Which doctor would you pick: a physician who is kind and warm, or one who is cold but graduated at the top of the class in medical school?
A new book makes a strong argument for the ones who are kind and warm, not just because they’re more pleasant, but because they have better patient outcomes.
“Compassionomics: The Revolutionary Scientific Evidence That Caring Makes a Difference,” written by physician-scientist team Stephen Trzeciak and Anthony Mazzarelli, provides overwhelming evidence for the healing power of compassion.
Kindness brings longer, healthier lives not only for patients, the book argues, but also for health-care professionals. When a physician is compassionate, patients heal better and faster, and the doctors are happier and less burned out.
Trzeciak is chair of medicine at New Jersey’s Cooper University Health Care and Cooper Medical School of Rowan University, and Mazzarelli is co-president and associate dean of clinical affairs there. The authors share their research on the art of healing. This conversation has been condensed and edited for clarity.
How do you define compassion?
Trzeciak: Compassion is an emotional response to another’s pain or suffering involving a desire to help. Compassion is often confused with a closely related term, empathy. While empathy is feeling and understanding another’s emotions, compassion also involves taking action.
Mazzarelli: There is neuroscience research using MRI scans to support this. When a person experiences empathy, the pain centers in the brain are activated. But when a person is focused on compassion — the action component of trying to alleviate another’s suffering — a different area of the brain, a “reward” pathway, is activated.
In your book, you show that compassion can increase patients’ healing potential. Please explain.
Trzeciak: About 30 million Americans have diabetes. The estimated health-care costs of this is $327 billion annually. What happens if a health-care provider is compassionate? Research shows that the odds of patients having optimal blood-sugar control is 80 percent higher, even after controlling for age, socioeconomic status and gender. It also shows 41 percent lower odds of serious complications from diabetes.
How? One mechanism is better patient self-care and adherence to their treatment regimen. Research shows that when health-care providers care deeply about patients, and patients feel that, they are more likely to take their medicine.
Mazzarelli: Another example is patients undergoing surgery. Studies show that warm, supportive interactions from either doctors or nurses right before going in for surgery resulted in patients being more calm (with better achievement of adequate sedation) at the start of surgery and a decrease in the need for opiate medication following surgery. Patients also spent less time in the hospital.
Are physicians and nurses aware of how their behavior can affect healing?
Trzeciak: We believe most underestimate the power of compassion. We curated the data from more than 1,000 research abstracts and 250 research papers published in medical journals to answer one question: Does compassion really matter?
When you look at the scientific evidence, you come to realize that compassion matters in not only meaningful ways but also measurable ways.
What advice would you give someone about selecting a physician with compassion?
Mazzarelli: Here are some behaviors to look for in a medical provider:
- Sitting (versus standing) while speaking with you.
- Facing you and making eye contact.
- Caring about your emotional and psychological well-being.
- Stay away from physicians who interrupt patients when they are speaking.
A 2018 study from the Mayo Clinic found that when patients are first describing their main medical concern, physicians interrupt patients within 11 seconds on average.
By the way, researchers have found that patients only need, on average, 29 seconds to fully describe their main concern
Burnout rates are high among health-care providers. You say compassion is also protective for those who care for patients. How and why is this the case?
Mazzarelli: Compassion for others is a positive experience that increases one’s fulfillment in the practice of medicine and builds resilience and resistance to burnout.
Trzeciak: The historical view is that too much compassion may lead to burnout. However, research shows that an inverse relationship actually exists between burnout and compassion among health-care providers.
Health-care systems have financial incentives that are not necessarily aligned with exceptional caring. How do you transform medicine from within given these challenges?
Mazzarelli: Compassion for patients is associated with lower medical expenditures. Patients who feel their primary care doctors practice patient-centered care are less likely to utilize excessive health-care services. They also had lower medical bill charges, by about 50 percent.
Another study explains why this is the case: Patients who receive compassionate care recover more quickly from the symptom that brought them to the doctor, have fewer visits, tests and referrals. The proportion of these patients who are referred to specialists is 59 percent lower, and diagnostic testing is 84 percent lower.
Do people really want compassion from a surgeon? If I’m operated on, I’d prefer the doctor who can do the surgery most expertly rather than the one who is kind to me.
Mazzarelli: Research shows that physicians who are suffering from “depersonalization”— thinking of patients as objects rather than human beings — are prone to making major medical errors. This is also true for surgeons.
In fact, in a Mayo Clinic study of 7,905 United States surgeons, researchers found that over a three-month period, the proportion of surgeons who committed a major surgical error was three times higher among those with the highest levels of depersonalization.
The researchers found that the number one reason for these major surgical errors was a lapse in clinical judgment. Perhaps you should think about that before you go under the knife?