Five keys, three Ts and mindfulness: adding compassion to your practice

October 9, 2019 Jane Coutts

5 keys for doctors to practice with compassion in health care

A kind word, a gentle touch, paying attention: science shows acts of compassion such as these make patients feel better. They also make providers feel better. They even make the beancounters feel better (compassion leads to better care and better outcomes—both of which can save money).

Why, then, is compassion often absent from health care and even actively discouraged?

There seems to be a number of answers to that. For a long time, according to Dr. Stephen Trzeciak,  the developer of compassionomics (more on that later), doctors were told not to get emotionally invested in patients to avoid burnout.

Some writers suggest the common failure to distinguish between compassion and empathy might have undermined support for the latter. Empathy, according to the Canadian Oxford Dictionary, is “the power of identifying oneself mentally (and so fully comprehending) a person.” Compassion, while built on the capacity to empathize “…involves the additional step of wanting to alleviate suffering,” Antonio Fernando and colleagues say in the British Journal of General Practice. Empathy without compassion, they explain, can lead to lingering distress “which may contribute to emotional fatigue and burnout.” A paper by Mills and Chapman says empathy is an awareness of another’s experience but “compassion relates specifically to contexts of suffering and the alleviation of it.”

In the 2017 paper in the Journal of Medical Hypotheses that introduced the concept of compassionomics, Trzeciak and his co-authors Brian Roberts and Anthony Mazzarelli listed benefits of compassion for doctors, patients and the health care system. For physicians, it can help counter emotional strain: “Observational data indicate that health care providers who are able to maintain empathy for patients and consistently practice with compassion have less burnout, more resilience, and superior well-being.”

Compassionate care, they say, is associated with better outcomes for patients in a range of conditions, while a lack of compassion is linked to “lower quality of care and increased risk of harm to patients through medical errors.” It can also increase costs, because providers who don’t establish a human connection with their patients tend to rely more on technology, unnecessary tests and referrals to specialists.

In a paper on the World Economic Forum website, “Compassion: what it is and why it matters in medicine,” two Italian doctors give several examples of studies that show the importance of compassion to patients’ health, doing everything from lowering post-operative pain, increasing survival in lung cancer patients and cutting hospitalization rates for diabetics.

It's important to note, as Trzeciak and his colleagues point out, that most research to date on compassion has been observational. Indeed, that’s why they proposed compassionomics as a field of study—to establish a sound scientific basis for what they and others believe to be true. Their paper calls for formal studies to test interventions designed to increase compassionate behaviour by health care providers, so its impact on outcomes can be measured.

If their hypotheses are confirmed, the authors say, “the results will have immediate and major implications for the landscape of healthcare delivery, including how we select candidates for healthcare provider training, how we train them, and what we value in our health systems.”

Short of volunteering to take part in a randomized controlled trial, what can you do to increase compassion in your own practice?

In the Journal of General Practice Article mentioned above, Fernando (who studies compassion in medical practice at the University of Auckland in New Zealand) describes how external factors—from “toxic, soul-sapping weekend night shifts” to patients’ personalities—can affect compassion. A rude patient, a noisy consultation room, a stubborn illness: all these are likely to short-circuit good intentions. He recommends mindfulness training to help physicians screen out distractions and calm themselves so they can focus on the patient.

“Developing a state of mindfulness may allow health care professionals to more effectively self-regulate emotions, remaining balanced and focused on the present despite interpersonal, clinical, and institutional challenges,” Fernando writes in the Journal of Pain and Symptom Management, adding “Compassion training enhances a practitioner’s ability to 1) be aware of others’ suffering, 2) develop concern for others, 3) wish to relieve that suffering, and 4) be ready to relieve that suffering.”

A systematic review of training for empathy and compassion, published in the journal Public Library of Science, searched for specific skills and behaviour demonstrating compassion that should be taught to medical students. The authors came up with a list of five:

  • Sitting, rather than standing, when talking to patients;
  • Detecting patients’ non-verbal emotional cues;
  • Recognizing and responding to opportunities for compassion;
  • Non-verbal communication of caring (such as making eye contact);
  • Verbal statements of acknowledgment, validation and support.

The Italian doctors writing for the World Economic Forum offer much the same advice, but boiled down. “A good technique for showing compassion is simple: 3 Ts. Talk or listen, take time and touch. Merely taking the time to talk and listen to patients is comforting, as is a doctor’s touch.”

And don’t automatically assume you don’t have the time to be compassionate: Trzeciak told the Philadelphia Inquirer how a video made by Johns Hopkins University changed his practice. It showed how, when doctors took just 40 seconds to say to cancer patients they were on their difficult journey together, the patients’ anxiety was eased. Trzeciak tried giving every patient 40 seconds of compassion. “I connected more. I cared more, not less.”

The science of compassion is in its early stages, but human feelings when faced with illness are as old as time. People want a kind word, a gentle touch and to feel they’re not alone. As it turns out, the power of that connection flows both ways. Compassionate doctors deliver comfort and care to patients while reconnecting themselves with the concerns that drew them to medicine in the first place.

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This material is for informational purposes only. It is not intended to be a substitute for professional medical advice and should not be relied on as health or personal advice. The opinions stated by the authors are made in a personal capacity and do not necessarily reflect those of the Canadian Medical Association and its subsidiaries including Joule.  Feel passionate about physician-led innovation? Please connect with us at jouleinquiries@cma.ca.

About the author

Jane Coutts is an Ottawa-based writer and editor who specializes in healthcare issues. She worked as a journalist for 15 years, mainly at The Globe and Mail, where she was the health policy reporter for five years. Since she founded Coutts Communicates in 2002, Jane’s work has focused on making healthcare policy and research more readable and relevant. Jane also leads workshops plain-language writing.

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