This episode is sponsored by the Rush University Series at The Podcast by KevinMD.
As we enter a year and a half into a worldwide pandemic, many of us working in health care are fatigued, over-worked, and burned out on compassion. Burnout has been so widespread that the CDC published guidelines on how to cope with the stresses of the job as COVID-19 cases persist. As the Delta variant continues to spread and individuals remain unvaccinated despite the data, health care workers find themselves attempting to care for their patients and simultaneously try and care for themselves.
This article outlines some myths about the “softer side” of health care and focuses on compassion and rapport building— exploring the ways in which providing patient-centered care for those who seek our help not only improves clinical outcomes but can also help improve ourselves.
Myth 1: Rapport building takes too much time
With ever-mounting administrative duties, clinicians are often pressed for time while seeing patients. Adding in pressing urgencies brought on by the pandemic has only intensified this. From primary care and community settings to intensive care floors, doctors, nurses, and other health care workers have been dealing with COVID-19 patients directly or handling the fallout due to the pandemic response. These difficulties may leave patient encounters feeling rushed and frantic, compelling clinicians to leave seemingly extraneous interactions for another time. One small study found that, during a patient interview, physicians interrupted patients after a median of 11 seconds. A randomized controlled trial done at Johns Hopkins University found that compassion from a clinician can be conveyed in just 40 seconds during a patient encounter, significantly reducing anxiety and stress experienced by patients in the study. Much has been written about how to build rapport and trust with patients, and investing small amounts of time in this type of intervention has proven to yield positive results. This leads to our next myth.
Myth 2: The “soft skills” of expressing compassion and empathy don’t yield any positive, measurable clinical outcomes
While quality in clinical skill is the greatest predictor of clinical outcomes, several studies have exhibited that empathetic, patient-centered care has been shown to be significant in yielding positive results. One study conducted at Harvard Medical School found that patients diagnosed and treated for IBS expressed a significant improvement in symptom relief when physicians expressed empathy in a randomized controlled trial. Another smaller study done at Michigan State University also found that participants’ pain was modulated by engaging in pleasant conversation with a doctor. More interestingly, empathetic care may have some involvement in improving the immune system as well. A study published in Family Medicine examined the course and duration of colds in 350 patients. The results showed that individuals treated with empathy and compassion by clinicians had a significantly shorter and milder course of illness.
Myth 3: Compassion doesn’t lead to any long-term positive outcomes
Dr. Avril Danczak, a primary care physician and educator in the U.K., explains, “Rapport is like money. It increases in importance when you don’t have any … and when you do have rapport, a lot of opportunities appear.” Longer-term relationships necessitate several encounters with a patient over a period of time. When good rapport is established, many opportunities for intervention can lead to better chances for change. A correlative study published in the Journal of Academic Medicine found that a patient-physician relationship grounded in empathy and compassion leads to better hemoglobin A1C control and consistently lower LDLs over 3 years. Of the 891 patients who participated in the study, 59 percent performed better with medication adherence, demonstrating a positive relationship between physician compassion and positive clinical outcomes.
Myth 4: I’m probably showing compassion already. I’m a doctor/nurse, after all!
The choice to go into health care not only requires patience and a desire to help, but also years of hard work and dedication to the profession. However, the assumption that the choice to pursue a profession in health care implicates a natural propensity for compassion is too broad of a generalization that may not capture everyone’s motivations. A survey conducted by the Schwartz Center for Compassionate Healthcare found that of the 800 hospitalized patients surveyed, only 54 percent of respondents reported that they felt they experienced compassionate care while in the hospital. This figure when compared to the 78 percent of clinicians who felt they provided empathetic care appears to be incongruent. For this reason, compassionate care and patient communication have started to be taught in medical schools across the country to improve the translation between the clinician’s empathy and the patient’s perception.
Myth 5: Compassionate care only benefits the patient
Helen Riess, MD is an assistant professor of psychiatry at Harvard Medical School and the director of the Empathy and Relational Science Program there. She states that physician burnout can often be attributed to a kind of “depersonalization, where patients are seen more like as a number, or a diagnosis, one on a list instead of like real people.” Several cross-cultural studies have shown a negative relationship between empathy and burnout. In an article published in the Journal of General Internal Medicine, Dr. Riess states that this is in part by the pressures exerted on us by the medical system in general, and our subsequent perceived inefficacy as health care professionals because of it. Conversely, several studies have linked clinician empathy to higher levels of satisfaction, and some have even demonstrated that providing compassionate care can be a protective factor in preventing burnout.
As we continue to contend with the marathon of the pandemic, a collective self-check-in is in order. Physician and nurse burnout has consistently been a fixture in each discipline, adding to that the continual addition of COVID-19 cases. While it can be tempting to muddle through every day of our duties, it stands to reason that a reevaluation of priorities can only provide benefits. Many resources are available to clinicians who want to incorporate empathy into their practice. Strategies like including motivational interviewing and the use of consultation models can be deployed to help guide patient interviews in a way that helps a patient feel heard and understood. Like any clinical skill, these strategies for communicating with patients require time and practice. And, like many of the skills we learn, the data suggests that compassion is a skill worth investing time in practicing, not only for our patients but for ourselves, too.
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