Compassionomics

Currently, the recommended prescription for burnout in health care workers is “escapism.” Get away. Pull back. Detach. Go on a nature hike. Meditate…or do yoga.

  I get it. Sometimes you just need to get away, and I believe that things that help you relax (like nature hikes or yoga) have their place. But I was not buying that escapism was the answer.

  My intuition, and my twenty years of experience, told me that the true antidote to burnout was not in escaping, but rather at the point of care. After a rigorous systematic review of the biomedical literature, and newly armed with all the scientific data that compassion can be a powerful therapy for the giver, too, I believed the solution was in more human connection, not less. That was my hypothesis.

  So, in searching for recovery from burnout, I did the only thing I knew how to do…I took the “research nerd” approach. I decided to test my hypothesis. I decided to do an experiment—on myself. In this experiment, there was only one study subject: me. I was the “n of 1.”

  I tested the hypothesis that having more compassion for others would transform my experience. I gave patients my forty seconds of compassion. I connected more, not less. I cared more, not less. I leaned in, rather than pulling back.

  And that was when the “fog” of burnout began to lift for me. Being intentional about compassion, and giving others my forty seconds of compassion, changed everything.

  But let’s be clear: You don’t have to be a health care worker to feel burned out. If you are feeling this way, consider testing the compassion hypothesis…for yourself.

  Try your “n of 1” experiment.

  See those in need around you and give them your forty seconds of compassion, every opportunity that you have. See how it transforms your experience.

  But don’t do it because I say so; do it because science says so.

  —Stephen Trzeciak, M.D., TEDxPenn, April 7, 2018

  CONCLUSION:

  “We live in a time when science is validating what humans have known throughout the ages: that compassion is not a luxury; it is a necessity for our well-being, resilience, and survival.”

  —Joan Halifax

  When we started on this journey together, we set out to answer this question: Does compassion really matter?

  In these pages, we have laid out all the evidence: the results of a systematic review of the biomedical literature in which we curated and synthesized the data from more than 1,000 scientific abstracts and more than 250 original science research papers.

  You’ve seen the unmistakable difference that compassion can make.

  Compassion matters—for patients, for patient care, and for those who care for patients.

  After analyzing all of the evidence, we conclude with confidence: compassion matters—for patients, for patient care, and for those who care for patients.

  Compassion matters in not only meaningful ways, but also in measurable ways. Compassionate care is more effective than health care without compassion, by virtue of the fact that human connection confers distinct and measurable benefits.

  Remember that these data are not what we think, nor are they what we believe. Rather, they are what we found. Compassionate care belongs in the domain of evidence-based medicine.

  Compassionomics, therefore, is where the science and the art of medicine converge. There is science in the art of medicine, and the science is strong.

  This journey represents a scientific awakening for us—an awakening to a truth that was right in front of us all along. We see it now. And now, after you have seen all the data, we hope that you, too, are awakened to the true power of compassion.

  If you’ve read this far, it is likely that you already knew in your heart that compassion was powerful. But we never aimed to change your heart; your heart was already in the right place. Rather, in writing this book we aimed to change your mind…to help open your eyes to the scientific basis of what you already know to be the right thing to do.

  And yet, a scientific justification for compassion was never really necessary. Compassion was, and always will be, the right thing to do. It’s about treating patients the way they ought to be treated, the way they want to be treated, and the way we would want to be treated ourselves.

  Still, after seeing all the science behind the power of compassion, we hope that you will be even more inspired to use your compassion at every opportunity you have.

  You are powerful. Science shows that your compassion can be more powerful than you’ve ever dreamed. You don’t have to be board-certified—or even go to medical school or nursing school—to make a critical difference in the lives of others. (Or even in your own life.)

  Way back in Chapter 1, you saw a list of reasons (excuses, really) to justify why health care providers frequently fail to treat patients with compassion. Some people, for example, just don’t see that there’s a problem. But now you know that’s just not true. There’s a compassion crisis in health care.

  Some people say they just don’t have time to be compassionate. But now you know that’s not true either—that it takes, on average, just forty seconds to confer all the benefits that compassion provides. You do, in fact, have time.

  Others say they just don’t know how to be compassionate. It’s not in their nature. But now you understand that compassionate behaviors can be learned. You can learn, if you adopt a “growth mindset” and sincerely try.

  Then there are the burned out health care providers who say they just don’t care anymore; they don’t care enough to show compassion. But you’ve learned that compassion can be so powerful for the giver that using compassion can actually help people begin to care again.

  And finally, there are the health care providers who just don’t believe compassion is that important. They think of compassion as just a “nice to have”, not a science-backed intervention that must never be omitted.

  But you have now reviewed a tidal wave of data on compassion’s effects across a multitude of diseases and conditions. You’ve seen the physiological and psychological benefits, the improvement in patient self-care, and the effects on health care quality and financial sustainability that compassion delivers.

  So any health care provider reading this book should be fresh out of excuses. No one that cares about delivering quality care today has a defensible reason to omit compassion from patient care. Rather, as Dr. Francis Peabody, a distinguished Harvard professor and physician, taught in a landmark JAMA article many decades ago, “The secret of the care of the patient is in caring for the patient.”433

  One last thing: and this is perhaps the most important lesson of the book. It’s so important that we saved it for last.

  Even when compassion can’t “make a difference,” it makes a difference.

  There are many times when compassion won’t be able to change an outcome for patients and their families…when it just can’t alter tragic circumstances. But always remember this: Even when compassion can’t “make a difference,” it makes a difference.

  And that’s why we—or rather, Anthony specifically—wanted to share a very personal experience with just how true this is in the most difficult of times.

  Anthony’s Story434

  When I started medical school, compassion wasn’t explicitly part of our curriculum. It wasn’t the title of any lecture. It wasn’t the answer on any test. And yet, I know that as a student I learned about compassion in the halls and patient rooms of our hospital.

  For instance, in the triage area of our obstetrics (OB) department, I recall very clearly in my mind learning how to care for concerned mothers-to-be. I specifically remember one time that I watched as a concerned mother was waiting anxiously to be evaluated. Through the curtains, she could hear the heartbeat monitors for all the other patients.

  I could see the worry on her face as the OB triage nurse started to do her evaluation. The nurse could tell the patient was concerned, but the nurse was clearly trying to stay upbeat.

  The mother was worried because, even though she was full-term and
the baby was due in a few days, she hadn’t felt the baby move for hours. The nurse was moving the monitor pads around trying to find a heartbeat. It’s not that unusual to have trouble finding a heartbeat, but it just added to the tension and the mother knew it.

  It fed her panic. But the nurse remained calm; her voice soothing.

  The patient looked up at me, but I wasn’t going to go anywhere near those monitor pads. Nothing in my education was going to make me any better at understanding what was going on than the triage nurse. I remember the nurse finally said that she would get the physician, but she didn’t leave before offering some more reassuring words to this mother who was now really starting to worry.

  The physician rolled in the ultrasound machine, introduced herself, and offered the same calming tone. It was somewhere between, “I know this might be really bad,” and, “Everything’s gonna be okay.” It seemed to strike the right balance which was, “You’re in the right place, and you’re going to get the right care, and the right thing’s happening right now.”

  It only took a few seconds before the worst-case scenario was obvious even to me. There was no heartbeat in that fully formed baby. The mother knew the answer was clear to the physician.

  “Is there a heartbeat?” asked the mother.

  The physician gave it to her straight: “There is not a heartbeat.”

  I’ll never forget the absolute sorrow at that moment. I relive that moment over and over again. Because while I had encountered this exact situation as a medical student, in this particular case, everything was alarmingly different.

  In the very same room where I had experienced this situation as a medical student, I was actually now an attending physician.

  And this baby was not just the patient’s baby, but my son.

  And this patient was not just the mother, but my wife.

  And I was not just the person standing there observing, but I was the father and the husband.

  While I had witnessed this scene before, I had never experienced such moments from that perspective. I have relived it hundreds, if not thousands, of times in my mind since, and I cannot tell you how much I still remember and appreciate every small aspect of compassion from everyone involved that day.

  From every carefully chosen word, every supportive inflection and tone, every warm touch or moment of silence in support, the littlest things matter deeply in these situations.

  And not just in the moments when patients first learn of a devastating loss or tragic diagnosis. No, the memories of those moments—and the compassion that was shared then—will be replayed again, and again, and again in all the years to come.

  Their importance is magnified well beyond what caregivers realize. So I try to remember that, not only for the patients that I care for, but also for their families as well.

  Patients and families may not remember your name or your face, but they will never forget the smallest comforts you offered in those moments because they will never forget the memory of what they were feeling.

  —Anthony Mazzarelli, M.D., Annals of Internal Medicine, April 4, 2017

  In such moments of unspeakable pain, let us always remember the enduring words of Kenneth B. Schwartz: Compassion “makes the unbearable bearable.”

  Compassion always matters.

  ACKNOWLEDGMENTS:

  Mutually, we want to express our deep gratitude for all of the people who made this project possible. First, we want to thank all of those that shared their personal stories with us, whether they were ultimately used in these pages or not. The willingness of so many to share heartfelt stories about themselves and their patients not only helped the data come alive but also it inspired us throughout the process of writing the book. Especially, we thank: Kacey Zorzi, Christine Fox, Meredith Johanson, Alann Solina, Mark Angelo, John Baxter, Alexandra Lane, and Jennifer Abraczinskas.

  We also want to thank important pioneers in the field: the late Kenneth B. Schwartz and the Schwartz Center for Compassionate Healthcare, and the late Dr. Arnold P. Gold, Dr. Sandra Gold, and the Arnold P. Gold Foundation. For decades, they have been a guiding light toward more compassionate care in medicine.

  We thank our colleagues at Cooper University Health Care. We are honored to work with such an impressive group of people. They have embraced this project and these concepts from the start, and we are continually impressed with their desire to increase compassionate care. Every day, they reinforce to us that caring makes a difference. In particular, we want to thank the physician and nursing leaders for their dedication to patients and to each other’s success.

  Dr. Ed Viner, mentioned multiple times in these pages, has been (and continues to be) a champion of all of the ideals contained in this book. Thank you Ed for your leadership, and for lighting the spark in us to “science this up.”

  We also thank the Board of Trustees at Cooper University Health Care, particularly our Chairman, George E. Norcross, III. His efforts to revitalize Camden, the city invincible, are a fantastic demonstration of compassion - for an entire community.

  It is rare to find a medical school Dean that is as approachable and supportive as Annette Reboli, MD, the Dean of Cooper Medical School of Rowan University. Dean Reboli has not only been a supporter of this work from the beginning, but she has a deep understanding of these concepts from her own experience as a physician. We believe that the students, trainees, and faculty of CMSRU will be on the forefront of the research, education, and practice of compassionomics in the future, and it will be in large part because of her vision. We truly appreciate all she has done for us.

  We would be remiss if we did not point out how much we appreciate the leadership of Cooper’s CEO for the last six years, Adrienne Kirby, PhD, FACHE. Her influence and guidance has been felt through the entire institution and it has no doubt left a mark on this book.

  We are incredibly grateful for the talents and commitment of Chris Roman, who was with us every step of the way in writing this book, and kept us moving forward and on track. Likewise, we are thankful for the tireless efforts of Jamie Stewart. Jamie not only brought the book to life, but she also had the extra patience needed to work with two science geeks who have never written a book before. We also thank Lindy Sikes, for her excellent work in proofreading and polishing. Many thanks also to Craig Deao, not only for nudging us at the very beginning and helping us believe that we could write a book, but also for keeping an eye on this project through to its completion.

  We are especially grateful for Dr. Brian Roberts, who is the Science Director for our compassion research program at Cooper. In these pages, you read about Brian’s ongoing research on the effects of compassionate care in the Emergency Department. He was an invaluable resource for us, helping us analyze much of the statistics in the studies included in this book. Brian is a brilliant scientist, and undoubtedly in the years to come he will leave an indelible mark on the field of compassion science. At the end of our careers, we predict that our main “claim to fame” will be that we once worked with the famous Dr. Roberts.

  We are grateful for the mentorship and leadership of Dr. Michael Chansky, the Chief of Emergency Medicine at Cooper University Health Care and Chair of Emergency Medicine at Cooper Medical School of Rowan University. It is under Mike’s leadership that such creative and cutting edge ideas and research happen. Much of our compassion science research is occurring in his department. Specifically in that regard, we thank Hope Kilgannon, Chris Jones, Valerie Braz, Lisa Shea, Jeena Moss, and the entire team, for embracing the hypotheses and believing that they must be tested rigorously in order for our work to have the greatest impact.

  It is important to us to acknowledge our appreciation of Dr. Eric Kupersmith, the Chief Physician Executive at Cooper University Health Care. Without Eric’s support and tireless efforts, there is no way we could have considered embarking on this project. Eric is a Jedi Knight when it comes to practicing compassion in physician leadership, and he is a role model for how to approach people with the utmos
t compassion and simultaneously holding them accountable. We suspect that the next book in this arena will likely have his name on it.

  We also thank Dr. Jeffrey Brenner. Jeff’s compassion for the most vulnerable citizens of Camden City led him to groundbreaking health care discoveries that have become a national model for bringing better health to the most at-risk populations. He has served as a resource, sounding board, and mentor to both us for many years. Jeff built the practice that generated some memorable stories contained in this book. He created an environment that was infused with a distinctive kind of caring, and that compassionate culture continues to this day.

  We owe a special debt of gratitude to our colleague Anthony Welch. Anthony not only gave us feedback on an early draft of the book, but he was a tireless advocate in other ways as well. Before coming to Cooper, Anthony had not previously worked in the health care field, but we believe he has found a home in health care where his talents will help countless others in meaningful ways for years to come.

  We also want to thank Stacey Burling of the Philadelphia Inquirer and John Kopp of Philly Voice, for their early “buy in” on compassionomics, and for helping us realize how the message resonates with people.

  There are many others whose help was incredibly valuable to this project, and we are very grateful for their efforts: Tom Rubino, Jennifer Knorr, Maureen Miller, Dina Matthews, Rebecca Smith, Anthony Perno, Jennifer Perno, Jake Gordon, Jason Dravis, Lauren Westwood, Lynne Mahoney, Tasha Wells, Jared Hart, Ben Haney, Greg Stocker, and John McDonald.