Re-humanizing healthcare and strengtheninghsc.ghs.org/wp-content/uploads/2014/10/PDF-Youngson-compassion.pdfand strengthening caring and compassion “Endless days and nights filled

Re-humanizing healthcare and strengthening

caring and compassion



Dr Robin Youngson CoFounder of Hearts in Healthcare



COMPASSION: The humane quality of

understanding suffering and wanting to

do something about it



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



“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.”



Kathy’s story

(play video)



…and emotional memories

of care last a lifetime

The experience of care

triggers a powerful

biological response in

the patient…

Photo credit: Gus Chan



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



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



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!



The science of interpersonal connection



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



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



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!



Randomised trial of

compassionate care for

homeless patients

presenting to ER -

30% reduction in repeat

visits in next month



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



Physician-patient relationship has bigger effect size on 5-year

risk of cardiovascular event than prescribing statins



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).



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



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%



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)



Our thoughts,

feelings and

intentions change

the biology of our

patients

Compassionate caring can be as

powerful as the drugs we use…



The caring

crisis

Two out of

five health

workers are

incapable of

caring for

patients

Photo credit: Guy Mayer







Australia 2013



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



empathy sympathy

non- judgement sensitivity

motivation tolerance of distress

Paul Gilbert

model of

compassion



“Approach” “Withdrawal”

kindness appreciation gratitude mindfulness the joy of service

Two competing systems of motivation:

pain anxiety fear distress





Number 1 priority: Health and

wellbeing of health professionals



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…



The scientific evidence for

all these claims can be

found in the book that

launched Hearts in

Healthcare



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





heartsinhealthcare.com

{the movement for human-centred healthcare}

Documents

Re-humanizing healthcare and strengtheninghsc.ghs.org/wp-content/uploads/2014/10/PDF-Youngson-compassion.pdfand strengthening caring and compassion “Endless days and nights filled