Michael Crain, MD
There is no doubt that knowledge, skills, and experiences are all critical to the practice of medicine. But over the long course of my life and career, I have come to realize that there is an even more important component—one’s values: approaching one’s work with compassion and humanism. While this may seem self-evident, it is not easy to achieve. It requires integrity; compassion, tolerance and empathy toward others; a tireless commitment to excellence; a willingness to work respectfully and collaboratively with one’s colleagues; and a spirit of altruism and true service. And today, we honor you—medical students who embrace these values and seek to apply them to your life’s work. These are the characteristics we want not only in ourselves, but for providers throughout the healthcare system. While they are all important, this evening I will focus on the most central component of these values, and the one hardest to find within our healthcare system today—compassion.
Over the past few decades, I have seen compassion quietly fade from our profession. Yet now, thanks to organizations like the Gold Humanism Honor Society and TPIU, we are reasserting its importance. As technology and electronic medical records were developed and universally deployed, key aspects of medicine came to the forefront—quantitative analysis, metrics, population health, cost controls, and much more. Gradually, our work as physicians became increasingly digitized and measurable; and payers, the insurance industry, regulators, hospital systems, and businesses ran with it. The intentions of these companies and leaders were understandable—they believe that standardization, documentation and analytics improves productivity and the system at large, as if they were applying such principles to building a car or delivering goods. But this process has led to neglecting the most important aspect in healthcare, the human connection. I can say with confidence, however, that these goals are not mutually exclusive. Through the dedication and hard work of young doctors like yourselves, we can bring compassion back to the work and field we love, while maintaining the best patient outcomes and keeping healthcare costs affordable and under control.
Compassion in healthcare is sensitivity and understanding of a patient’s problems with a desire to help them. It is at once both a feeling and an action. This is the very basis of being a physician—having empathy for our patients and wanting to help them improve their health, well-being, and quality of life. With this in mind, to be a physician without compassion is not to be a physician at all.
But why should we bring compassion back to our field? Why not treat healthcare as we might treat manufacturing—faceless, quantitative, functional and empirical? We can line up our patients, after all, test their glucose levels, identify the diabetics, and provide insulin. A healthcare factory could do all of that and achieve nice efficiencies in the process. But there is another, vitally important metric, which is qualitative, the quality of the service we provide. We live in an increasingly diverse world, and each person who seeks medical attention comes to us with a unique set of experiences, needs and concerns. As physicians, we must take the time to listen to our patients—to their concerns, fears, hopes and dreams. It is only in this way, by understanding your patient, their experiences at home, work, and in the community, that you can develop a meaningful and compassionate connection. This trust, this human connection, will lead to far better patient outcomes; to lower healthcare costs overall; and to a happier healthcare provider with a more fulfilling life experience.
Most patients want their physician to be compassionate. But what evidence do we have that compassion in healthcare really matters? Diabetes serves as a good example for demonstrating its impact on patient outcomes and healthcare costs. In this country, over $200 billion dollars is spent on diabetic care each year. We know that better glucose control is associated with improved patient outcomes and, potentially, with less costly complications. It makes sense that a diabetic patient is more likely to follow the advice of a compassionate healthcare provider, on issues including insulin, diet and lifestyle.
Research studies confirm this concept. In 2011, an article in Academic Medicine found that the odds of optimal glucose control were 80% higher with compassionate physicians. An article published in Academic Medicine in 2012 demonstrated that patients who were cared for by a compassionate physician had 40% lower rates of serious diabetic complications. Many other studies have come to the same basic conclusion, that compassionate care improves patient outcomes at a lower cost.
Perhaps the importance of compassion was demonstrated most dramatically over this past year, through the pandemic. The sadness of the family and friends of a loved one hospitalized and isolated with Covid is truly heartbreaking. In this instance, as in so many others, compassionate care not only impacted patients but their families and all who know and love them. Our nation has experienced a collective trauma that should not and cannot be minimalized; as we emerge from the pandemic, caring providers will be more important than ever. Almost everyone has been impacted in some way by this crisis. The increased psychological stress it has caused, and the delay in patients receiving routine medical care, demands a more caring and compassionate patient approach in the years to come. I would even assert that the lack of compassion, the eroding of the traditional doctor-patient relationship, has likely added to the distrust in Covid vaccines.
We can agree that compassionate physicians improve patient outcomes and lower healthcare costs. Many physicians are compassionate people by nature; others learn to be compassionate through their medical training. Typically, physicians say that the most rewarding part of their job is their relationships with their patients. So, what happens when you take away the most satisfying aspect of one’s profession? Job dissatisfaction and the relatively new condition commonly known as “burnout.” Some have suggested that physician burnout comes from working too many hours. To me, it is the result of taking away the most rewarding part of our profession—that essential human connection. It is the industrialization, the depersonalization of the field that is causing physician burnout, not working too much. Doing less, taking more time off, is not the answer. Research has shown that physicians who maintain a human connection with their patients feel less burned out. Compassionate healthcare is not only good for patients and our healthcare system, but better for physicians and providers as well! Let the Golden Rule, along with the Hippocratic Oath, be our guiding star!
Importantly, physicians—no matter how well intentioned—will not succeed in providing compassionate care to their patients without a compassionate team around them. But you must lead the way. Chaos theory tells us that small and subtle changes can end up having massive consequences. Likewise, compassionate leadership breeds compassion throughout an organization and, as you may already know, compassion is infectious. That is why you must be role models, why you must sustain and build upon the leadership you have shown here at the Frank Netter School, and why you must continue to demonstrate compassion not only to your patients but to your entire healthcare teams. Treating your staff with compassion will make them far more likely to play that forward, to treat one another and their patients with the same degree of care.
There is no doubt that compassion is most important in primary care, but it is much needed in all medical and surgical specialties, even in Radiology. Primary care physicians need the time to practice compassionate healthcare and must not be financially penalized for doing so. Providers must have the time they need to listen to their patients, and to understand them. As a Radiologist, I give each patient my full attention, whether for an exam or in consultation. When I meet a patient, I confirm their name, I introduce myself, I patiently explain the procedure or exam, and I ask if they have questions. I give them my business card with my office and cell phone numbers, and I tell them to call me with any further questions. In my case, it only takes several minutes to provide this additional, compassionate experience to my patients, yet it makes all the difference—to them and to me. I would not do it any other way.
Compassionate leadership, though, requires knowledge of the healthcare system at large, not only your office but the hospital system, community, government and insurers. Access to medical care for everyone must be part of a compassionate healthcare system. A compassionate physician leader also needs to be creative and to develop new ideas. For example, back in 2012, when I started Lung Cancer Screening, insurance companies would not pay for this lifesaving exam. I knew patients would likely not pay the routine charges for a CT scan, so I created a Community Benefit Program, lowering the cost to $100. It is a program that we still have today. This experience made me realize that many people were not receiving vital imaging exams because they did not have the necessary insurance coverage. Although insurance rules state that we cannot lower our rates for the uninsured, we can give them a 50% “prompt payer discount” for any exam, a program that I started in 2012 and which continues today. In other words, compassion is the alignment of empathy with action. As a compassionate leader, take every opportunity to make a positive change for your community.
And remember—listen also to the suggestions and ideas of your entire team, from receptionists, to colleague physicians, to administrators. Ask them questions. You will never learn to be a compassionate leader if you are unwilling to learn from others. Ask your staff what challenges they encounter with registering, scheduling and interacting with your patients. Assume the best in them, that they too are thoughtful about their jobs and want to improve the patient experience. Learn also about the costs of medical care, including hospital vs non-hospital costs. Order those exams that will make a difference to your patient’s health. When you ask questions, you may find that the patient experience is going well, but that is the less likely outcome. I once asked to see the letter that patients receive when they do not pay their bills on time, and I was horrified. I now review and edit every form letter that is sent to my patients. I look at these as they would, I put myself in their place, from their perspective. As I said, compassion is the alignment of empathy with action, and all parts of the patient experience matter, including paying the bills. Be the type of physician you want for yourself, and create the team that is as caring as you are.
Here in Connecticut, TPIU has been helping to spread the word about compassionate healthcare on TV, on radio, in the print media and online. We promote the importance of compassionate care to our community, our physicians, our healthcare leaders, and our local government. Just as the GHHS honors medical students for their humanism, TPIU honors practicing providers for their humanity and compassion. We had our first awards ceremony in October 2019, where we honored several local caregivers, including your own Dean Koeppen for his excellent work promoting compassionate healthcare. Assuming that this miserable COVID virus is finally, mercifully behind us, we are hoping to arrange an Educational and Award Symposium this October.
Let me conclude by saying that—because of smart, caring and devoted students like you—the future of medicine is bright and filled with possibility. We can and will reassert a personal, caring touch to the delivery of healthcare, one that is centered on patients and their needs, and which utilizes both quantitative and qualitative metrics to provide meaningful, effective and lasting care. We must become partners with our patients, have them be full participants in their healthcare treatments and decisions, and hold them accountable for doing their part in maintaining their health.
Tonight, we recognize and celebrate all of you students who promote humanism in medicine. You have demonstrated your willingness to go the extra mile, to take the time and make the effort necessary to provide your patients with a compassionate experience. In so doing, I have no doubt that your work will lead to improved patient experiences and outcomes, to comforting your patient’s families and loved ones, to increasing confidence overall in medicine and the healthcare experience, and to far more fulfilling lives and professions for you, your colleagues and your teams.
Tonight, we assert that the human connection is the key to a successful healthcare system. But achieving our goal will not be without its challenges—throughout your careers you will come across forces that push you hard in other directions, for short-term profits and efficiencies based on metrics and data that, far too often, have been wrongly interpreted. At those times, remind yourselves of why you went into this profession in the first place. What motivated you to go through all the time and effort to become a doctor? My guess is that it was not to do the most medical procedures, to compile the most data, or to handle a conveyer belt of patients. No, I imagine it was because you care—about people, about relieving suffering, about changing and improving lives. So be bold, be creative and make it happen. Make it all about the patient.
Thank you.