Compassionomics Read online

  A commitment to one another, to a common purpose, and to our highest ideals—that is the powerful force that has always sustained us as a nation. We are a country that rightly values the ethics of self-reliance and rugged individualism, but we also understand the necessity of our larger communal ethic—that our greatest achievements as Americans are the result of collective struggle and sacrifice.

  At the heart of that ideal is our ability in any moment, to choose to exercise compassion.

  Throughout our history, it has been those seemingly small acts of kindness, decency, and compassion that have affected change. And as this book demonstrates, practicing compassion—caring for one another, and seeing the struggles of others as our own—isn’t just the right thing to do, it’s the smart thing to do.

  In Compassionomics: The Revolutionary Scientific Evidence that Caring Makes a Difference, Dr. Stephen Trzeciak and Dr. Anthony Mazzarelli focus on the health care system to show us the tangible and significant ways that compassion makes a crucial difference in health care. They show that compassion isn’t just a nice idea, it’s a practice that when put into action improves lives.

  At the heart of this book is the truth that it’s precisely how little effort compassion really takes that makes it so impactful. In every moment, in every industry, we all have the power—and the time—to be kind.

  —Cory A. Booker

  United States Senator

  PREFACE:

  An Explanatory Note on the Origins of this Book

  “Life’s most urgent question is, ‘What are you doing for others?’”

  —Dr. Martin Luther King, Jr.

  For researchers, a scientific awakening may come in a single watershed moment, a powerful event or observation that instantaneously changes their entire worldview and the purpose and trajectory of their research career. In other instances, a scientific awakening takes a much longer arc and is the product of a cumulative, iterative, and evolutionary understanding that is experienced over time. The genesis of this book was actually a little bit of both.

  Dr. Stephen Trzeciak is a physician scientist (a self-described “research nerd”) and specialist in intensive care medicine. He had been conducting clinical research on critically ill patients in the intensive care unit (ICU) for more than a decade. Trzeciak was not in the market for an awakening.

  Quite the contrary. In his estimation, everything was going exactly as planned. His research program was hitting every milestone for “success.” He was publishing his research in some of the most prestigious medical journals, receiving research grants from the National Institutes of Health to fund his work, and was frequently invited to speak at major scientific conferences both nationally and internationally. Life was good. There was no plan to mess with “success.”

  And then, an unexpected question from a 12-year-old turned everything upside down and literally made Trzeciak change the trajectory of his life’s work. That 12-year-old was his son, who was in seventh grade at the time.

  One evening, Trzeciak’s son came into his study at home and asked for help. “Dad, I have to give a talk for my class at school,” he said. “I know you give a lot of talks. Can you help me prepare mine?”

  Trzeciak thought to himself, “What a great father-son bonding opportunity!” So he said, “Of course!” and asked his son to tell him more about his talk.

  Then his middle schooler pulled out a piece of paper from his assignment book and laid it on Trzeciak’s desk. This was the assignment:

  “What is the most pressing problem of our time?”

  Trzeciak was taken aback. He had never pondered the most pressing problem of a generation during his own formative years. But he was eager to engage now.

  “Okay, whatcha got?” he asked.

  His son jumped right in, with both feet. “Okay, I have these slides, and these images, and these references, so I’m almost there…,” he explained.

  But while the topic was meaningful, Trzeciak was not buying it. “Do you really believe that this is the most pressing problem of our time?” he asked. “Because if you do not really believe it, you are not going to convince anybody else in your class.”

  As you might expect from a 12-year-old, his son wanted to just finish what he’d started. “Look Dad, I just have to get this assignment done, okay?” he explained. “And I have everything I need to tell this story.”

  But Trzeciak advised him to stop and take some time to really think about it. Take some time. “Of course, there is no one single most pressing problem of our time,” he suggested. “But you need to find the most pressing problem of our time…for you.”

  Two nights later, after careful consideration, his son returned with what he really believed was the most pressing problem of our time. In his eyes. Through his lens of experience. The topic that he ultimately selected is not what’s important. What’s important is that his son actually believed in its importance. And he prepared a talk that not only his classmates found compelling, but he did, too.

  This mentoring experience gave Trzeciak pause. As he contemplated his life’s work, he realized that he was not following his own advice; he’d dedicated his hard-won skills and talents to research, but never examined whether he was applying them to the area he believed to be the most pressing problem of our time. Why had he never asked himself that question?

  Here’s why: research scientists typically develop a successful career in a particular way. It usually goes something like this: “I’m at the University of ABC, and here we are experts in XYZ, so that’s what I’m going to study.” Or, “At my institution, we have a one-of-a-kind research instrument; no one else can get these data, so that’s what I’m going to focus on.” Or, “My mentor is Dr. Jones, and he is a world-renowned expert who can open doors for me, so I am going to do what he does.”

  These are the usual blueprints for “success,” as it is typically defined, in research scientist career development. Hopefully, someone who follows this path is actually quite interested in what they end up committing their careers to, and it’s something they find intellectually stimulating and meaningful.

  But, do they actually believe that what they are working on is the most pressing problem of our time? And, more importantly, what would happen if they actually did?

  Thus began a period of great introspection for Trzeciak. He asked himself: Was his research at the time meaningful? Definitely. Was he working on what he believed to be the most pressing problem of our time? Definitely not.

  This was going to torment him. He knew he had to find the most pressing problem of our time, for him. Through his lens of experience. And in his scope of influence as a physician scientist. But what was it?

  You could say he was having an existential crisis. He felt lost.

  As fate would have it, that is precisely when he bumped up against a request from someone who would ultimately lead him to his answer.

  Dr. Anthony Mazzarelli is a physician executive, emergency medicine physician, lawyer, and bioethicist. At the time that Trzeciak was first beginning to consider the most pressing problem of our time, Mazzarelli was newly promoted to chief medical officer at Trzeciak’s institution, Cooper University Health Care.

  Mazzarelli had responsibility for leading a practice of more than six hundred physicians at a major academic health system with more than $1 billion in annual revenue. Like most C-suite physician executives, Mazzarelli was charged with the critically important goals of improving patient experience and physician engagement throughout the entire health system. But initially, it was not clear to him where to start.

  He was well aware of the data that demonstrated an epidemic of burnout among health care providers. And he knew that burnout was directly linked to compassion fatigue and depersonalization—an inability to make a personal connection with patients—among caregivers.

  Through his own clinical experience and intuition, he knew that this must have meaningful effects on patients and patient care. But he could not prove it. N
ot yet. He needed data, in order to compel others in his health system to make a meaningful change in how they would care for people. He needed help.

  So Mazzarelli turned to an unconventional choice. He called in the institution’s top physician scientist, Trzeciak, to do a systematic scientific evaluation of these topics that were traditionally considered “touchy-feely” in the domain of medicine.

  Mazzarelli’s thinking was this: if there were scientific data linking better human “connection” with better patient outcomes, then there was hope. The academic faculty at Cooper—who insist upon practicing evidence-based medicine (appropriately so)—would be more likely to buy into new initiatives to improve the patient experience. And, frankly, Mazzarelli needed to be convinced himself. So that’s why he asked Trzeciak to get involved.

  In their initial meeting, Trzeciak thought Mazzarelli was crazy. Literally crazy. Trzeciak actually had no interest in getting involved with what he then considered to be “soft” science. Mazzarelli and Trzeciak had been colleagues for years, practicing alongside each other.

  However, now Mazzarelli was in his new role and technically Trzeciak’s new boss. Not wanting to disappoint a colleague—or the new chief—Trzeciak nodded a lot and pretended to look super interested in the idea. (Maybe you’ve had this experience yourself?)

  In that meeting, Mazzarelli laid down the charge. “Here’s the question,” he said. “Does treating patients with more compassion really matter? Does caring make a difference? Does it matter in measurable ways? Put as much scientific rigor to it as you possibly can. I need you to ‘science this up!’”

  Science of caring? Trzeciak used to think that science and caring were mutually exclusive. Of course, he always believed that compassion was a moral imperative and that health care providers have a duty to treat every patient with compassion. It’s a cornerstone of the art of medicine. But scientific evidence? Really? However, his charge from Mazzarelli was clear.

  Fortunately, Trzeciak already had training and extensive experience in synthesizing a body of evidence in the biomedical literature: a methodology called systematic review. Trzeciak figured that he would quickly search the available science—check all the boxes—to show that he applied some legitimate methodology, and then be able report back to Mazzarelli the bad news that there is no scientific rationale for caring. Then, he assumed they would be left with just the conventional rationale—that caring is the right thing to do.

  After that, he figured he could go back to his search for his most pressing problem of our time. Or so he thought. What happened instead was nothing short of an awakening for both of them.

  What they kept coming back to, over a two-year period of synthesizing all the data, was one distinct element of human connection, and that was compassion. The data on compassion was eye-opening indeed. Epidemiology data indicated that there is currently a compassion crisis in health care. Literally, a crisis.1

  But, there was also crystal clear evidence showing that compassion could affect patients and health care in not only meaningful, but also measurable, ways. As Trzeciak dove deeper and deeper into the data he shared with Mazzarelli, a clear picture emerged for both of them.

  The presence of compassion has the power to improve patient outcomes, and its absence can lead to devastating, and even fatal, consequences. Additionally, it has substantial impact on health care costs, both to patients and to the overall health care system. The insights that the data provide to both caregivers and health care leaders has the power to change both the delivery of care and the way in which health systems are managed.

  It was an awakening to a body of evidence that was actually right in front of Trzeciak and Mazzarelli all along. In fact, it has been right in front of everyone in medicine all along. Decades of research, hundreds of studies…converging almost all in the same direction. It just had never been synthesized before, in aggregate, with a rigorous scientific approach. For both Trzeciak and Mazzarelli, it was a truly transformative experience. Compassion science became an obsession.2

  And that is how you know you have found the most pressing problem of your time. You get out of bed differently in the morning. You put your feet on the floor differently, with purpose. For the first time in their lives, Trzeciak and Mazzarelli found that they did not need alarm clocks anymore.

  It was time to get up and go! The most pressing problem of our time—through their lens of experience—needed them. It was a clear departure from the science Trzeciak had been working on during the course of his entire research career. (But major departures are common when one finally identifies the most pressing problem of one’s time.)

  For them, the most pressing problem of our time is the compassion crisis. Both in health care and, more broadly, in the world today.

  That was the watershed moment of this scientific awakening, when they realized it was all about compassion. This became the “why” for this book.

  The iterative part of the scientific awakening was the two-year-long journey through all of the data on the power of compassion. That is the “what” of this book.

  But the end result is an awakening indeed. Once you see the pattern in the data, it is impossible to unsee it. It becomes impossible to ignore the effects that compassion (or an absence of compassion) may be having all around us every day.

  Ultimately, this book is not about what Trzeciak and Mazzarelli think, nor is it what they believe, but rather it is what they found…

  Compassion matters.

  Now that they see it, they feel the need to share it. And not just data, but also compelling and fascinating patient stories from the front lines of medicine that bring the data to life.

  And that is how this book came to be.

  INTRODUCTION:

  “Love and compassion are necessities, not luxuries. Without them, humanity cannot survive.”

  —Dalai Lama

  The picture typically painted of early man is one of the rugged, self-sufficient hunter-gatherer: a mighty warrior whose equally rugged partner is tending the hearth back at the cave, training their offspring how to survive alone, if necessary, in the harsh environment.

  This fits the notion of Charles Darwin’s “survival of the fittest” evolutionary theory—where it is imagined that the strongest and toughest are pitted against each other so that they can pass on their robust, superior genetic material to the next generation.

  Then, as the story goes, as humans became more “civilized,” they looked up to the heavens, as well as down at their tools, and human reason took over. They began to develop a moral compass that led them to feel empathy for each other and to treat each other with compassion. Ultimately, this theory evolved into the modern day concepts of morality.

  That’s the narrative that everyone is used to hearing. However, it’s not quite how it actually happened.

  You might be surprised to learn that Darwin did not originate the phrase “survival of the fittest,” for which he is known. It was actually Herbert Spencer, a notable British biologist and anthropologist, who coined the phrase after reading Darwin’s views on evolution. Over time, this framing became misconstrued into the widely-held belief that Darwin’s views were justification for aggressive, gladiator-like behavior.

  What Darwin actually concluded was different and even more remarkable. According to Darwin, the communities with the greatest compassion for others would “flourish the best and rear the greatest number of offspring.”3 In short, the body of scientific evidence supports that compassion actually protects the species.

  This makes sense: the hunter that shared his extra earnings with those in need could count on others to do the same when he needed help in the future. It was the other-focused, more compassionate humans that were the ones that survived to pass on their genes.

  At a very basic level, research supports that compassion is something intrinsic to the human condition. For example, studies show that infants will resonate with the cries of others in distress and that toddlers are naturall
y inclined to altruistically help others.4, 5, 6 There is a general consensus among scientists that compassion for others is, in fact, evolutionary.7

  Furthermore, compassion is integral to the belief system of almost all world religions and has been a fundamental moral imperative in essentially all cultures and civilizations throughout history. This makes it much less likely that the practice of compassion for others was the product of human reason and much more likely that it is the manifestation of scientific benefit for advancing the species.

  Compassion is also considered integral to the provision of health care. Compassion is explicitly included in the American Medical Association’s (AMA) Principles of Medical Ethics, with item one stating that, “A physician shall be dedicated to providing competent medical care with compassion.”8

  In the United Kingdom, compassion is considered to be one of the core values of health care, according to the National Health Service (NHS) Constitution.9

  But what is compassion exactly?

  Compassion is defined as the emotional response to another’s pain or suffering, involving an authentic desire to help.

  The etymology of the word is a derivation of the Latin words “pati” and “cum,” which together mean “to suffer with.” But a precise definition of compassion is necessary as a starting point for this book. Nomenclature matters in any scientific domain to ensure that comparisons are “apples to apples.”