Make compassion a priority in patient-centered care

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In 1992, the American Academy of Pediatrics (AAP) ad-hoc committee on the patient-centered medical home (PCMH) put out a policy statement highlighting, among other key attributes, the importance of compassionate care.

By 2007, a shared group comprised of the AAP, American Academy of Family Physicians, American College of Physicians and American Osteopathic Association developed and shared a statement of joint principles of the medical home, which also noted many of its key attributes.

As I reviewed the evolution of the policy statement and principles I was struck by the fact that by 2007, compassionate care was no longer set as one of the highest priority areas for the PCMH but rather included as a subset under quality and safety.

So why is compassion no longer a key focus of the PCMH?

When I posed this question to an expert in this space, the response and perspective was quite interesting:

“Pediatricians have tended to always practice this way, with compassion. As other organizations came to the table and the PCMH concept expanded beyond the pediatric office, more and more weight was placed on the technical aspects of care provision and less and less on compassionate care.”

And when I step back and take a more global view of challenges within the healthcare system I find the further we move away from a focus on compassion the further we move away from our ultimate goal and responsibility of ensuring those we are blessed and entrusted to serve are well taken care of and kept safe.

Some examples:

– We hear more and more about the shortage of primary care physicians and yet we don’t create a model of primary care that allows physicians the opportunity to truly connect with their patients, develop relationship and trust, hear whole stories, share empathy, and show compassion, while also having the opportunity to truly connect with their own passion for healing.

– We hear more and more about physician burnout and nurses suffering from depression and yet we continue to incentivize with money, continue to focus on productivity and continue to under staff healthcare organizations (placing our patients and our staff at risk). We continue to move further and further away from our patients and compassionate care provision (while noting “technology will replace human connection”) and wonder why we no longer have joy in healing (but rather burnout and depression).

– We talk more and more about improving health outcomes and doing so efficiently and yet we dismiss the empirical data that supports the view that compassion in healing improves health outcomes.

– Physicians pledge to honor the Hippocratic Oath, which includes the statement ” … warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.” Yet we do not create systems that allow for a focus on warmth and sympathy along with an appropriate balance of surgical, pharmaceutical and other medical /behavioral interventions.

The patient-centered medical home and its continued evolution is certainly a step in the right direction but we must refocus its principles to ensure compassionate care is elevated in the hierarchy of priorities.

Medicine is not a job. It is not even a career. At its heart, medicine is a calling.

And as healthcare leaders (regardless of the model, e.g., PCMH, ACO, etc.) it is our job to best position healthcare professionals to honor their calling and care for their patients compassionately if we are to optimally serve all those entrusted to us.

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7 comments

  1. Thoughful piece there is a tension though and imperfection in naming particular priorities. It’s about prioritizing the right focus for the issue. It’s not going to help a patient if you get their meds wrong because you didn’t focus on the technical when they have a complicated meds list cos you were so focused on showing empathy and compassion. Neither is it helpful to focus on a diabetes patient’s HbA1c and not connect with them over the death of a close relative. This is where professionalism passion and good mentoring and organisational culture help health providers be the best provider in the moment with the patient. As for under staffing let’s take responsibility for constantly evolving work practices delegations and processes instead of hanging onto the way things have always been done and we might find more time and more rewarded staff.

    • Thank you Fiona for such an astute response.

      It is truly a must that the clinical research and science of medicine be optimized.

      [That said see John Ioannidis work out of Stanford for challenges in the research space along with Lies, Damned Lies, and Medical Science by David Freedman: http://www.theatlantic.com/magazine/archive/2010/11/lies-damned-lies-and-medical-science/308269/%5D

      And the PCMH intent for many was to maintain a focus in this area and prop up further with technology.

      Unfortunately the unintended (or intended) consequences also led to less of a focus on compassion for doctors, nurses, staff, patients and families … causing harm to each …

      (see Pamela Wible, MD work in physician suicide for example: “We lose a medical school full of physicians every year to suicide: An interview with Dr. Pamela Wible” … http://www.kevinmd.com/blog/2015/11/we-lose-a-medical-school-full-of-physicians-every-year-to-suicide-an-interview-with-dr-pamela-wible.html)

      … and a lack of connection and understanding of the science of compassion and empathy to optimal healing.

      It is essential the balance of focus leverages all key drivers within the complex adaptive system to achieve optimal healthcare.

      And in doing so also assess and determine the appropriate staffing model (which may be different by location) and then honor that model (evolving as necessary) to ensure again optimal outcomes.

      Thank you again for reading and sharing.

      Sincerely,

      Tom

  2. How do I submit something I have written for publication? I am an RN of twenty years now and this article touched me. Inspired me as I become disabled myself from a chronic illness I cannot afford. I am treated with much more compassion when I introduce myself as a fellow healthcare professional.

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