AFFIRM’s firearm injury reduction mission at the Aspen Institute is rooted in compassion for others, not only for victims of firearm injuries, but also for those at risk of becoming its victims. authors.
One of AFFIRM’s explicit goals is to employ evidence-based practices, and we think this begs the question: does compassion really matter? Sure, compassion is a cornerstone of the art of medicine, but do evidence-based effects of compassion belong in medical science?
Compassion is the emotional response to another’s pain and suffering with a genuine desire to help. (psychological bull. 2010;136:351; https://bit.ly/3CxF9uO.) It is distinct from empathy, which is about understanding and acting on the pain and suffering of others: empathy and action equal compassion.
We set out to investigate the scientific evidence for compassion in medicine, not ethically or emotionally, but through the prism of science. We have organized data from over 1000 scientific abstracts and over 250 original scientific research papers into our book, Compassionomics: groundbreaking scientific proof that caring makes a difference. (Studer Group: Pensacola, FL 2019.)
Loss of compassion
A first important question: Do we have a problem? Research shows an erosion of the relationship between those who provide health care and their patients, particularly a loss of compassion. Nearly half of Americans think health care providers are unsympathetic. (Health Affairs [Millwood]. 2011;30:1772.) Studies in all specialties have reported that physicians miss most opportunities to respond to patients with compassion. (JAMA. 2000;284:1021; https://bit.ly/3lGCw2H.) Research finds that a third of physicians are so burnt out that they suffer from depersonalization, an inability to make a personal connection. (Mayo ClinProc. 2015;90:1600.) This can result in insensitive or indifferent behavior.
This crisis of compassion has prompted us to analyze the scientific data on the effects of compassion on patients, patient care and caregivers. Is compassion just nice to have in patient care or is it part of evidence-based medicine?
We found that compassionate care coupled with clinical excellence was associated with better outcomes for many conditions, including the common cold, migraines, chronic low back pain and diabetes. How? ‘Or’ What? Human connection can modulate physiology, such as stress-mediated illness, immune response, and a patient’s experience of pain. Compassion can also improve outcomes through improved self-care for the patient, such as better adherence to treatment. (J Am Board Fam Med. 2013;26:40.) When healthcare providers care deeply about patients, patients are more likely to follow doctors’ advice, including adherence to treatment recommendations. (J Gen Med Intern. 2006;21:661; https://bit.ly/3nQe9Cl.) A randomized trial also found that compassionate care reduced repeat emergency room visits in homeless patients. (Lancet. 1995;345:1131.)
Compassion can also improve psychological outcomes for patients, relieving anxiety, depression, and emotional distress from serious illness. Preliminary research from our group shows that nearly a third of survivors of a life-threatening medical emergency due to respiratory failure later developed post-traumatic stress disorder (PTSD), and the compassion of caregivers in the emergency room was associated with a significantly lower rate of development of these symptoms. (Medical intensive care. 2019;45:815.)
This may be the result of the reduction in fear and psychological trauma of patients. Communicating with patients at such a crucial time in their lives can have lasting effects. Research shows that years after a life-threatening emergency, patients remember vividly how they felt, and the compassion (or lack thereof) of a caregiver is one of the most salient memories. (Int. Emergency Nurses. 2015;23:115.) Compassion matters not only significantly, but also measurably, and its benefits not only have a measurable beneficial effect for patients, but also for caregivers.
Most evidence supports an inverse association between compassion and burnout. (Burn Res. 2017;6:18; https://bit.ly/3zlaa2Y.) These data do not allow us to directly infer cause and effect, but suggest that compassion may be protective. Connecting with compassion and the meaningful relationships that come with it can be a positive and fulfilling experience that counteracts burnout and builds resilience. (Soc Cogn Affect Neurosci. 2014;9:873; https://bit.ly/3AqTDvC.) Neuroscience research shows that compassion for others activates a reward center in the brain. (Soc Cogn Affect Neurosci. 2015;10:1291; https://bit.ly/3nRwcby; Cerebral cortex. 2013;23:1552.) Compassion can heal the healer.
Research from our group and others indicates that change is possible if clinicians are to develop compassion and realize these benefits (PLoS One. 2019;14:e0221412; https://bit.ly/3lGX8YI), and that empathy and compassion are malleable. (J Pers Soc Psychol. 2014;107:475.) This argues that clinicians can improve in compassion, just as they improve in the technical aspects of care, through intentionality and practice. Fortunately, research shows that true compassion takes less than a minute (J Clin Oncol. 1999;17:371), and that spending time helping others can increase the feeling that you have plenty of time. (Psychol Sci. 2012;23:1233.)
We are still in the throes of a pandemic, an epidemic of burnout and now an unprecedented shortage of healthcare workers, and we believe that compassion matters more than ever. (Emsi. “The demographic drought”; https://bit.ly/2XuTAAo.) This is especially true in our compassion for our colleagues. One of the clearest messages we gleaned from our journey through the evidence is that relationships are essential for resilience. In stressful environments, leaning into co-worker relationships and connecting more (and in a meaningful way) can buffer stress and promote resilience and resistance to burnout. Of course, we didn’t need scientific evidence to tell us what we intuitively know, that we need to take care of each other in this crisis. But science shows that taking good care of those around you can be the best medicine for yourself. (Wonder Drug: 7 Scientifically Proven Ways Serving Others Is The Best Medicine For Yourself; to be published in 2022.)?
Dr. Trzeciakis an intensivist and Chief of Medicine at Cooper University Health Care and Professor of Medicine and Emergency Medicine and Chair of the Department of Medicine at Cooper Medical School at Rowan University in Camden, NJ. Follow him on Twitter@StephenTrzeciak. Dr Mazzarelliis an emergency physician, Co-Chair/CEO of Cooper University Health Care and Associate Professor of Emergency Medicine at Cooper Medical School at Rowan University in Camden. Follow him on Twitter@AJMazzarelli.