Before I interviewed Professor Stephen Trzeciak for my podcast I had read the book he co-wrote with
Dr Anthony Mazzarelli from cover to cover. However, our conversation really brought the key lessons from the book Compassionomics [1] into relief. I thought they were worth sharing.
If you are a healthcare professional, or anyone with an interest in compassion in the workplace, read on.
1 — There is a compassion crisis in medicine
In the US 50% of patients believe that neither the healthcare system nor healthcare providers are compassionate [2]. Physicians miss 60–90% of opportunities to respond to patients with compassion. Similar data is available from the UK and Ireland. Research conducted at the Mayo Clinic shows that the median time before interruption when a patient is trying to explain their reason for going to a doctor is just 11 seconds [3].
More than a third of physicians suffer from depersonalisation, an inability to make a personal connection. In an era of electronic patient records, physicians typically spend more time looking at a computer screen than looking a patient in the eyes.
“there wouldn’t be a compassion crisis in healthcare if we really understood the magnitude of the effect.”
If we want to set about remedying the compassion crisis in society as a whole (see my recent article The Real Price of Incivility for more on this) then medicine is a good place to start. Michael West of the King’s Fund observes: “Imagine if all 1.4m employees of the (UK) NHS experienced compassion from their colleagues, and if they treated all of the one million people that the NHS treats every 36 hours with compassion, then they would take that experience out with them into the wider community.”
2 — Compassion benefits patients
You might ask why Trzeciak and Mazzarelli needed to review 1,000 peer-reviewed scientific papers before they came to this conclusion, yet their work is significant for the range and extent of the benefits it reveals. They found 24 different mechanisms whereby compassion could affect patients. They grouped these into four domains: effects on quality of care, effects on patient self-care, physiological effects, and psychological effects.
In the quality of care domain they found if you are compassionate towards your patients you are more likely to be meticulous and less prone to making major medical errors. In the patient self-care domain, research shows that if you are compassionate towards your patients, they are more likely to adhere to the course of treatment: scientists at John Hopkins University [4] found 33% better adherence where the patient felt their doctor knew them as a person. They also found physiological benefits from compassion in the same patient cohort: feeling “known as a person” was associated with 20% higher odds of no detectable virus in the blood.
It might be intuitively evident that compassion for others can modulate the psychological distress of others. Trzeciak and Mazzarelli reference the clinical evidence for this, for example a study from the US Institute of Mental Health found high compassion of nursing aides in care homes is associated with lower depression in residents [5].
3 — Compassion benefits medical practitioners!
The American Medical Association (AMA) estimates the cost to the US economy of the staff turnover associated with physician burnout as $12bn annually.
At medical school Trzeciak was advised to maintain a degree of emotional detachment from his patients in the interests of self-care. His research reveals a strong inverse association between physician compassion and burnout — “compassion can be a powerful therapy for the giver too” [6]. When you bear witness to pain and suffering you activate the pain centres of your brain, but moving on to compassionate action activates the reward pathways. “Compassion feels good” and caring for others is fulfilling.
4 — Compassion can be taught
Contrary to the belief Trzeciak once held that people were either wired for compassion or they were not, he says there is plentiful evidence that compassionate behaviours can be taught and learnt. He summarised this particular body of evidence in PLoS ONE journal last year [7]. The caveat is the physician needs to have a growth mindset, i.e. consider compassion a skill rather than a trait and believe that he or she can improve in this area, in order for the training to be effective.
5 — There are financial benefits to compassion
Aside from reducing physician burnout the financial benefits of compassion should make every politician sit up and take notice. There is a whole chapter in Compassionomics about the revenue and costs side of the equation.
My own favourite example is a UK study that found that when a patient has an unmet need for a personal connection with their General Practitioner (primary care physician), they are 41% more likely to be referred to a specialist [8]. In the UK over the past 20 years primary care surgeries have reduced consultation times down to seven minutes or less. It is sobering to think that all they have achieved through this is to shuffle their patients into the more expensive realm of secondary care.
Ongoing work
Trzeciak has an ongoing research programme at Cooper University Healthcare and Cooper Medical School of Rowan University around the quantification of the effects of compassion in healthcare. He maintains that it is not until you quantify the impact for patients and for those who care for them that compassion will be given appropriate priority. It belongs in the domain of evidence-based medicine. He says “there wouldn’t be a compassion crisis in healthcare if we really understood the magnitude of the effect.”
When Compassionomics was first published there was an article in the Washington Post with the social media tagline “Who would you rather have; a physician who graduated at the top of the class in medical school, or a physician who is compassionate?” Trzeciak and Mazzarelli’s groundbreaking work demonstrates why we should be seeking someone who combines both.
References
Trzeciak S, and Mazzarelli A. Compassionomics: The Revolutionary Scientific Evidence that Caring Makes a Difference. Pensacola: Studer Group (2019).
Lown BA, Rosen J and Marttila J. “An Agenda for Improving Compassionate Care: A Survey Shows About Half of Patients Say Such Care is Missing.” Health Affairs 30(9) (2011): 1772–8
Singh O et al. “Eliciting the Patient’s Agenda: Secondary Analysis of Recorded Clinical Encounters.” Journal of General Internal Medicine 34(1) (2018): 36–40
Flicklinger et al. “Clinician Empathy is Associated with Differences in Patient-Clinician Communication Behaviors and Higher Self-Medication Self-Efficacy in HIV Care.” Patient Education and Counselling 99(2) (2016): 220–6
Hollinger-Samson N and Pearson J. “The Relationship between Staff Empathy and Depressive Symptoms in Nursing Home Residents.” Ageing and Mental Health 4(1) (2000) 56–65
Wilkinson H et al. “Examining the Relationship between Burnout and Empathy in Healthcare Professionals: A Systematic Review. Burnout Research 6 (2017):18–29
Patel S et cl. “Curricula for Empathy and Compassion Training in Medical Education: A Systematic Review. PLoS ONE 14(8) (2019): e0221412
Little, P. et al, Observation Study of Effect of Patient Centredness, BMJ 323 (2003): 908–11