seconds of compassion to patients every chance he got.  “I connected more. I cared more, not less,” he said. “That's when the fog of burnout began to lift, so it changed everything for me, too.”

Trzeciak said there's already evidence that very little of the time doctors spend with patients — less than 1 percent — is devoted to expressions of empathy or compassion. Empathy, he said, is feeling another's pain.  Compassion goes beyond empathy to include taking action to help.

There's also evidence that patients are more likely to follow doctors' instructions and doctors are less likely to order unnecessary tests when there is a compassionate relationship. Doctors who are burned out are more likely to make mistakes. These relationships all potentially affect the cost of care, an area that Trzeciak thinks needs more study.

“Ultimately, payers drive change in health care,” he said.


More resources:

Listen to Dr. Trzeciak’s TEDx talk

Does Taking Time for Compassion Make Doctors Better at their Jobs? | npr.org

Compassiononomics: the Business Case for Caring | smerconish.com

Next month we’ll explore the benefits of compassion, ritual and belief in placebo studies; from the NPR podcast Hidden Brain.