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April 24, 2010, the Mayor and City Council made Seattle the first city in the United States

April 24, 2010, the Mayor and City Council made Seattle the first city in the United States to take on a ten-year commitment to become a more compassionate city. Compassionate Action Network. Physician/Patient Compassion. Steve Overman MD MPH DocOverman@gmail.com.

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April 24, 2010, the Mayor and City Council made Seattle the first city in the United States

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  1. April 24, 2010, the Mayor and City Council made Seattle the first city in the United States to take on a ten-year commitment to become a more compassionate city Compassionate Action Network

  2. Physician/Patient Compassion Steve Overman MD MPH DocOverman@gmail.com The Seattle Arthritis Clinic

  3. Compassion The human quality of understanding the suffering of others and wanting to do something about it.

  4. Rachel Naomi Remen, MD “We suffer not because we are in pain, but because we are in pain alone.” Kitchen Table Wisdom

  5. Do you want the most compassionate care orthe best care outcomes? “The Bell Curve” AtulGawanda, MD MPHThe New Yorker 12.6.2004

  6. Mast Cell Activation Disorder • Anaphylaxis and fear of death • Fear of the unknown – what triggers? • Disability with chronic daily symptoms • Overwhelmed trying to navigate complex medical symptom to find answers • Social isolation from lost confidence and friends saying “You don’t look sick”

  7. Crossing the Quality Chasm: A New Health System for the 21st CenturyThe Institute of Medicine, 2001 • Donald Berwick, MD 10 Rules for Healthcare System Redesign Rule # 7 : “The health care system should make information available to patients and their families that allow them to make informed decisions when selecting a health plan, hospital, or clinical practice, or choosing among alternative treatments.”

  8. The Bell Curveof Normal Distribution

  9. Advances in Scientific Evidence “Chasm” Rule #5 - Evidence-based decision making: Patients should receive care based on the best available scientific knowledge

  10. Annie If you were her parent, what would you have done?

  11. Compassionate Care? “Dr. Warwick’s combination of focus, aggressiveness, and inventiveness is what makes him extraordinary. He thinks hard about his patients, he pushes them, and he does not hesitate to improvise.”

  12. What is the evidence? • Does compassionate lead to better outcomes? • Can a person learn to become more compassionate?

  13. What correlates with Empathy? • dutifulness • prosocial behavior • moral reasoning • good attitudes toward elderly patients • a reduction in malpractice litigation • patient satisfaction • physician satisfaction • better therapeutic relationships • competence in history taking and performance of physical examinations AND • better clinical outcomes Hojat: “Empirical Benefits of Empathy in Medicine”, Am Jr Psy, 2002

  14. How Compassion Improves Outcomes “Superior treatment effects enabled by a successful relationship between the patient and the treating physician have been reported in many studies . The effects can be attributed to treatment processes like : • adherence and compliance, • information exchange, • adjustment of expectations, • self-regulation and coping, which are fostering treatment results like functional status, return to work rates, • pain relief, • reduction of depression and anxiety • and adjusting clinical parameters like blood pressure and blood sugar levels.” Dibbelt: “Patient-doctor interaction in rehabilitation”. Patient Educ Couns. 2009 Sep;76(3):328-35

  15. How Compassion Improves Outcomes • Earlier and more accurate diagnoses • More efficient treatment planning and patient adherence • Communication increased physical functioning, emotional health, and decreased physical symptoms of pain • Patients feel more secure and emotional states impact the rate of healing. Post: “Compassionate care enhancement: benefits and outcomes” The International Journal of Person Centered Medicine Volume 1 Issue 4 pp 808-813, 2011 www.psychologytoday.com

  16. How are we doing? • How are compassionate care goals reflected in the redesign of our healthcare system? • How compassionate is our care in the perception of patients and physicians? • And for those who want to be the best, or for patients who want the best, how do we create and assure compassionate care?

  17. Crossing the Quality Chasm: A New Health System for the 21st CenturyTen rules for healthcare system redesign Rule #1. “Care based on continuous healing relationships. Patients should receive care whenever they need it and in many forms, not just face-to-face visits.” Rule #2. “Customization based on patient needs and values. The system of care should be designed to meet the most common types of needs, but have the capability to respond to individual patient choices and preferences.” Rule 3. “The patient as the source of control. Patients should be given the necessary information and the opportunity to exercise the degree of control they choose over health care decisions that affect them.” Rule 4. “Shared knowledge and the free flow of information. Patients should have unfettered access to their own medical information and to clinical knowledge. Clinicians and patients should communicate effectively and share information.”

  18. An Agenda For Improving Compassionate Care: A Survey Shows About Half Of PatientsSay Such Care Is Missing Show respect for you, your family, and those important to you 68 Treat you as a person, not just a disease 66 Convey information to you in a way that is understandable 63 Communicate test results in a timely and sensitive manner 63 Gain your trust 61 Listen attentively to you 59 Always involve you in decisions about your treatment 59 Express sensitivity, caring, and compassion for your situation 58 Spend enough time with you 53 Consider the effect of your illness on you, your family, and the people most important to you 51 Comfortably discuss sensitive, emotional, or psychological issues 50 Strive to understand your emotional need 49 Give you hope, even when the news is bad 48 Show understanding of your cultural and religious beliefs 47 Lown: “An Agenda For Improving Compassionate Care: A Survey Shows About Half of Patients Say Such Care is Missing “ Health Affairs,30, no.9 (2011):1772-1778

  19. Are the youth our hope? • A meta-analysis of Interpersonal Reactivity Indexof 13,000 American college students between 1979 and 2009 • 75% students were less empathetic than students 30 years ago • An increase in social isolation, has coincided with the drop in empathy Konrath SH online in Personality and Social Psychology Review: Aug 2010

  20. Are we isolated and lost and therefore less empathic? Should we despair?

  21. David ElaimyGolf Coach Course on CompassionSwedish Medical CenterGordon Irving, MD Director of the Pain Center Performance = Skills - Interferences

  22. Providing COMPASSIONate Care “The human quality of understanding the suffering of others and wanting to do something about it.” Skills understanding other’s suffering by giving attention and wanting to do something through understanding the 4 phases of chronic illness minus Interferences

  23. Business Week Doctors Without Boundaries “Anger Management Goes to the Doctor”

  24. Watch and learn from these additional pictures slideshows. • Pet Health • What You Need to Know About Fleas & Ticks • Nerve Pain • Symptoms, Causes and Treatment Options • Food Frauds • What Can Wreck Your Diet Interferences • Poor emotional health • Environmental “noise” • “Me” focus • Looking ahead • Lost hope for the patient

  25. Brain Function • Functional MRI allows study of brain activity. • Patients with Fibromyalgia have “real” pain • Empathy triggers mirror neurons and the stress ctr • Stress centers activate the immune, endocrine and autonomic nervous systems. • Compassion (empathy followed by the desire to help) turns off those stress centers Lutz A et al. (2008). Regulation of the Neural Circuitry of Emotion by Compassion Meditation: Effects of Meditative Expertise PLoS ONE, 3 (3) DOI: 0.1371/journal.pone.0001897

  26. Training the BrainCan you teach old dogs new tricks? • Angry doctors training – tests of emotional self awareness; breathing exercises, visualization, self-talk* • Compassion Cultivation Training protocol (CCT) resulted in significant improvements in all three domains of compassion—compassion for others, receiving compassion from others, and self-compassion.** *Chase Scheinbaum: Bloomberg.com August 12,2012 **Jazaieri: “Enhancing Compassion: A Randomized Controlled Trial of a Compassion Cultivation Training Program; J Happiness Stud; 2012 DOI 10.1007/s10902-012-9373-z

  27. Wanting to do something? • Does understanding and knowing ‘ what to do’ create motivation? • Joy said, “I can be WELL and still have an illness.”

  28. The 4 PHASES of Chronic, Invisible Illness 1) GETTING SICK • Crisis of the onset of illness • Fears of the unknown. 2) BEING SICK • Controlling pain and inflammation • Feelings of frustration and anger

  29. The 4 PHASES of Chronic, Invisible Illness 3) GRIEF & ACCEPTANCE • “The illness is not going away.” • Working through grief and finding acceptance 4) LEARNING TO LIVE WELL • Finding meaning in her illness • Understanding allow rejoining her community • Giving back to her family and society.

  30. “Seeing Things Their Way” Phase I - crisis needs HOPE Phase II - being sick needs CONFIDENCE Phase III – finding acceptance needs SHARING Phase IV - finding meaning needs PARTNERSHIP

  31. Do you want compassionate care or the best outcomes? • Gawanda - Is this, “Focus, aggressiveness, and inventiveness is what makes him extraordinary”, compassionate care? • Berwick - Will the Chasm’ s first four rules of “healing relationships; patient needs and values; the patient as the source of control; access to medical information” promote compassionate care?

  32. Compassion is a shared experience It is good for you It is good for your family It is good for your doctor

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