the purpose compassion is healingcompassioninhealth.co.nz/slides/chc 2019 - ry...the purpose of...

The Purpose of Compassion

The Purpose of Compassion is healing

Dr Robin Youngson, Anaesthetic SpecialistCoFounder of Hearts in Healthcare


Caring is shown in the smallest acts that take just a moment…


Chloe 2019- Healed from both her physical and emotional wounds


Compassion is the calling that brought us into the healing professions – knowing suffering and wanting to do something about it


Professor Tania Singer, Director, Department of Social Neuroscience, Max Planck Institute for Human, Cognitive and Brain Sciences, Leipzig


The science of interpersonal connection


Electromagnetic coupling of hearts and brains between individuals


Mirror neurons

Interpersonal neurodevelopment


Cascading reactions in the healing response…wellness genes up-regulatednew protein synthesistissue healingenhanced immunitylowered blood pressurepositive emotions

cancer genes activatedstress hormonestissue breakdowncompromised immunityraised blood pressurenegative emotions

wounding


Compassionate caring may matter as much as the treatments we administer


Adding compassion to my anaesthetic practice


Supportive pre-op visit by anesthesiologist:- Halved the dose of post-op opiates

Non-supportive pre-op visit by anesthesiologist:- Length of stay 2.7 days longer

Harvard study 1964: Randomised trial of supportive / non‐supportive manner in pre‐op visit by anesthesiologist


Preoperative anxiety in ambulatory surgery: The impact of an empathic patient-centered approach on psychological and clinical outcomes. Patient Educ Couns. 2016 May;99(5):733-8.

Randomized, controlled trial of empathetic pre-op consultation:

• Better wound healing• Better surgical

outcomes• Less anxiety• Less pain• Higher levels of daily

activities


Diabetic patients of high empathy primary care physicians had 42% fewer hospital admissions for metabolic crisis than patients of low-empathy physicians

Photo credit: Sriram Bala


Compassionate, whole-person care in terminal lung cancer –early access to palliative care

• Fewer patients have depression, 16% vs 38%

• Fewer patients chose aggressive end of life care, 33% vs 54%

• Reduced overall cost of care• But increased median survival,

11.6 months vs 8.9 months!


Randomised trial of compassionate care for homeless patients presenting to ER -30% reduction in repeat visits in next month


Trauma patients who rated their surgeon “high empathy” are twenty times more likely to fall into the better subjective outcomes group at six weeks after discharge:• Very satisfied with care• Believe that treatment is effective• Treatment makes me feel better• Improved quality of life


Physician-patient relationship has bigger effect size on 5-year mortality than smoking cessation or taking aspirin.


Having a doctor who cares for you reduces the 5-year risk of stroke, heart-attack and death MORE than smoking cessation

The Purpose of CompassionR

espo

nse

rate

Treatment effect sizeDRUG ALONE

DRUG PLUS COMPASSION

COMPASSION

Compassion enhances treatment effect


0 10 20 30

Commonground

No commonground

% Receiving diagnostic tests

0 10 20

Commonground

No commonground

% Receiving specialist referral

Dramatic reduction in healthcare utilisation as a result of finding common ground with patient, through compassionate, patient-centredprimary care (Stewart 2000)

Patients who found common ground with their doctor also had better recovery from their discomfort and concern, and better mental health 2 months later

25%

6%

15%

4%


Compassionate, patient-centred

care

More

Less

Median

TOTAL cost of healthcare is 50% higher

TOTAL cost of healthcare is 50% higher

When patients receive less than median patient-centered care, the TOTAL cost of their healthcare is 50% higher!

Fewer interventions, better outcomes

Fewer interventions, better outcomes

255 patientsMedian annual cost of care $948

254 patientsMedian annual cost of care $1435

Bertakis 2011


The deeper purpose of compassion is healing

It’s not enough to just treat physical disease


ACE Study – Adverse Childhood Experiences

• Physical, sexual and verbal abuse.

• Physical and emotional neglect.• A family member with depression,

diagnosed with other mental illness, addicted to alcohol or another substance, or in prison.

• Witnessing a mother being abused.

• Losing a parent to separation, divorce or other reason.


ACE score = 4Odds ratio: Smokers x 2, alcoholic x 7, COPD x 4,attempted suicide X 12

ACE score = 6 or higherLifespan shortened by twenty years.More likely to be violent, to have more marriages, more broken bones, more drug prescriptions, more depression, and more autoimmune diseases.


What is the meaning of healing?


Transcending suffering


Human beings have incredible capacity for health, healing, wellbeing and resilience…


Nine week mind-body program altered expression of 1,059 genes in a trial of patients with inflammatory bowel disease and improved outcomes

Kuo B, et al. (2015) PLoS ONE 10(4): e0123861. doi:10.1371/journal. pone.0123861


Our life experiences, beliefs and internal stories dynamically change our gene expression, altering health outcomes.

Psychotherapy changes gene expressionIn patients who responded to psychotherapy for Borderline Personality Disorder, improvement was associated with up-regulation of the gene for brain-derived neurotrophicfactor (BDNF).


Comprehensive lifestyle change can reverse coronary artery disease and halt the progression of prostate cancer(controlled trials)

Dean Ornish, MD

How does Dr Ornish define lifestyle change?

Good diet Moderate exercise Social support Relaxation


Spontaneous remission/regression

“SR of neoplasms occurs when the malignant tumor mass partially or completely disappears without any treatment or as a result of a therapy considered inadequate to influence systemic neoplastic disease.”(Kaiser et al, In Vivo 2000 Nov‐Dec; 14(6): 773‐788)

3,500 documented case reports in 800 medical journals, in 20 languages


The most POWERFUL WAY to support the natural healing process is compassionate care of the whole person…


SATISFIES THE QUADRUPLE

AIM:

Better outcomesBetter patient satisfactionMore cost-effectiveHappier health professionals


Why isn’t this change spreading like wildfire?


After twenty years of trying to lead change, in multiple countries, this is my conclusion…

While there are many compassionate health workers, our healthcare system is fundamentally incompatible with compassion and caring.

(for two reasons)


Our evidence-based medicine is based on a science that specifically excludes any effects of consciousness or relationship.

We have hundreds of guidelines for the treatment of disease, none for care of the whole person.

1


2 We have industrialisedhealthcare so

that hurried care and throughput is valued more than outcomes.

It’s a system that rushes to treat symptoms and not underlying causes.


WHAT DO WE NEED TO CHANGE?

1. We need a new science, a science of healing not a science of disease

2. We need to change our individual practice and be supported to do that

3. We need new healthcare organisations based on a fundamentally different philosophy


1November 2020, ClaudelandsConvention Centre, Hamilton. 5-day event.

The world’s first summit on the ‘Science of Healing’- Supported by crowd-funding not commercial sponsorship

SCIENCE


2Practice groups in multiple locations in NZ and internationally, supporting each other in compassionate, whole person care.

I intend to crowd-fund a ‘Happy Healers Handbook’

PRACTICE


Buurtzorg: A healthcare system with no bosses

• 7,000 nurses nationally• ‘Best employer’ in the

Netherlands 3 years running• Average patient satisfaction

9.1/10• ED visits reduced by 1/3• Patients recovered twice as

fast from illness and injury• Productivity improved by 40%

Ernst & Young 2009

3 NEW ORGANISATIONS


Want to learn more?


1. Seligman MEP. Positive Health. Applied Psychology: An International Review N. 2008;57:3‐18.2. Toker S, Melamed S, Berliner S, Zeltser D, Shapira I. Burnout and risk of coronary heart disease: a prospective study of 8838 employees. Psychosomatic medicine. 2012;74(8):840‐7.3. Perroud N, et al. Response to psychotherapy in borderline personality disorder and methylation status of the BDNF gene. Transl Psychiatry. 2013 Jan 15;3:e207. doi: 10.1038/tp.2012.140.4. Tryggvadottir L et al. Population‐based study of changing breast cancer risk in Icelandic BRCA2 mutation carriers, 1920‐2000. J Natl Cancer Inst. 2006 Jan 18;98(2):116‐22.5. Riess H, Kelley JM, Bailey RW, Dunn EJ, Phillips M. Empathy Training for Resident Physicians: A Randomized Controlled Trial of a Neuroscience‐Informed Curriculum. Journal of General Internal Medicine. 2012;27(10):1280‐1286. doi:10.1007/s11606‐012‐2063‐z.6. Del Canale S, Louis DZ, Maio V, Wang X, Rossi G, Hojat M, et al. The relationship between physician empathy and disease complications: an empirical study of primary care physicians and their diabetic patients in Parma, Italy. Academic Medicine : Journal of the Association of American Medical Colleges. 2012;87(9):1243‐9.7. Dahlin CM, Kelley JM, Jackson VA, Temel JS. Early palliative care for lung cancer: improving quality of life and increasing survival. Int J Palliat Nurs. 2010;16(9):420‐3.8. Redelmeier DA, Molin JP, Tibshirani RJ. A randomised trial of compassionate care for the homeless in an emergency department. Lancet. 1995;345(8958):1131‐4.9. Egbert LD, Battit GE, Welch CE, Bartlett MK. Reduction of Postoperative Pain by Encouragement and Instruction of Patients. A Study of Doctor‐Patient Rapport. The New England Journal of Medicine. 1964;270:825‐7.10. Kelley J1, Kraft‐Todd G, Schapira L, Kossowsky J, Riess H. The influence of the patient‐clinician relationship on healthcare outcomes: a systematic review and meta‐analysis of randomized controlled trials PLoS One. 2014 Apr 9;9(4):e94207. 11. Monroe CM. The effects of therapeutic touch on pain. J Holist Nurs. 2009;27(2):85‐92.12. Marta IE, Baldan SS, Berton AF, PavamM, da Silva MJ. The effectiveness of therapeutic touch on pain, depression and sleep in patients with chronic pain: clinical trial. Rev Esc Enferm USP. 2010;44(4):1100‐6.13. Coakley AB, Duffy ME. The effect of therapeutic touch on postoperative patients. J Holist Nurs. 2010;28(3):193‐200.14. Stewart M, Brown JB, Donner A, McWhinney IR, Oates J, Weston WW, et al. The impact of patient‐centered care on outcomes. J Fam Pract. 2000;49(9):796‐804.15. Bertakis KD, Azari R. Patient‐centered care is associated with decreased health care utilization. J Am Board FamMed. 2011;24(3):229‐39.16. Decety J. The Neurodevelopment of Empathy in Humans. Developmental Neuroscience. 2010;32(4):257‐67.17. Youngson R. Time to Care: How to love your patients and your job. Raglan: Rebelheart Publishers; 2012.

References


heartsinhealthcare.com

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