« Freakonomics Radio

444. How Do You Cure a Compassion Crisis?

2020-12-16 | 🔗

Patients in the U.S. healthcare system often feel they’re treated with a lack of empathy. Doctors and nurses have tragically high levels of burnout. Could fixing the first problem solve the second? And does the rest of society need more compassion too?

This is an unofficial transcript meant for reference. Accuracy is not guaranteed.
This podcast dynamically inserts audio advertisements of varying lengths for each download. As a result, the transcription time indexes may be inaccurate.
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bonus? Episodes and you'll be supporting our show to that sticker premium. Dot com promo code freak thanks today episode is really interesting. There are two ways we could start it, but I can't decide which is better one way is nasty and vulgar like this, well. Where are your retirement or we could start with the uplifting story? Like bits, scientists defined compassion as an emotional response to another's pain or suffering involving an authentic desire to help. I don't know I can't make up my mind. What do you think I'd just politically heads for nasty tales uplifting in its tales? Ok, we'll get to the next.
speed up later. So, let's start here, my name is Anthony Mazzarelli, I'm the co president and CEO of Keuka Diversity, health care. The Cooper health system takes in about one point four, billion dollars. In annual revenues were level one trauma centre located our core hospital and came the New Jersey, but we have over a hundred sites. Measuredly doesn't just run the hospital, I'm also a bracket sing, emergency medicine, physician people who oh measuredly column, Mass and mass, is sort of an over achiever during his medical training, for instance at the Euro, two Pennsylvania. I have graduating with medical degree, allow degree and masters in bioethics and then did my rest. see, training in emergency medicine, here a Cooper and have not left Cooper since into doesn't fourteen measuredly was promoted to chief medical officer
and at that time are institution had engaged a consultant. The consultant did what consultants do in suggesting ways for the hospital to strengthen its bottom line. One idea the hospital should focus on improving patient experience. and physician engagement, and there was a list of things to ask our physicians to do which seemed frankly soft things that were kind of motion. Things that I was concerned that I was gonna have to I getting get in and fifty five hundred faculty members to have trouble getting do some of these mushy things had to do with the relationship between doctors and patients mass realise at most of what is being asked to do, was to get doctor to show more compassion. Now you might
whom that most people who choose medicine as a profession do so in part because they are compassionate or at least that their talk compassion during med school. If that's the case, Where does it go? Does compassion somehow evaporate overtime if so, Was there a viable way to increase it and can compare shouldn't even be measured before doing anything? What mass needed was some research so I turned to our number one and age funded researcher, the person with the most people patient, the most and age dollars. I've been a Cooper for seventeen years and it was these Steve Trees, yak trees. Yet is the chairman and chief of the Department of Medicine at Cooper and also more research nerd and about though a practising intensive as a specialist in intensive care medicine, so you're too doc. There's one specializing in intensive care, the other in May. urgency, medicine who, between them
we did thousands of people who each having one of the worst days of their lives? So I never doubted that compassion was essential and I dont know anyone of care that feels otherwise, or at least no one. That would admit to it. It's what we ought to do. The way we ought to treat patients but does it actually move the needle on outcomes in a measurable way? That's what I was sceptical about, but remember the consultants the hospital brought in did want that needle moved measuredly was willing to consider the dose of compassion might be worthwhile, so he reached out two trees, yak and sat with them and said Stephen. You see, this up for me. Can you look the data Hemison. He said no you're crazy. I don't want to be part of this. This is most This is not what I do and the hard science guy isn't it, but you said Steve areas, but that's because, didn't know there was such hard science available. How much time did you think you'd have
the waste and masses silly? We idea. Well, it didn't take long before I start to see them beginning of the signal on the data and that's when everything started to resonate, which, Jack was seeing in the data resonated with something else that was happening in his life. Ere. I sort of had an existential crisis like what am I gonna do with my career, so I just want to be clear about one thing I was not, in the market for any sort of a scientific awakening. My research programme was hitting every metric for six as we were publishing and some of the best journals. Everything was fine right, but then I had this question that was put to me. he doesn't mean the question from as the question came from my son, trees. Yak son was twelve years old. The question actually came from us. All homework assignment. The question was: what is the most pressing problem of our time? Trees yet talked over. These
I mean with his son, but then on his own. He kept thinking about the question and how it applied him. I knew that the research that I was working on was a very important but I also knew that it wasn't the most pressing problem of our time and I'm not old, but I'm too old to work on things that dont really matter. It led me to search for what is the most pressing problem of our time and after couple we digging around in this seemingly mushy research project that measuredly put em on he knew he'd found it. What he considered the most pressing problem of our time, at least in his field what I found in the data and also just looking around at health care. What I see is that we have a compassion crisis. You can either believe it. Man errors or it doesn't matter, but if it matters, how does it matter? How does it affect people? How does it affect health care? How does it affect the economics of health care? How does affect health care for
writers and burn out trees? Yakima really wound up writing a book that tries to answer these questions. It is called compassion. Comics. the revolutionary scientific evidence that carrying makes a difference, they and economics radio? How strong is evidence? How has the pandemic change the equation and is it does the healthcare system, where we need more compassion, I'm happy from stature and dubner productions. This is Freakonomics radio. The podcast explores the hidden side of everything. Here's your host Stephen Dubner
Ok, let's start by revisiting that definition of compassion, Stephen Trees. Yak again, scientists defined compassion as an emotional response to another's pain or suffering, involving an authentic desire to help. That sounds like exactly what you're setting out to do. If you become a nurse order, Practitioner physician assistant bore a physician and the hypothesis is compassion matters. We do Just mean it compassion matters in a moral or ethical or sentimental sense. We wanted to test the hypothesis that compassion matters in measurable ways for patients and for those who care for patients. here's one data point, but trees, Yakima israeli site in compassion, comics, when patients Sir asked what they consider extremely important traits in a doctor, eighty five per
then say yes to being treated with dignity and respect only twenty seven percent ceiling want them trained and one of the best medical schools. Only fifty eight percent say, has a lot of experience Anthony measuredly again, please, didn't want these factors that are or on the spectrum of empathy and compassion. So we do want to be crystal clear about once, the number one driver of clinical outcomes is clinical excellence, if you're a surgeon and you bought the surgery or, if you're, a physician, prescribes the wrong medication, there is no amount of compassion, that's gonna, that it's not an either or it's an ant, so it's compassion and clinical excellence that produce the best clinical outcomes. When you're going Look at data about the value and effect of compassion and medical care, How do you search for their I'm guessing? Compare
Action is not a key word in all these medical studies. Yes, a great question because you can look up pneumonia in pubs? Mad pub met is the equivalent of Google and look at them, you'll get every article in the pneumonia. If you were to look up compassion, or empathy. You will not necessarily get every article, so we had to do something which was essentially the equivalent of the dewy decimal system. We had to go back and do a systematic review of a reference of references, approach, Pool Arthur rules and then read all of those references and then read the references of those articles in the wreck. Suppose articles and keep doing that like a giant tree? That's why it took a couple years to do. so rather than seeking out empirical evidence on compassion per se, measuredly trees, yak organizer researcher and a set of characteristics that make up what is called patient centred care. These include
kindness, empathy, warmth, pretty much anything that shows doctors being nice to their patients of the research it looked at involved. Ten questions survey called the care measure. Patients are questions like how well did the doktor do at making you feel at ease how well the duck do it fully understanding your concerns at showing care, compassion at making a plan of action with you. In seeking out evidence on patient centred care, measuredly entries, Yak wound up reviewing two hundred and eighty one research articles that form what they saw as a collage of evidence about the power of compassion. Before We hear your argument and your evidence for The argument, let me just ask how persuaded are you that you're right, because I could imagine that we could identify benefits of compassionate care, but it may
be that you know doctors show more compassion to patients who are more compliant. So how persuaded argue that the owl comes are not driven by something else, whether observable or unobserved, able, while Stevie snapped a correct me a lot. on this, because I am a lawyer also he would we say to me. Look we're not making arguments were testing hypothesis, he would say we need to be equally open. That compassion isn't something they is measurable and meaningful right. So it's important to recognise the difference between association and causation and causation can only be inferred from certain study designs. But what is really compelling and to specifically gets your question when you push all the data together and you see it all curated, essentially, for the first time, this signal is so consistent across the studies that it really doesn't make a whole lot of sense
to conclude anything else, summits here are some of the evidence: the trees yak, an Israeli compiled sure. So, first, it's important to think about mechanisms There are many broad categories by which compassion for patients can be beneficial, and the first is physiological compassion for patients. can actually modulate a patient's perception of pain. It can have immune system effects there, also endocrine effects, which means in patients with diabetes. There is evidence that they are better blow glucose control and fewer complications when their treated with compassion on a regular basis. There is also broadly psychological effects so compassion for patients can reduce symptoms of depression, reduce symptoms of anxiety, reduce emotional dis, grass associated with somatic illnesses like having cancer,
those are some amazing and amazingly concrete claims for something that both trees, yet an Mazur suspected, might be mushy. So, let's interrogate this evidence. Consider transacts first claim passion for patients can actually modulate a patient's perception of pain. How did they reach that conclusion? There book site several research papers that take a variety of approaches. One was a randomize controlled trial than at Harvard Medical School with patients suffering from irritable, bowel syndrome. Found that compassionate care, for instance, a doctor's simply saying I can understand how difficult abs is for you. This lead patients to report significantly higher rates of symptom relief Another study, this one from Michigan State University. Also, you randomized experiment. That's the Good NEWS. The bad news is the subject pool with tiny, just nine patients. In any case these
nine patients were recruited from the waiting room of primary care clinic and random, We divided into two groups. The control group got their standard visit with the doktor. The treatment group got the compassionate version with the doktor engaging in warm conversation trying to make the patient feel at ease and encouraging follow up questions afterward the rest, it has put all nine patients in an MRI machine in order to measure their brain activity. Each patient was Then, given a painful stimulus, while being shown an image of the doktor who seeing them the treatment group, that is the patients who received the compassionate care. Should forty seven, percent less activation in the region, the brain known for experiencing pain. Again, it's a small study and MRI evidence is hardly perfect, but still this type of study has persuaded trees yak, the compassion can indeed modulate pain.
I didn't say, eliminate pain but attenuate pain or ones. Experiences and one of the mechanisms by which this happens. One of many potential mechanisms by which compassion can modulate their pain is the release of endorphins. So when endorphins are circulating, they are essentially natural opiates trees. Yak also believed that compassion creates trust between patient in doktor. In many ways, the touch of a trusted other can reduce experience of pain. A study from the University of Haifa in Israel, for instance, gave people a painful stimulus while holding the hand of either a stranger or loved holding the strangers hand, didn't lessen the pain at all, but people reported a fifty percent reduction in pain while holding the loved ones hand, there's other research showing broader claims about human connection,
there is evidence that human connection also modulator, can a fact ones, autonomic nerve. systems are the autonomic nervous system? Is the part of the nervous system that does everything that you don't have to think of like controlling your heart rate and your cartier respiratory system trees yet points evidence. The compassion also affects wits, known as the parasympathetic nervous system. This can boost the flow of oxytocin molecule known as the trust hormone. Now. These physiological benefits of compassion are to me at least quite surprising. Somewhat less surprising are the reported psychological benefits. that's probably intuitive, to some extent that treating someone with compassion can help their mental health. But we have also seeing this and a study that we recently published here at Cooper. This study was by Brian Roberts, an emergency medicine, Doktor Brian.
A study on the effects of compassion and the subsequent development of Peter, Yes, the post, traumatic stress disorder. He was studying people whose PTSD didn't come from, war or some traumatic loss. It came from spending time in the hospital, so approximately one third of patients that go through the experience of critical illness in an ice. You end up making diagnostic criteria for PTSD at thirty days. Even if you just come to the e r with a life threatening medical emergency twenty five percent of those patients and making diagnostic criterion. PTSD a thirty days, here's the hypothesis brine Roberts wanted to explore. The
Treating e r- and I see you, patients with more compassion, might decrease the prevalence of PTSD at what he found was that more compassion from the patient's perspective was associated with lower development of eighty as the thirty day, so perhaps compassion for people, while they're going through terrify medical emergencies actually help them with their psychological effects down the road. So I mentioned this compassion. Comics idea to one doktor friend of mine he's a a gastrointestinal, just specialty, Cancer carries bleak fifties early sixties and he pushed back in the following way. He said that doctors, like him, used to practice lots of compassion because he said there wasn't much else they could do when someone was diagnosed with cancer and now that there are so many more treatment options that he'd rather deliver a lot of science than bunch of compassion. So there is an opportunity. Cost argument to this right,
for if we're gonna spend a lot of time, teaching Andorra focusing on these kind of softer skills? Does the science suffer compassion actually takes? almost no time like less than a minute. There was a randomize control trial from Johns Hopkins in a cancer population and in the primary out Measure was anxiety if you have cancer or somebody close to you as you know that anxieties pretty import and what they found is that the compassionate care at a significantly better, in fact on the patients anxiety level. But what was most striking is that it only took forty seconds for the intervention and we found five other studies which show that it is less than a minute, and some people would argue there. It be no time dimension at all, because it doesn't take any extra time to treat somebody with compassion that big, a fair response back might be, Ok, fine! You found five studies as less than a minute by your opening yourself up,
to a ton more questioned your opening self up to a much longer visit, but that's also been studied There is no significant increase in the total length of time that people spend again. I think that the problem that it is sometimes very hard in medicine to take on. New paradigm shift, say it's hard for medicine to take on a paradigm shift. That is an understatement. The history of medicine is replete with innovations. Years sometimes decades to work their way into the mainstream hand. Hygiene, for instance, is basic that now seat medicine is a difficult enterprise, complicated one and in many ways a conservative one with good reason? Remember: first, do no harm so
imagine you are hospital administrator and some researcher comes in your office preaching the virtues of compassion. It has demonstrable physiology. vehicle in psychological benefits. They tell you it doesn't take much time or effort. They tell you, bad enough to convince you to round up all your doctors and tell them, on top of it anything else there doing that they also need to show more compassion to their patients. Maybe, but if not, What if that researcher also tells you that compassion will save you a lot of money You pay more attention now so compassion, creased revenue and decrease costs. How can compassion, increase revenues, there's patient. Who will pay more for that? We have been about hospitals that have higher margins that have better patient experience. That's true. According to data collected by federal survey of hospital patients,
and hospitals that perform well on. The survey are also reimbursed at a higher rate by the centres for Medicare Medicaid services, but it's the decreasing costs that, I think, is the most interesting. There is consistent evidence that when you care deeply for patients- and they know that there are more likely to take their medicine. and non adherence to medical therapy in the? U s alone, accounts for us. More between a hundred and two hundred and eighty billion dollars of avoidable downstream healthcare costs than if compassion is something that can help people be moored here, even as capturing a fraction of that it decrease cost in a healthcare system which is approaching nineteen percent of the GDP? That's one way it can decrease, us another way is in studies where there's really patient centred care. The proportion of patients who were referred to specialists was fifty nine percent
flower. While those who underwent diagnostic testing was eighty four percent lower, I can see how fewer referrals to specialists and less strict testing would certainly lower costs. But how do we know that those lower costs are in at the expense of better outcomes, because obviously some referrals in some tests are necessary? He said there's a whole section in the book dedicated to the data on quality of care, and we ve found associations in the data between more caring and fewer errors, and many of us and Healthcare Ben exposed folks, and fortunately, there are few and far between who maybe care as much as we think they ought to or they once did, or they once did right. If their burned out.
If you go to medical coverage, there is one thing that is drowning out just about every other topic, that's being discussed, and that's a topic of burnt out they among healthcare providers. Indeed, the World Health Organization recently added burn out to its international classification of disease, not as a medical condition, but an ox occasional phenomenon. Plainly, medicine isn't the only occupation were burned out can happen, but, as will here after the break, it is rising the common among doctors, so, This have to do with compassion, we'll find out. along with some potential solutions, that's right after this. reckon radio sponsored by cell on Amazon when,
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chipped items only excludes oversized and freight items restrictions applied, Anthony Measuredly and Stephen Trees, yak our doctors and administrators at Cooper, University, health care in camp in New Jersey. That's just across the Delaware River from Philadelphia. They have co, authored a book called compassion on X, It argues that when doctors treat their patients with compassion, it improves met the outcomes and reduces costs. But there is a problem: There is a compassion crisis in health care. How can that be? How can the most caring of caring professions be lacking in compassion before we get into the causes? Would you like an example? Of course you would
Remember the beginning of this episode. I mentioned a certain nasty and vulgar incident. Let me just pause here to emphasise that this example is not representative of most healthcare professionals. Most people who get into medicine do so because they want to help people. They take a vow to uphold a standard, but occasionally that standard, is filing into doesn't. Thirteen, for instance, a man went to have a common ass could be and a medical facility and rest in Virginia. There was the guy student ravages to perform the procedure and address these geologists and medical system, the patient plan to record the doctors instructions on his phone once the calm ask me was over, but he accidently recorded all procedure from his nervous questions before things got started.
the doctors talking about him once he was anesthetize, they start talking about an earlier problem. The patient had Annabelle rash most finding out about it. After all, before and I don't care, in case, you can catch up the end these Ya'Ll just says one then, these things about being in Annexes Ya'Ll just is making people shut the hell up, and then she continues alternately talking to her colleagues and the nest. The ties patient reminder five minutes to talk to you and I wanted to punch you in the face and you up a little bit.
Was, so you'll think smile so we penis Ebola. She sets, which is not the thing, then She says she's going to enter hemorrhoids on the patients chart. Even though we don't see them and probably won't, even though we don't see them and probably want this patient after waking up and hearing the phone recording sued, the doctors, the gastro interest was ultimately dismissed from the case, but
the anesthesiologist and her practice were ordered to pay a half million dollars and damages again. This is just one incident and an egregious example for sure but if you want to make an argument for the lack of compassion in health care, it's a good example. On the other hand, if you want to make an argument, having compassion can save you money as has really intrigues. Yak argue you can use this lawsuit as an exam people were, the lack of compassion can be very expensive, and yet they say there is still a huge deficit in compassionate care. Here's trees yet again that data suggest that physicians specifically miss approximately sixty to ninety percent. of opportunities to respond to patients with compassion. Give me a simple example of a physician failing to exercise compassion. Let's start with the most basic.
recent data from the male clinic show that physicians will interrupt patients in this men of their main, concern at the eleven second mark. That's media in time to first interruption, so patients may not even get to fully exploit the main concern that they have. This kind of problem is driven in large part by how doctors are compensated, as you likely now our health care system tends to put more value on procedures and tests, then, conversation or prevention. This is hard for doctors themselves. Many of them are frustrated that their profession, long viewed as a calling has become so transactional, but there also appears to be perception. Gap between physicians impatience, consider a survey done by the short centre for compassionate Healthcare, which included eight.
Andrea, recently, hospitalized patients and more than five hundred doctors. When asked. If most healthcare professionals provide compassionate care, seventy eight percent- the doctors- said yes for patients. That number, which is fifty four percent, so that data- and there are other data corroborated- show quite clearly that many of our health care providers can have a blind spot with respect to how, while their connecting with their patients, we are thinking that work, providing them with the emotional support that they need, but the data show that that's not what were actually do every what's missing in this equation. It appears to be empathy. Yes, empathy.
Is a human capacity that allows us to perceive process and respond to others, emotional states, but Helen Reese. She is a Harvard psychiatrist who also practices at Massachusetts. General Hospital, where she directs a programme, does empathy, research, and training. There have been many studies, both in medical students and in Prague, sing physicians, that diamonds, there is definitely a deficit and empathy and compassion but say on a scale of one to ten. What is the median american doctors, empathy level sands about foreign fool, that's discouraging! Isn't it, I think so, and it's not to blame the doctors. I just think that our system right now is working to get the outcome that we are seeing the first of all Medicine has become a business and whereas
you used to have time to get to know patience and to really for relationships. It's much more about who put now how many people you can squeeze into afternoon means tentatives are much higher to see somebody for twenty minutes to just prescribe their medicine than to see them as a whole person. Reese argues This scenario is a big driver of physician burn out. How is that defined burn out his defined when You things are happening called a personalization where patients are seen more like as a number or a diagnosis one on a list instead of like real people, the sense of deep east effectiveness. It is feeling like no matter how hard I work, I just don't really feel like I'm doing a good job. Emotional, exhaustion last year
National Academy of Medicine, publisher report, putting the rate of physician burn out in the? U S between forty and fifty four percent, that's roughly double the burn out rate among workers and other fields, even after controlling for hours and other factors. It's also estimated that the rate of physicians suicide is double that of the general population between three and four hundred doctors each year in the general population, there are many attempts by when first patients decide they have had enough. They know how to end their lives and they have what's called a successful outcome. Courses couldn't before from the truth, as bad as physician burn out has been, in recent years covered made it worse. A recent meds Gabe survey found that two thirds of the doctors who responded said their burn out symptoms had intensified during pandemic, a quarter of Instead, they are considering early retirement in part because their income is falling
nurses are also thought, have very high rates of Byrne, how, although frustratingly there's less data on nurses and the law? Data on your suicide is even worse. Among doctors, burnout is known to start early its estimated that forty four percent of medical students suffer from burn out before they even make. did the residency. I talk to medical students and residents all the time and they say when I chose the profession. I thought I'd be spending most of the time with patients, but the average residents spent about twelve minutes a day with their patient. The rest of the time is all work done through the computer. This is a complaint we ve before, on the show, from a to go at this point, a glorified data entry, clerk and go on day is among the most prominent physicians in America, a surgeon, public health risks, picture and best selling author, I spend more time
Indeed, entry in my Since then, I do seeing my patients and that's just broken if people are feeling exhausted, disconnected from the reason that brought them to the profession and they're, not feeling very effective in their jobs. Their morale is going to decay, and cynicism can start to creep in, there is a cult novel published in eighteen. Seventy eight called the House of God, which is still popular among medical students. It follows a group of first year residence at work in the hospital, the House of God, as their name for the hospital itself. Here's one passage before the house God, I loved old people, now they were no longer old people. They were gomes. Gomer is doctor, slang forget,
out of my emergency room. The passage continues, I did not, could not love them anymore. I struggled to rest and cannot, and I struggled to love and cannot for I'm all each doubt like a man's shirt wash too many times when I started Mega school give hash. It wasn't a part of the curriculum, Anthony measure oh he again, it wasn't a title have any lecture. It wasn't on any test and Stephen Trees, yet classically the teaching in medical education, and this wasn't taught as part of the formal curriculum. This is just what you pick it from your peers, there's this thinking that don't get too close to patients, because that could make you around to getting better that treaty acts. The current medical school curricula are more likely to focus on empathy and compassion. He says: there's no
stably standard for this kind of training. Nor is it likely to be evidence based, but at least the air was moving in the right direction. Also, these new technology, like virtual reality to help medical students, learn to interact patients here again is the psychiatrist. Helen Reese. There was a company that made this wrist device, helped you experience what it was like to have park and cynicism and when I tried it and I couldn't even hold a pen. I realize I had no idea how hard it would even be too right, thing or zip up your jacket and in instantly gave me more empathy for people can't control their movements some years back, Reese cofounded, a company called empathetic, looks you is live and virtual sessions to teach anyone, but mainly healthcare workers. How to be more empathetic. Empathy is how
Oh, we perceive the emotional states of others and that gets mapped onto our brain. So empathy is needed in order to show compassion. So how does this translates into advice for doctors? Empathy is in part a shared experience, and so, if you Patient is really worried about something and you're sitting there flat line you're, not catching any of the emotion and we're not suggesting that you get it just is upset. Is the patient but there should be a change in your physiology when something very emotionally charged is happening, and that's why, if doctors, looking at computer screens and not catching a facial expression and they're, not really hearing it in the tone of voice. They can miss something. That's extremely important to the patient Reese herself designed the programme that empathetic uses to teach empathy.
on a walk in the woods one day. A kind of came to me that the word empathy could act as an acronym all seven ways that we connect. Ok, let's start with IE there first way that we can act with, you buddy is through eye contact. That says, I see you, you exist, and it goes back, as early is mother infant bonding that a child knows they exist through the gaze of the mother was holding them and oxytocin is released when people gazed at one another in bonds, people and in health care people feel a free, aids, small and vulnerable. That gaze actually means a lot. The next letter is four muscles of facial expression and had he use that, because there,
no f in empathy. First phase, it's fair there our muscles in the face. Well, they are which our expression, so it works. The idea here is that our facial- Russians, usually mimic someone else's concern or sorrow. The p increases. Acronym is for posture or body language. A is for affect the tea is for tone of voice. The h is for hearing the pace, the entire patient in medicine it so easy to focus on the injured body, part the pancreas said as abnormalities or the heart. That's got a murmur, but we ve got a back up and realise that His body parts are attached to a person and only carry about how your wound is healing is not going to make that patient feel very cared about, even though you ve done a brilliant surgery, and that leaves us with the. Why,
the. Why is the most interesting one of all, and that is your wrist bonds, and it's not. What you say next year response is your feeling of being with that person, because most feelings or mutual any you're feeling good after an interaction chances are the other person is too, but it you're feeling a little like something. Tilted there. We encourage taking some moments to reflect back on what has happened and ask yourself was I wrapped did I seem rushed? Did I cut the person? did I not answer their questions like when things are off. We should not just move on and say: oh well, because often times it's that gap, Will you kindly know something was quite right,
Helen Rhesus argument is that if you want to increase compassion among doctors and other healthcare personnel, you have to start with empathy and that these the prerequisite and if the empathy doesn't come, naturally or if it gets Reached away over time, and if people have to be taught to exhibit empathy, will that's what needs to happen and there's one more reason why it needs to happen. This is the most rare. Ethical argument that Stephen Trees, Yak and Anthony Mass make in their book compassionate mix all that stuff about how compassion is good for patients, both physiologically and psychologically. That's not so radical.
all the evidence that physician burn out is a huge problem, also not so radical. Here's. The radical proposal, compassion is not a one way street its benefits, a crew not only to patients, they argue, but to doctors and nurses is well compassion, in other words, will heal the healers. Several studies have linked compassion or empathy to lower levels of burn out. It's really hard for studies like that to prove causation, but researchers have documented physiological benefits of despair.
Sing compassion. Sometimes it's called the helpers high, driven, perhaps by a spike in endorphins. Dispensing compassion can also activate the parasympathetic nervous system, which produces a calming effect compassion. The thing that doctors need to show is the very thing that doctors need. That, at least, is the argument put forth by transaction measuredly. The preponderance of evidence shows that there is an inverse association between compassion and burn out, so more compassion, lower burn out, lower compassion, higher burn out healthcare providers who have lower compassion for patients are more predisposed to getting burned out under the same amount of stress. So we believe that having a fulfilling doctor, patient relationship or a nurse patient relationship gives you that fulfilling part of medicine, and if you don't have that.
Then it's just one stress after another. soon after trees. Yakima israeli begin to focus on the science of compassion. They started a program at Cooper, health system, two mentor physicians on how to connect and communicate with patients measuredly reports at the hospital has since made improvements every year in patient satisfaction, physician, engagement and financial performance although measuredly, true to what he has learned during his compassion on its journey, was careful to know that quota. Of course, we can only report Association rather than definitive causation from these data let me ask you, since you were the sceptic coming in Steve, I'm really curious, know what kind of effect this work the research in writing the book and trying to put into practice what kind of effect
that's had on you personally and or professionally sure. So, after going through, all of the data and specifically seeing the signal that compassion can be beneficial for the giver too. That really left an indelible mark on me because after twenty years of working in an I, you and me the people on the worst day of their life? I came to the realisation that I had every symptom burn out. Every single on, and I assure you that's not a good place to be so having just synthesized all the evidence. It compassion can be beneficial for the giver too. I decided to do an experiment I myself and I tried very hard- and I still do to this day, working to connect with people more, not less. It's not only the patients for me, it's their families, many of my patients or so sick. They can. They can't talk on a ventilator
for example, by connecting more, not less leaning in rather than pulling back, and for me that was when the fog burn out began to lift and you also realise that you can get better at compassion- they can be taught, it can be learned, and you have to be very intentional in practice: yet every day, can you give me an example, or two of some that you say that you wouldn't have said, or maybe it's something that you say differently- that the way you you touch so one that you may not have touched before. Is it term eye contact? Actually, it's not some. thing that I say oftentimes is something that I dont say it's just being present at practice: critical care, and there are a lot of times when the outcome is not something that can be changed and sometimes you just need to sit with people in their suffering. You're, not gonna, go Through this alone, I am here with you in fact, just in the ice recently. I had to give essentially
news to a woman whose brother was fighting for his life. We still hopeful that he could recover, but he was so severe that it was very likely that he might not enemies devastating to her because he had been her rock throughout her whole life and at the and that discussion she said you don't remember me, do you and I I'm sorry, I don't, and she said. I wouldn't think that you would you see so many patients here. I it's ok, but eight years ago my mom was in that room right across the hall there and you were her doctor and we had to have this talk, and you had to tell me that she was dying and there's nothing we can do for her and what she remembered was the nurses and the fact She never felt alone. To that whole experience shows that the kindness of your nurses and how they helped me through that she said it keeps coming back to me. It comes back to me all the time I think,
about that because it was so hard at the time, but every time I think about it. I think about that. I of those nurses and so going back to what We talk about earlier, even other Four two hundred and eighty one references in this book of original science research papers that show compassion matters. Even when I can't make a difference on the outcome. It still makes a difference maybe it's too much to ask at this moment, but would have been nice if the science of compassion could perhaps be spread around throughout society, not just confined to medicine, if the people who receive empathy and compassion or left better off, and if the people who dispense it are also left better off I cannot see any reason to be stingy with it. Just a thought do with it. What you will I will leave you today with the sign off we ve been using since early in the pandemic. It's a sign,
I now realise that indicates my own appetite for the more compassion all around it goes like this, we'll be back next week until then take care of yourself, and if you can someone else too, economics. Radio is produced by stature and w productions we can be read. That radio at for economics dot com. This episode was by Morgan Levy, our staff also includes Alison Craig low Mark Mccluskey Gregg Ribbon Zack Le Pen, Ski Daphne Chen married to do in that area are in turn, is immaterial than we had hoped this week from Jasmine, cleaner
Our theme song is MR fortune by the hitchhikers. All the other music was composed by Willy scare. You can get free connivance radio on any pod guessed at if you'd, like the entire back, catalogued use sticker at or go to, free cannot stop com where we also published transcripts and show notes. As always, ready books art, and we we slaved or every word, but not the dedication. That was very easy for us to write and we did it Here, too, all the nurses we ve ever worked with, because Stephen, I feel That's where we learned a lot about providing compassion, stature. your health first Cooper University Healthcare. That's our aim Our doors are open. In fact they never closed
the world has changed when you visited Cooper Office, so things may be a little different new safety, place, but our medical, for its commitment to putting your health first remains unchanged, your health is important to us, so delay your health care offices are safe because we put your health first, Cooper University Healthcare?
Transcript generated on 2020-12-18.