Re-humanizing healthcare and strengthening
caring and compassion
Re-humanizing healthcare and strengthening
caring and compassion
Dr Robin Youngson CoFounder of Hearts in Healthcare
Re-humanizing healthcare and strengthening
caring and compassion
COMPASSION: The humane quality of
understanding suffering and wanting to
do something about it
Re-humanizing healthcare and strengthening
caring and compassion
Post-traumatic Stress Disorder after intensive care Sarah Wake, patient, describes her experience of post-traumatic stress
disorder after receiving treatment in ICU. BMJ 2013;346:f3232 doi: 10.1136/bmj.f3232
Re-humanizing healthcare and strengthening
caring and compassion
“Endless days and nights filled with strange broken sleep. A
sea of fragmented menacing faces and shadows swimming
through erratic beeps and bells. A large cackling face floating
over me, constantly morphing and changing shape. The staring
old lady in the bed opposite, her sallow skin disintegrating,
eyeballs disappearing to reveal deep dark holes from which
cockroaches crawled. Her weary face melting like wax into a
big grey smudge. Deafening, haunting laughter filling every
space. Blood seeping through holes and cracks in my skin,
forming a puddle of red around me. Small insects scuttling up
my arms and legs. My chest locked to the bed with wires and
straps, as a plastic mask repeatedly smothered me. A
strangling sensation around my neck. A warm metallic taste. An
invisible force pinning my body down as a dark curtain was
drawn closed.”
Re-humanizing healthcare and strengthening
caring and compassion
Kathy’s story
(play video)
Re-humanizing healthcare and strengthening
caring and compassion
…and emotional memories
of care last a lifetime
The experience of care
triggers a powerful
biological response in
the patient…
Photo credit: Gus Chan
Re-humanizing healthcare and strengthening
caring and compassion
Pessimists The profound influence
of psychological
wellbeing Long-term survival after
heart attack:
- pessimists have 4 times
higher death rate from
cardiac disease and 3
times higher mortality from
all causes of death
Optimists
Re-humanizing healthcare and strengthening
caring and compassion
The profound influence
of psychological
wellbeing Chances of getting clinical
influenza after standard
inoculation:
- 3 times as many
pessimists get influenza,
as optimists
Optimists
Pessimists
Re-humanizing healthcare and strengthening
caring and compassion
Burnout causes a 40% increased in heart attack and stroke – a bigger risk than
smoking, high cholesterol or lack of exercise. Those with the highest 20% of
burnout scores have a 79% increased risk of coronary heart disease!
Re-humanizing healthcare and strengthening
caring and compassion
The science of interpersonal connection
Re-humanizing healthcare and strengthening
caring and compassion
Cascading reactions in the healing response… wellness genes up-regulated
new protein synthesis
tissue healing
enhanced immunity
lowered blood pressure
positive emotions
cancer genes activated
stress hormones
tissue breakdown
compromised immunity
raised blood pressure
negative emotions
wounding
Re-humanizing healthcare and strengthening
caring and compassion
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
Re-humanizing healthcare and strengthening
caring and compassion
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!
Re-humanizing healthcare and strengthening
caring and compassion
Randomised trial of
compassionate care for
homeless patients
presenting to ER -
30% reduction in repeat
visits in next month
Re-humanizing healthcare and strengthening
caring and compassion
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
Re-humanizing healthcare and strengthening
caring and compassion
Physician-patient relationship has bigger effect size on 5-year
risk of cardiovascular event than prescribing statins
Re-humanizing healthcare and strengthening
caring and compassion
Our life experiences, beliefs and internal stories dynamically
change our gene expression, altering health outcomes.
Psychotherapy changes
gene expression
In patients who responded to
psychotherapy for Borderline
Personality Disorder,
improvement was associated
with up-regulation of the gene
for brain-derived neurotrophic
factor (BDNF).
Re-humanizing healthcare and strengthening
caring and compassion
The healing power of touch:
- evidence from randomised
controlled trials
• Reduced pain, reduced cortisol,
enhanced immune function
in post-op patients
• Reduced rate of complications
and hospital length of stay in premature infants
• Reduced pain levels in multiple studies (meta analysis)
• Reduced fatigue and pain in cancer patients
• Increased haemoglobin levels in anaemic students
Re-humanizing healthcare and strengthening
caring and compassion
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-centred
primary 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%
Re-humanizing healthcare and strengthening
caring and compassion
0 500 1000 1500
Below median patient-centred care (n=254)
Above median patient-centred care (n=255)
Median annual cost of healthcare
$948
$1435
The percentage of interactions in family and general internal
medicine that are patient-centred predicts total cost of healthcare
(Bertakis 2011)
Re-humanizing healthcare and strengthening
caring and compassion
Our thoughts,
feelings and
intentions change
the biology of our
patients
Compassionate caring can be as
powerful as the drugs we use…
Re-humanizing healthcare and strengthening
caring and compassion
The caring
crisis
Two out of
five health
workers are
incapable of
caring for
patients
Photo credit: Guy Mayer
Re-humanizing healthcare and strengthening
caring and compassion
Re-humanizing healthcare and strengthening
caring and compassion
Re-humanizing healthcare and strengthening
caring and compassion
Australia 2013
Re-humanizing healthcare and strengthening
caring and compassion
The industrialization of
healthcare with a focus on
budgets, throughputs,
production, and targets has
dehumanized the system:
- Loss of compassion
- Patients suffering
- Care fragmented
- Health workers burning out
- Costs out of control
- The system in crisis
Re-humanizing healthcare and strengthening
caring and compassion
empathy sympathy
non- judgement sensitivity
motivation tolerance of distress
Paul Gilbert
model of
compassion
Re-humanizing healthcare and strengthening
caring and compassion
“Approach” “Withdrawal”
kindness appreciation gratitude mindfulness the joy of service
Two competing systems of motivation:
pain anxiety fear distress
Re-humanizing healthcare and strengthening
caring and compassion
Re-humanizing healthcare and strengthening
caring and compassion
Number 1 priority: Health and
wellbeing of health professionals
Re-humanizing healthcare and strengthening
caring and compassion
kindness
appreciation
gratitude
mindfulness
self-compassion
choosing to love
their work
The only health professionals
who flourish in the broken
system are those who learn and
practice the daily habits of…
Re-humanizing healthcare and strengthening
caring and compassion
The scientific evidence for
all these claims can be
found in the book that
launched Hearts in
Healthcare
Re-humanizing healthcare and strengthening
caring and compassion
Five daily practices that can transform your life… 1. Choose your thoughts
on your journey to work 2. Small acts of kindness 3. Making the human connection 4. Find out first your patient’s concerns 5. Treat every patient like a family
member Photo credit: Lewishamdreamer
Re-humanizing healthcare and strengthening
caring and compassion
Re-humanizing healthcare and strengthening
caring and compassion
heartsinhealthcare.com
{the movement for human-centred healthcare}