Standing AFFIRM

Figure: firearm injury, compassion, violence preventionFigureFigureThe mission of firearm injury reduction of AFFIRM at the Aspen Institute is rooted in compassion for others, not only for the victims of firearm injury but also for those at risk of becoming perpetrators. One of AFFIRM's explicit aims is to employ evidence-based practices, and we believe this begs the question: Does compassion really matter? Of course, compassion is a cornerstone of the art of medicine, but do the evidence-based effects of compassion belong in the science of medicine? Compassion is the emotional response to another's pain and suffering with an authentic desire to help. (Psychol Bull. 2010;136[3]:351; https://bit.ly/3CxF9uO.) It is distinct from empathy, which is understanding another's pain and suffering, and takes responsive action: empathy and action equal compassion. We set out to investigate the scientific evidence for compassion in medicine, not ethically or emotionally but through the lens of science. We curated data from more than 1000 scientific abstracts and more than 250 original science research papers in our book, Compassionomics: The Revolutionary Scientific Evidence that Caring Makes a Difference. (Studer Group: Pensacola, FL 2019.) Loss of Compassion An important first question: Do we have a problem? Research shows an erosion of the relationship between those providing health care and their patients, specifically a loss of compassion. Nearly half of Americans believe that health care providers are not compassionate. (Health Aff [Millwood]. 2011;30[9]:1772.) Studies across specialties have reported that physicians miss most opportunities to respond to patients with compassion. (JAMA. 2000;284[8]:1021; https://bit.ly/3lGCw2H.) Research finds that one-third of physicians are so burned out that they suffer from depersonalization, an inability to make a personal connection. (Mayo Clin Proc. 2015;90[12]:1600.) This can result in callous or uncaring behavior. This compassion crisis 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 caring for patients or does it belong in evidence-based medicine? We found that compassionate care coupled with clinical excellence has been associated with improved outcomes for many conditions, including the common cold, migraine headaches, chronic low back pain, and diabetes. How? Human connection can modulate physiology, such as stress-mediated disease, the immune response, and a patient's experience of pain. Compassion can also improve outcomes through enhanced patient self-care, such as better adherence to therapy. (J Am Board Fam Med. 2013;26[4]:40.) When health care providers care deeply about patients, patients are more likely to follow physicians' advice, including adherence to treatment recommendations. (J Gen Intern Med. 2006;21[6]:661; https://bit.ly/3nQe9Cl.) A randomized trial also found that compassionate care decreased repeat visits to the ED among homeless patients. (Lancet. 1995;345[8958]:1131.) Compassion can also improve psychological outcomes for patients, relieving the 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 subsequently developed posttraumatic stress disorder (PTSD), and caregiver compassion in the ED was associated with significantly lower rate of development of those symptoms. (Intensive Care Med. 2019;45[6]:815.) Measurable Benefits This may be a result of reducing patients' fear and psychological trauma. Connecting with patients at such a pivotal moment in their lives can have lasting effects. Research shows that years after a life-threatening emergency, patients vividly remember how they were made to feel, and a caregiver's compassion (or lack of) is one of the most salient memories. (Int Emerg Nurs. 2015;23[2]:115.) Compassion matters not only in meaningful ways but also in measurable ones, and its benefits have not only a measurable beneficial effect for patients but for caregivers too. 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 infer cause and effect directly but suggest that compassion may be protective. Connecting with compassion and the meaningful relationships that flow from it can be a positive, fulfilling experience that counteracts burnout and builds resilience. (Soc Cogn Affect Neurosci. 2014;9[6]: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[9]:1291; https://bit.ly/3nRwcby; Cereb Cortex. 2013;23[7]:1552.) Compassion can heal the healer. Research from our group and others indicates that change is possible if clinicians want to grow their compassion and realize these benefits (PLoS One. 2019;14[8]:e0221412; https://bit.ly/3lGX8YI), and that empathy and compassion are malleable. (J Pers Soc Psychol. 2014;107[3]:475.) This supports that clinicians can get better at being compassionate, just like they improve at the technical aspects of care, through intentionality and practice. Fortunately, research shows that meaningful compassion takes less than one minute (J Clin Oncol. 1999;17[1]:371), and that investing time in helping others can increase the feeling that you have plenty of time. (Psychol Sci. 2012;23[10]:1233.) We are still in the throes of a pandemic, a burnout epidemic, and now an unprecedented health care workforce shortage, and we believe that compassion matters now more than ever. (Emsi. “The Demographic Drought;” https://bit.ly/2XuTAAo.) This is especially true in our compassion for our coworkers. One of the clearest messages we gleaned from our journey through the evidence is that relationships are key to resilience. In stressful environments, leaning in to relationships with colleagues and connecting more (and in meaningful ways) can buffer stress and promote resilience and resistance to burnout. Of course, we did not need scientific evidence to tell us what we know intuitively, that we need to take care of each other in this crisis. But the science illuminates that taking good care of those around you may be the best medicine for yourself. (Wonder Drug: 7 Scientifically-Proven Ways That Serving Others Is the Best Medicine for Yourself; to be published in 2022.)? Dr. Trzeciakis an intensivist and the chief of medicine at Cooper University Health Care and a professor of medicine and emergency medicine and the chair of the department of medicine at Cooper Medical School of Rowan University in Camden, NJ. Follow him on Twitter@StephenTrzeciak. Dr. Mazzarelliis an emergency physician, the co-president/CEO of Cooper University Health Care, and an associate professor of emergency medicine at Cooper Medical School of Rowan University in Camden. Follow him on Twitter@AJMazzarelli.