Compassionomics

  For each person we have named here, there are many more that have helped in so many ways. We are grateful for all of you.

  Lastly, we are grateful for the hundreds of researchers whose collective studies, some that date back half a century, comprise the message of this book. It is the works of these scholars that opened our eyes to the true power of compassion, and compelled us to tell this story.

  Personal Acknowledgments from Stephen Trzeciak:

  First, I thank my parents, Vi and Walt, for starting me on this journey, and encouraging me and supporting me unconditionally every step of the way.

  I thank Dr. Ed Viner for being an inspiration for this book, and an exemplary role model for compassionate care. It is a tremendous honor to follow in his footsteps as the Chair of Medicine at Cooper, a role that was his for more than two decades. I am very grateful for all the support and encouragement he has given me, and continues to give me.

  I am especially grateful for Dr. Phil Dellinger. He has been not only an amazing mentor and ardent supporter for me over the years, but also a very close friend. I am not sure where I would be today if not for him. Definitely not writing a book, that’s for sure.

  I am so thankful for Dr. Sergio Zanotti, the real Professor. I thank him for his friendship and constant encouragement over the years, and for helping me believe I could do this.

  I also thank Dr. Nitin Puri, who is not only an amazing friend, but also the leader of our group of critical care physicians at Cooper (in which I still practice). Nitin is an inspirational leader who cares deeply about people, and I am very thankful to be one of those people. Nitin is already doing a way better job of leading our critical care team than the guy who did it before him, and I am thankful for that.

  I thank all of the nurses that I have been so fortunate to work alongside in the intensive care unit at Cooper for the past 16 years. They put their hearts and souls into caring for the critically ill. They have been a wellspring of compassion for patients that continues to amaze me to this day. My medical training and textbooks taught me how to treat patients, but these nurses have helped me understand what it really means to take care of patients.

  I owe a special debt of gratitude, one I could not possibly repay, to the patients and families I have had the privilege of caring for in the Cooper ICU over the past 16 years. The lessons they taught me were part of the genesis of this book, and a common thread through all of its pages.

  I am so fortunate to be part of an incredible group of people in the Adult Health Institute (AHI) at Cooper, especially: Pam Ladu, Megan Avila, Sunil Marwaha, Jim Haddock, Karen Kutner, Dan Hyman, Eddie Mahamitra, Mark Angelo, and so many others. Thank you for helping our health care providers give great care. I look forward to collaborating with you to infuse the lessons from compassionomics into everything that we do.

  I am especially thankful for Rebecca Smith, my awesome assistant. I would love to say that Rebecca and I make a great team, but that would be giving me too much credit. She is responsible for so much of our success, and this book would never have come together without her support. In addition, Rebecca shows great kindness to everyone we collaborate with, and that sets a great example for me and the whole AHI team to follow.

  Sometimes people can be instrumental in writing a book just by being early “believers”. To that end, I want to thank Carson Marr and the entire team at TEDx Penn. I wasn’t sure this message would resonate until they believed in it and invited me to share it on the TEDx stage. That experience inspired me to tell this story, and without it, this book may never have happened. Thank you.

  I want to thank another great encourager, my colleague Dr. Dominic Vachon, and the team at the Ruth M. Hillebrand Center for Compassionate Care in Medicine at the University of Notre Dame. I am eternally grateful to my whole Notre Dame family, for always supporting me and encouraging me to dream big.

  There are dozens of people in my church family that have encouraged and supported me through this project, but I especially want to thank: Lorenzo Eagles, Brian Catanella, Dan Wonneberger, Jonathan Miller, Dick Herman, Cal Knowlton, and Stuart Spencer. You guys live the principles of compassionomics every day, and you are amazing role models for me.

  Above all, I am forever grateful for the support of my loving wife Tamara, who is the most compassionate person I have ever known, and who has taught me more about compassion than anyone ever could.

  Lastly, I thank my wonderful children - Christian, Isabel, Bethany, and Jonathan - for inspiring me every day. People will say that this book is written for the health care industry, but the secret of this book is that the message contained in these pages is actually for them.

  —Steve Trzeciak

  Personal Acknowledgments from Anthony Mazzarelli:

  Above all I would like to thank my wife Joanne. I am incredibly lucky to have such a supportive partner and friend. As a practicing cardiologist, she is not only clinically excellent but loved by her patients which made her perfect when I needed her during key moments when I would get stuck or needed advice during the writing process. She is always unbelievably supportive no matter the endeavor, but her particular support on this project, I believe, comes from the fact that she herself is a regular practitioner of the ideas expressed in this book. There were many nights where I’m sure that Joanne just wanted to go to sleep, but I kept her up to listen to an idea for a chapter or to get her opinion on the framing of a story. I sometimes wonder how she is so patient with me.

  I would also like to thank my parents, Joe and Virginia, who have always supported everything I have done with such passion that I have always had no choice but to see things through to the end to make sure the value of their support was fully realized. As my children grow older I wonder how I could ever measure up to be even a fraction of the supportive and loving parent as each of them.

  To my children - Sophia, JP, Leo, and forever in our hearts Joseph - you have all inspired me not only to write this book but to want people to read it. Don’t tell our publisher, but we don’t really care about how many books we sell. We do, however, care deeply about increasing the amount of compassionate care that exists in the world. That’s the world in which I hope you can grow old.

  My most heartfelt thanks goes to Michael Smerconish whose mentorship, guidance, and influence over the years is likely the reason I even participated in writing this book. “You need to write a book,” has been his advice for probably a decade now. In Chapter 1 we postulate that the compassion crisis might be an extension of the decrease of compassion in our society in general as evidenced by the growing polarization among those that identify with political parties. For those that know Michael, you know this is one of his mantras and you may even recognize the data we quote. Michael is the SiriusXM and CNN host that is treating the disease of polarization with data-driven, thoughtful, independent discussion. Since compassion is the desire to take action in response to others pain, he is media’s compassionate host.

  I need to thank TC Scornavacchi since she was the first person I ever showed the book pitch. It was awful. However, she had the compassion to not only give me advice to make it better but to never, not for one second, take the position that it shouldn’t happen. Her encouragement, support, and friendship is enduring and much appreciated. It should come as no surprise to those that know TC that she is the voice for the Audible version of the book. She has the perfect pipes and the perfect personality to convey this message.

  I am very grateful to Rich Zeoli. Not only did Rich read early drafts of the book to offer guidance, but his continual counsel has been invaluable. Rich is a rising star and will soon be a national name. However, that never stops him from remembering his New Jersey roots and to spend whatever time I needed from him for help with this project.

  I also want to thank Sacha Montas, MD, JD, MBE. If you are thinking, “What a nerd with all those degrees,” I completely agree. Sacha is the person that first got me interested in the academic side of medicine many years ago in coll
ege when he introduced me to the world of bioethics. He continues to be the best sounding board a friend can have, and played that same role with respect to this book.

  I would be remiss if I did not give a special thanks to Jennifer Knorr. In the world of executive assistants she has few, if any, equals. Her job would be exponentially easier if she did not choose to show compassion and kindness to others when dealing with them. She has never wavered from this practice, on good days and bad, which I appreciate almost as much as the fact that without her I would be completely lost. She also keeps the train running on time.

  Thank you to the senior leadership team at Cooper. I know how hard you work to serve our patients and our employees, and your desire to have a culture of compassion within our organization. That dedication has also served as a muse for this book.

  I especially want to thank my Co-President, Kevin O’Dowd, who I have the pleasure to work with closely every day. Health care is incredibly tumultuous and unpredictable, so having such a steady, calm, thoughtful, intelligent partner, especially one that excels more than me in all those traits, is incredibly valuable. His belief that the concepts in this book can help us serve patients, providers, and the entire health care system better is particularly inspiring.

  Lastly, I would like to thank all of the past, present, and future patients I have ever been given the privilege to take care of in the Emergency Department. I hope I continue to grow in my journey to provide more compassionate care so that I can serve you better.

  —Anthony Mazzarelli

  REFERENCES:

  1. Lown, B. A., J. Rosen, and J. Marttila. “An Agenda for Improving Compassionate Care: A Survey Shows About Half of Patients Say Such Care Is Missing.” Health Affairs 30, no. 9 (September, 2011): 1772-8.

  2. Burling, Stacey. “Cooper Doctors Study ‘Compassion Crisis’ in Health Care.” Philadelphia Inquirer. March 15, 2018.

  3. Darwin, Charles. The Descent of Man, and Selection in Relation to Sex. London: John Murray, 1871.

  4. Spinrad, Tracy L., and Cynthia A. Stifter. “Toddlers’ Empathy-Related Responding to Distress: Predictions from Negative Emotionality and Maternal Behavior in Infancy.” Infancy 10, no. 2 (2006): 97-121.

  5. Hepach, Robert, Amrisha Vaish, and Michael Tomasello. “Young Children Are Intrinsically Motivated to See Others Helped.” Psychological Science 23, no. 9 (September 1, 2012): 967-72.

  6. Warneken, Felix, and Michael Tomasello. “Helping and Cooperation at 14 Months of Age.” Infancy 11, no. 3 (2007): 271-94.

  7. Goetz, Jennifer L., Dacher Keltner, and Emiliana Simon-Thomas. “Compassion: An Evolutionary Analysis and Empirical Review.” Psychological Bulletin 136, no. 3 (May, 2010): 351-74.

  8. “AMA Principles of Medical Ethics.” 2001, accessed November 12, 2018, https://www.ama-assn.org/about/publications-newsletters/ama-principles-medical-ethics.

  9. “The NHS Consitution for England.” 2015, accessed November 12, 2018, https://www.gov.uk/government/publications/the-nhs-constitution-for-england/the-nhs-constitution-for-england#nhs-values.

  10. Lamm, Claus, Jean Decety, and Tania Singer. “Meta-Analytic Evidence for Common and Distinct Neural Networks Associated with Directly Experienced Pain and Empathy for Pain.” Neuroimage 54, no. 3 (February 1, 2011): 2492-502.

  11. Klimecki, Olga M., Susanne Leiberg, Matthieu Ricard, and Tania Singer. “Differential Pattern of Functional Brain Plasticity after Compassion and Empathy Training.” Social Cognitive and Affective Neuroscience 9, no. 6 (June, 2014): 873-9.

  12. Klimecki, Olga M., Susanne Leiberg, Claus Lamm, and Tania Singer. “Functional Neural Plasticity and Associated Changes in Positive Affect after Compassion Training.” Cerebral Cortex 23, no. 7 (July, 2013): 1552-61.

  13. McNeill, Donald P., Donald A. Morrison, and Henri J. Nouwen. Compassion, a Reflection on the Christian Life. Garden City: Doubleday, 1982.

  14. Trzeciak, Stephen, Brian W. Roberts, and Anthony J. Mazzarelli. “Compassionomics: Hypothesis and Experimental Approach.” Medical Hypotheses 107 (September, 2017): 92-97.

  15. The Local. “Bus Driver Convicted for Deadly Crash.” (2008). Published electronically April 28, 2008.

  16. “Six Dead and Dozens Injured after Two Buses Collide.” 2007, accessed November 10, 2018, https://sverigesradio.se/sida/artikel.aspx?programid=2054&artikel=1226195.

  17. Lennquist, Sten (Ed.). Medical Response to Major Incidents and Disasters: A Practical Guide for All Medical Staff. Berlin: Springer, 2012.

  18. Doohan, Isabelle, and Britt-Inger Saveman. “Need for Compassion in Prehospital and Emergency Care: A Qualitative Study on Bus Crash Survivors’ Experiences.” International Emergency Nursing 23, no. 2 (April, 2015): 115-9.

  19. Graham, David A. “Really, Would You Let Your Daughter Marry a Democrat?” The Atlantic, September 27, 2012.

  20. Davis, Lauren. “Dignity Health Survey Finds Majority of Americans Rate Kindness as Top Factor in Quality Health Care.” news release, November 13, 2013.

  21. Konrath, Sara H., Edward H. O’Brien, and Courtney Hsing. “Changes in Dispositional Empathy in American College Students over Time: A Meta-Analysis.” Personality and Social Psychology Review 15, no. 2 (May, 2011): 180-98.

  22. Making Caring Common Project, “The Children We Mean to Raise: The Real Messages Adults Are Sending About Values,” (Cambridge: Harvard Graduate School of Education, 2014).

  23. Doherty, Carroll, Jocelyn Kiley, and Bridget Johnson. “A Divided and Pessimistic Electorate.” Pew Research Center, 2016.

  24. Darley, John M., and C. Daniel Batson. ““From Jerusalem to Jericho”: A Study of Situational and Dispositional Variables in Helping Behavior.” Journal of Personality and Social Psychology 27, no. 1 (1973): 100-08.

  25. The Schwartz Center for Compassionate Healthcare. “National Survey Data Presented at the Compassion in Action Conference Show Mixed Reactions on State of Compassion in U.S. Healthcare.” news release, June 27, 2017, https://www.prnewswire.com/news-releases/national-survey-data-presented-at-the-compassion-in-action-conference-show-mixed-reactions-on-state-of-compassion-in-us-healthcare-300480125.html.

  26. Bernstein, Lenny. “Once Again, U.S. Has Most Expensive, Least Effective Health Care System in Survey.” The Washington Post, June 16, 2014.

  27. Francis, Robert. “Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry.” London: Department of Health, 2013.

  28. Campbell, Denis. “David Cameron’s Prescription for NHS Failings: Target Pay for Nurses.” The Guardian, February 6, 2013.

  29. Lown, Beth A., Hilary Dunne, Steven J. Muncer, and Raymond Chadwick. “How Important Is Compassionate Healthcare to You? A Comparison of the Perceptions of People in the United States and Ireland.” Journal of Research in Nursing 22, no. 1-2 (2017): 60-69.

  30. Shanafelt, Tait D., Omar Hasan, Lotte N. Dyrbye, Christine Sinsky, Daniel Satele, Jeff Sloan, and Colin P. West. “Changes in Burnout and Satisfaction with Work-Life Balance in Physicians and the General Us Working Population between 2011 and 2014.” Mayo Clinic Proceedings 90, no. 12 (December, 2015): 1600-13.

  31. Soler, Jean Karl, Hakan Yaman, Magdalena Esteva, Frank Dobbs, Radost Spiridonova Asenova, Milica Katic, Zlata Ozvacic, et al. “Burnout in European Family Doctors: The EGPRN Study.” Family Practice 25, no. 4 (August, 2008): 245-65.

  32. Rosen, Ilene M., Phyllis A. Gimotty, Judy A. Shea, and Lisa M. Bellini. “Evolution of Sleep Quantity, Sleep Deprivation, Mood Disturbances, Empathy, and Burnout among Interns.” Academic Medicine 81, no. 1 (January, 2006): 82-5.

  33. Bellini, Lisa M., Michael Baime, and Judy A. Shea. “Variation of Mood and Empathy During Internship.” JAMA 287, no. 23 (June 19, 2002): 3143-6.

  34. Beckman, H. B., and R. M. Frankel. “The Effect of Physician Behavior on the Collection of Data.” Annals of Internal Medicine 101, no. 5 (November, 1984): 692-6.

  35. Marvel, M. K., R. M. Epstein, K. Flowers, and H. B. Beckman. “Soliciting the Patient’s Agenda: Have We Improved?”. JAMA 281, no. 3 (January
20, 1999): 283-7.

  36. Singh Ospina, Naykky, Kari A. Phillips, Rene Rodriguez-Gutierrez, Ana Castaneda-Guarderas, Michael R. Gionfriddo, Megan E. Branda, and Victor M. Montori. “Eliciting the Patient’s Agenda-Secondary Analysis of Recorded Clinical Encounters.” Journal of General Internal Medicine 34, no. 1 (July 2, 2018): 36-40.

  37. Levinson, W., and N. Chaumeton. “Communication between Surgeons and Patients in Routine Office Visits.” Surgery 125, no. 2 (February, 1999): 127-34.

  38. Mendes, Elizabeth. “Americans Down on Congress, OK with Own Representative.” Gallup. Published electronically May 9, 2013.

  39. Kenny, David A., Wernke Veldhuijzen, Trudy van der Weijden, Annie Leblanc, Jocelyn Lockyer, France Legare, and Craig Campbell. “Interpersonal Perception in the Context of Doctor-Patient Relationships: A Dyadic Analysis of Doctor-Patient Communication.” Social Science and Medicine 70, no. 5 (March, 2010): 763-8.

  40. Hall, J. A., T. S. Stein, D. L. Roter, and N. Rieser. “Inaccuracies in Physicians’ Perceptions of Their Patients.” Medical Care 37, no. 11 (November, 1999): 1164-8.

  41. Block, Lauren, Lindsey Hutzler, Robert Habicht, Albert W. Wu, Sanjay V. Desai, Kathryn Novello Silva, Timothy Niessen, Nora Oliver, and Leonard Feldman. “Do Internal Medicine Interns Practice Etiquette-Based Communication? A Critical Look at the Inpatient Encounter.” Journal of Hospital Medicine 8, no. 11 (November, 2013): 631-4.

  42. Davis, David A., Paul E. Mazmanian, Michael Fordis, R. Van Harrison, Kevin E. Thorpe, and Laure Perrier. “Accuracy of Physician Self-Assessment Compared with Observed Measures of Competence: A Systematic Review.” JAMA 296, no. 9 (September, 6 2006): 1094-102.

  43. Weng, Hui-Ching, Hung-Chi Chen, Han-Jung Chen, Kang Lu, and Shin-Yuan Hung. “Doctors’ Emotional Intelligence and the Patient-Doctor Relationship.” Medical Education 42, no. 7 (July, 2008): 703-11.