In one brief moment, an exchange of compassion, understanding, and respect from a health care provider, can not only change an entire experience for a patient; it may mean the difference between recovery and healing, or complications and death.
Allison was a 24 year old young woman suffering from an inherited genetic connective tissue disorder that leads to joint hypermobility, skin hyperelasticity or laxity, and tissue weakness. One of Allison’s significant challenges with her disease was profound disabling pain. She had established a long term (6 year) health care relationship with a primary medical physician who understood the complexity this disease placed on her daily life, and thus her disease was relatively well managed in his care. The physician had made referrals to a clinic specializing in connective tissue disorders, but the wait list for a new patient appointment was nearly 18 months in length. Therefore, Allison relied heavily on the health care relationship with her primary physician. However, earlier this year, her primary physician retired and she was sent to another medical provider in the same clinic for continued management. Even though that provider had access to all of her records along with treatment management plans; their first visit fell apart completely. Allison arrived to her appointment in severe pain, with her mother Margaret for support. Allison explained her pain and reviewed her use of medications to control the pain, and she then informed the provider that her narcotic was due for renewal, with only a few pills left. The provider promptly refused to renew her narcotics, and in fact stated that she was “drug seeking” implying she was abusing drugs. Allison began to fall apart emotionally, and her mother stepped in to support her. Margaret outlined to the provider the history of Allison’s disease, the severity of her pain with its degree of debilitation, and how the only way the pain had been effectively managed was with the regular scheduled dosing of narcotic. Margaret further explained their history of trying other approaches (medical and non medical), all of which had not been successful. She further explained that they still had an 18 month wait to see the specialists for a detailed plan of treatment for her connective tissue disease. The medical provider, while seemingly listening to their comments, would not acknowledge their validity, and again refused to renew the narcotic. He was adamant that Allison was “drug seeking” and in fact, he then stated that he intended to document this in her records; such that if she went to any other provider for treatment or relief, it would be evident she was in fact “drug seeking”. There was a complete dissolution of any relationship between Allison, Margaret and this provider, with no establishment of rapport, respect, and common ground.
By the time Allison arrived home from the appointment she became overwhelmed with anxiety and fear. She screamed at her mother, acting out her fears and worry towards Margaret, as if her mother was to blame for the outcome at the appointment. As the next few days wore on, Allison’s distress moved into a state of debilitating pain. She ran out of her narcotic, and her pain was unbearable. This downward cycle led to a loss of sleep and a deeper state of depression than had already been present. Her chronic illness was spiraling out of control. Margaret was equally distraught and immediately did what she knew to do, she sought out solutions. She made inquiries into other medical providers, called friends who could connect her with specialists in other states, and sought natural treatments to help manage Allison’s pain. As the days progressed, Margaret was also in tears. She could find little support, and she made an effort to rebuild a relationship with Allison’s primary physician. This meeting was not successful with her leaving feeling he could not listen or understand their concerns. Margaret was finally able to find another medical provider who agreed to meet with Allison, after learning of the difficulties. But, by this point, Allison was no longer able to cope. Allison stated that any reserve of energy she may have had to survive on a daily basis was gone. Any hope she may have had for a future state of wellness was gone. All that remained for Allison, was the will to die. She could no longer face the debilitating condition of her body, and the associated pain. When the single treatment that had allowed her to have some semblance of stability was removed by a physician who seemed to not care or understand, her world crashed. She made an attempt to kill herself, unsuccessfully.
While this story may seem dramatic, unreal, or rare; in fact it is not. The degree of instability and tenuousness in the health care patient-physician relationships sits right on the edge of despair for many individuals. While there were many factors that contributed to the above scenario, there is one known factor here; that had a respectful and compassionate health care relationship been established where both the provider and patient achieved some common ground and understanding, then it is very likely the patient would have had a more beneficial outcome.
Research evidence is clear, that the quality of a patient’s health is directly related to quality of the patient-physician relationship. There are four types of patient-physician communication problems that are most likely to lead to legal action by the patient: 1) deserting the patient, 2) devaluing the patient’s views, 3) delivering information poorly, and 4) failing to understand the patient’s perspective (Schleiter, 2009). However, when the patient feels they are perceived as being “known as a person”, meaning that the physician understands them as a unique human being or is empathetic; the patient is more likely to be more satisfied with their care and have greater improvement in their medical condition (Beach 2006, DelCanale 2012, Ha 2010).
Our health care system fails us, and one key reason is due to misplaced focus. Technological advances in medicine have created extraordinary opportunities for understanding disease, treatment and outcomes, yet come with overshadowing directives to reach quotas, financial goals, and health care profits. Along with that, are the incredible stresses placed upon health care providers to achieve so much in such a short time.
What has become lost in health care, is the “sacred soul” of medicine: the medical provider as healer. One who recognizes the sacredness that lies in the deeper understanding that we each are unique, complex, interconnected persons. The sacred soul of medicine has wisdom that lies not only in the depth of understanding medical disease; but lies in reverence of the complexity of the emotional, spiritual, cultural, physical, financial, and environmental facets that contribute to an individual’s illness. The sacred soul of medicine is the Compassionate Healer.
The Compassionate Healer understands, that health and healing must begin in the first exchange with a patient and be carried out through every interaction. The Compassionate Healer recognizes that as human beings, we all carry with us a lifetime of influences, beliefs, traditions, and responses; and that when we follow our basic human nature of kindness, we engender more powerful, meaningful and harmonious relationships.
His Holiness the Dalai Lama, has dedicated his life to living with and teaching compassion; and he emphasizes the following points on bringing compassion into health care relationships (Mayo 2016):
- treat everyone the same (recognizing we are all equal)
- educate the sense of oneness (we are all human beings, emphasizing our sameness rather than our differences)
- promote human value
- offer kindness and love
How do we train and support the Compassionate Healer in healthcare? Compassion is not merely an action, but a way of being. To “be” a Compassionate Healer involves more than acting in a kind manner, it requires engaging in radical empathy. Being compassionate meets meeting another person “where they are”, in an effort to understand (from their perspective) what they are sensing and experiencing. Being compassionate means to listen and respond in such a way, that you begin to understand on a holistic level, the degree of distress or suffering the person experiences.
The “act” of the the Compassionate Healer begins at the entry point in the health care relationship, where the physician has an opportunity to create the foundation for a strong, respectful, compassionate patient-provider health care relationship. It starts before the patient and physician meet, with the physician being prompt; demonstrating respect for the patient’s time and schedule. The physician then should conduct a detailed patient assessment of the multifaceted dimensions (emotional, physical, spiritual, environmental, financial) which are deeply woven into their patient’s beliefs and perceptions of their health and wellness. This approach exhibits empathy and awareness that the patient is a unique and complex human being. The physician must then build the relationship through being empathetic and acting with deep listening, learning and exploring sources of illness and treatment options; utilizing a model of shared decision making. This approach engenders equality in the relationship along with respect, compassion and kindness.
The foundation for positive, successful health outcomes in the health care delivery system lies in the patient-physician relationship, and the Compassionate Healer is the key to this relationship. The Compassionate healer brings trust, empathy, emotional support, and the desire to truly understand and alleviate the patient’s suffering and disease. As our health care system continues towards drastic change, training and supporting the role of the Compassionate Healer must become a priority.
References:
Beach, M. C., Keruly, J., & Moore, R. D. (2006). Is the Quality of the Patient-Provider Relationship Associated with Better Adherence and Health Outcomes for Patients with HIV? Journal of General Internal Medicine, 21(6), 661–665. http://doi.org/10.1111/j.1525-1497.2006.00399.
DelCanale, et. al. (2012).The Relationship between Physician Empathy and Disease Complications: an empirical study of primary care physicians and their diabetic patients in Parma, Italy. Academic Medicine, 2012 Sep;87(9):1243-9.
Ha, J. F., & Longnecker, N. (2010). Doctor-Patient Communication: A Review.The Ochsner Journal, 10(1), 38–43.
Schleiter, K. E. (2009). Difficult Patient-Physician Relationships and the Risk of Medical Malpractice Litigation. AMA Journal of Ethics, Volume 11, Number 3: 242-246.
Sharing, MayoClinic. (2016). Eight Lessons on Compassion in Health Care from the Dalai Lama. Sharing Mayo Clinic, March 4,2016. http://sharing.mayoclinic.org/discussion/eight-lessons-on-in-health-care-from-the-dalai-lama/
*provider and physician are used interchangeably
Maya Center 