Compassionomics Read online

  Most scientists define compassion as the emotional response to another’s pain or suffering, involving an authentic desire to help.7 It’s different from empathy, which is the feeling and understanding component (i.e., detecting and mirroring another’s emotions and experiencing their feelings) because compassion also involves taking action. Feeling empathy is a necessary precursor (or prerequisite) to motivate acts of compassion; so the terms are related, yet they are also distinct.

  There are actually neuroscience underpinnings for this distinction in terminology. When people are studied with a brain imaging test called functional magnetic resonance imaging (fMRI), which can detect subtle differences in cerebral blood flow, there is higher activity in areas of the brain that are firing at any given moment.

  When a person experiences empathy—the feeling component—the pain centers in the brain light up. That person is experiencing another’s pain.10 But when a person is focused on compassion—the action component of trying to alleviate another’s suffering—a distinctly different area of the brain, a “reward” pathway associated with affiliation and positive emotion, lights up.11, 12

  So neuroscience supports what is borne out through our own experience: encountering another’s pain can, in fact, be painful for us, but taking action to alleviate another’s suffering is a rewarding, positive experience. You can think of it like this: empathy hurts, but compassion heals. Accordingly, the key distinction here is that empathy is feeling; compassion is action.

  Another critically important distinction is that compassion is not simply being kind or nice. As compassion is defined as a response to another’s pain or suffering, it is implicit that human suffering is involved. Responding to that suffering is the essence of what it means to be human. If one lacks compassion, one is essentially lacking humanity.13

  Compassion (or a lack thereof) can have a powerful effect on human beings—not just the receiver of compassion, but the giver too.

  This being the case, perhaps it should be no surprise that compassion (or a lack thereof) can have a powerful effect on human beings—not just the receiver of compassion, but the giver too. Evolutionary science supports that compassion has benefited humankind collectively, but is it also possible that compassion has a meaningful and measurable effect on people individually? If so, how can that be examined through science?

  The answer is to study the people that are the most vulnerable, those in the most need of compassion, to make them the subject of scientific inquiry. These ideal subjects would have the greatest capacity to be “responders” to compassion.

  Rigorous review of the literature finds that these data already exist; they are the patients studied in the domain of medical science. In other words, health care is the optimal “laboratory” to test the effects of compassion at the individual person level.

  It turns out that researchers in medicine have already been studying this for decades, through more than two hundred published medical studies that speak straight to the science of compassion. When you gather all of these studies together and look at them for the first time collectively, what you find is quite remarkable.

  Traditionally, compassion has been confined to the art of medicine, completely distinct from the science of medicine. But, in this book, you will see the evidence that supports the overlap between these two areas and that there can be compelling science behind the art.

  We call this emerging field of science “compassionomics.” Simply stated, it’s the scientific evidence that caring makes a difference. Just as genomics is the branch of molecular biology that studies the human genome and its function, compassionomics is the branch of knowledge and scientific study of the effects of compassion on health, health care, and health care providers.14 In this book, you will see the evidence for the impact of compassion on each of these things.

  People in health care have always understood that treating patients with compassion is the right thing to do as a moral imperative. Therefore, the vast majority of people in health care do not need a change of heart. They know that patients ought to be treated with compassion.

  However, few health care providers realize the extent to which compassion matters. They do not realize how powerful their compassion can actually be. Science shows it’s a game changer. Accordingly, the aim of this book is not to change people’s hearts, but rather to change people’s minds—by sharing the overwhelming scientific evidence about the effects of compassion on patient outcomes, patient safety, provider well-being, employee engagement, and organizational performance.

  Once you understand the data, it changes your mind. You’ll realize that your compassion can be more powerful than you have ever known. And when you come to realize the power of your compassion for others, you will want to use it every opportunity that you have.

  CHAPTER 1:

  The Compassion Crisis

  “Our lack of compassion stems from our inability to see deeply into the nature of things.”

  —Surya Das

  If you have ever been the good Samaritan that has stopped at the scene of a motor vehicle accident, you may have witnessed what paramedics notice all the time: the scene can be unusually quiet, despite the presence of wrecked vehicles, shattered glass, and, sometimes, a few people with injuries. There is typically a sense that the chaos is over, and while a few people may need some medical attention, fortunately, the majority of the time there is not a life-threatening injury.

  This was not the case on a snowy stretch of highway outside of Uppsala, Sweden on February 27, 2007, when two commuter buses packed with passengers collided head-on. One of the bus drivers lost control in the icy, slushy conditions while trying to pass a parked truck on the side of the road.15

  The result was devastating. One bus was completely annihilated, and one bus was sheared in half. It took several fire engines, multiple medical helicopters, and ten ambulances to respond to the accident and sift through the twisted metal for survivors.16 The rescue circumstances of the scene, between the environmental surroundings and the incredible extent of the damage to the buses, was such a complex and time-consuming rescue operation that it later became a reference point in a disaster medicine textbook.17

  Tragically, six people died, but, miraculously, 56 people were saved.

  Five years later, researchers asked the question, “What do the survivors remember?” They interviewed every survivor and, using a rigorous qualitative research methodology, they found two common themes in the data.18 The first was completely expected: many spoke of the physical pain that they experienced at the moment of impact. It is not surprising that the experience of such physical pain is seared into one’s memory.

  But the other theme that came to the surface in this study was surprising. Another aspect of the event was also cemented in the memory of the 56 survivors: a lack of compassion from the caregivers at the hospital. This finding is even more striking when one learns that these individuals were actually taken to multiple different hospitals. Yet, they all had the same experience. A lack of compassion is what they remembered the most five years later. This study is eye opening, indeed.

  The Scope of the Problem

  Before diving into the data on the lack of compassion in health care, perhaps the question should be asked: “Is there decreasing compassion in our society in general?” Maybe health care is just following general trends.

  For example, the political divide in America is growing. As this gap widens, people are becoming less and less comfortable with those who hold views other than their own, regardless of whether they are conservative or liberal. According to data from The Atlantic, there has been a steady increase of both Republicans and Democrats who would be upset if their child married someone of the other political party. In 1960, it was essentially a non-issue among parents, with about five percent from each party that would be displeased if their son or daughter married someone from the other party. Today, about forty percent of parents would have a negative reaction about party intermarr
iage!19

  This unwillingness to look outward from one’s own “bubble” to those that have differing views is, ironically, one of the few things that members of both United States (U.S.) political parties share. By remaining in a bubble, it’s like everyone is becoming unable to see each other’s humanity. There is no way to show compassion if one cannot see another’s humanity.

  A recent survey study found that half of Americans believe our society in general is not compassionate and does not place a high value on compassion for others.20 The preponderance of data indicates that people are becoming significantly more self-focused and less other-focused. Our disposition is shifting away from compassion for others, and this shift appears to be accelerating over time.

  For example, a meta-analysis from the University of Michigan synthesized data for more than thirteen thousand U.S. undergraduate college students and found that students’ dispositional empathy (and specifically, students’ empathic concern for others) declined sharply from 1979-2009, and the decline in empathy was picking up speed over time.21

  Empathy is feeling; compassion is action.

  Because empathy (the feeling and understanding component) is a prerequisite for compassionate behavior (the action component), this study speaks directly to the state of compassion in America. While these were studies of college students, do not be so quick to dismiss this data as simply the selfishness of youth or isolationist attitudes of a generation.

  In fact, it turns out that grown-ups may be the ones actually at fault here. In a recent study from Harvard University, researchers surveyed ten thousand U.S. middle and high school students from 33 different schools and asked them what they believed their parents valued the most.

  They found that nearly two-thirds of our youth feel that their parents do not value caring for others as much as they value achievements and accolades.22 While parents may deny that they explicitly say this to their children, this study offers solid evidence of a generation that has internalized this message from older Americans.

  Perhaps the most striking data is from a recent Pew Research Center study that found fully one-third of all Americans do not even consider compassion for others to be among their core values.23

  One-third of all Americans do not even consider compassion for others to be among their core values.

  These recent studies on the state of compassion in the general population are important new data points, but the backdrop for the data was established decades ago in a famous study conducted by renowned Princeton University psychologists John Darley and Daniel Batson. Their classic experiment—a study of compassionate helping—found signs of a compassion crisis way back in 1973, even among people from who compassion is most expected.24

  Darley and Batson studied students at Princeton Theological Seminary (i.e., pastors-in-training). They randomly assigned the seminarians to either an intervention arm, in which they received a talk on the biblical parable of the Good Samaritan (i.e., a message of compassionate helping for a stranger in distress), or a control arm that received a talk on an unrelated, non-helping topic.

  Immediately afterward, the students were instructed to walk to another building for their next assignment. On their walk, they encountered a stranger in need: disheveled, lying on the side of the road between two buildings, moaning, obviously in distress. The man slumped over on the ground was what they call a “confederate” in psychology research. In other words, the stranger in distress was an actor who was part of the experiment.

  What Darley and Batson learned from their experiment was truly striking, in three particular ways. The first was the overall rate of a compassionate response, regardless of the arm of the study to which the seminarians were randomized. Overall, only forty percent of the seminarians stopped to help the man in distress. Keep in mind that the other sixty percent who did not stop to help were also studying to be pastors of a church.

  The second striking finding was the fact that the seminarians randomly assigned to hear the message of the Good Samaritan were no more likely to stop to help. The message did not matter.

  The third striking finding was what they found to be the major determinant of compassionate helping (i.e., what was going on in the minds of those who did not stop to help). That result is truly fascinating…so much so that Chapter 8 is devoted to it. But the key point to remember now is that a majority of well-intentioned people failed to show compassion to a struggling stranger, even those with explicit instruction to do so.

  So is the data from the bus crash the exception or the rule? Is health care an exception to what is happening in the rest of society? Isn’t health care supposed to be different? Special? Like the seminarians who walked right past the stranger in distress—failing to be good Samaritans—do health care workers walk right past patients in distress?

  The evidence in the biomedical literature is clear. The data for a lack of compassion in health care is just as striking as the data are in the general population. In fact, given the evidence of an erosion of compassion in the general population, it was likely only a matter of time before the epidemic infected health care. Make no mistake: at the present time in medicine, there is a serious compassion crisis.

  Let’s Go to the Data

  Let’s take a quick tour of the evidence on compassion in the health care domain. In one study from Harvard Medical School published in Health Affairs—one of the best-regarded health policy journals in the world—researchers surveyed 1,300 patients and physicians and asked the question, “Is the U.S. health care system compassionate?”1

  Nearly half of Americans believe that the U.S. health care system and health care providers are not compassionate.

  The result: physicians and patients were both split on this. Nearly half of the people in the two groups—both patients and physicians—said the U.S. health care system was not compassionate. Even more interesting: when researchers asked this same group of patients and physicians if U.S. health care providers were compassionate, three-fourths of physicians agreed they were. Physicians gave health care providers the benefit of the doubt.

  But patients? Not so much. Nearly half of patients said it’s not just the system that’s the problem…they said that the providers in the health care system are not compassionate. This study was quite rigorous in its methodology, so there’s really no question about whether these results are valid; this is how patients feel.

  In another survey study (a follow-up to the original Health Affairs report), the researchers found that 63 percent of health care providers say they have observed a decline in compassionate care over the past five years.25 It’s a downward trajectory.

  These findings are corroborated by many other studies. Here’s another: In a large-scale survey study, researchers found that 64 percent of patients in the U.S. said they’ve had a health care experience with a meaningful lack of compassion. And yet, in the same study, 87 percent said kind treatment by a physician is more important than other key considerations in choosing a health care provider—including wait time, travel distance, or cost.20

  Since the U.S. has the most expensive and, in many respects, the least effective health care system in the world, it would be easy to just point to cost pressures and an unwieldy health system as the cause of all of the ills within the U.S. system, including issues surrounding compassion for patients.26

  However, it’s not just the U.S. that is experiencing a compassion crisis; it’s worldwide. A public inquiry into the Mid Staffordshire National Health Service (NHS) Foundation Trust in the United Kingdom found, among many quality concerns, a widespread and striking lack of compassion from health care providers.27 This report prompted then-Prime Minister David Cameron to call for an urgent renewed focus on compassionate patient care in the NHS.28

  Similar data are found in Ireland. A survey study conducted in collaboration with Harvard Medical School found that for patients in Ireland, health care providers commonly fail to meet patient expectations for compassionate care.29

/>   Obviously, a big part of compassion for patients is making a personal connection, because it is a key element in seeing, feeling, and understanding another’s pain or suffering (i.e., empathy). As discussed earlier, feeling empathy for others is what motivates a person to respond to them with compassion.

  So it stands to reason that if one has difficulty making a personal connection with another individual, then compassionate behaviors are much less likely to occur. There is actually a ton of data on this subject of the inability to make a personal connection, and it is all relevant to the compassion crisis. It’s the research on the burnout syndrome among health care workers.

  Research has identified three hallmarks of burnout: emotional exhaustion, a lack of personal accomplishment, and depersonalization.

  Decades of rigorous research have identified three hallmarks of burnout: emotional exhaustion (being emotionally depleted or overextended), a lack of personal accomplishment (the feeling that one can’t really make a difference), and depersonalization. Depersonalization is the inability to make that personal connection.

  Specifically in health care, it’s an inability to make a personal connection with patients. With respect to health care providers and compassion, depersonalization is the phenomenon where health care providers find it easier to think about their patients as a cluster of symptoms rather than a whole human being.

  For example, thinking of the patient as “the chest pain in room six,” rather than knowing the patient in room six by name and as a person with very personal fears, anxieties, and worries. This is an important hallmark of the burnout syndrome. A recent Mayo Clinic survey study of 6,880 U.S. physicians found that 35 percent of physicians are so burned out that they are manifesting high levels of depersonalization.30 Interestingly, that is the exact same proportion—35 percent—of physicians who were found to have a high level of depersonalization when researchers studied 1,393 family physicians in Europe.31