By Dr. Maria Patriquin MD CCFP
For a printable pdf of Love Begins With the Letter “C”, click here.
Work and love
I send my Christmas cards after Christmas. I write about love after Valentine’s Day and so it goes. Let’s celebrate “love month”. Much has been written this month bestowing the health, emotional and longevity benefits of loving relationships (Vaillant, 2012) but little is spoken of the forbidden “L” word that is woven through our work as health care providers. We would never attribute such meaning, devotion, energy and purpose to anything other than what we Love.
Limited time, budgets, shrinking resources, an aging population, stressed kids, epidemic levels of depression and anxiety coupled with increasing expectations in a “not well” health care system has led to expanding roles and responsibilities for providers. “Burnout” and “compassion fatigue” are common in our language around how care is being impacted (McCray, Cronholm, Bogner, Gallo & Neill, 2008).
Our professional roles have evolved along with advances in technology (e.g. easier access to current information and more effective and efficient treatments). There is a push for technology to fill in the health care gaps, we will gain, but we stand to lose a lot as it can never replace human connection. With it comes a cost of losing opportunity and eventually ability to connect on a human level. We stand to lose our role as “healers” and that which creates our meaning, satisfaction and contentment with our work.
Healing necessitates a human connection and nothing can replace what happens when we are fully present. Space, time, words, gestures and touch permit expression and sharing of pain, suffering and similarly joy, love, hope and triumphs. Compassion is an emotional response to suffering that is accompanied by a desire to help. It differs from empathy, the emotional experience of another’s feelings (Sinclair, Norris, McConnell, Chochinov, Hack, Hagen, McClement & Bouchal, 2016).
What we know about compassion
Emerging research points to us possessing a “compassion instinct”. Observations of human infants and chimpanzees show they engage and are attentive when they themselves are helping and similarly when they witness others helping. This suggests that the body responds not just based on reward (Warneken & Tomasello, 2006).
Despite the numerous YouTube videos capturing people not coming to the aid of others in need, professors at Harvard have shown that helping is a primary impulse for both children and adults (Rand, Greene and Nowak, 2013). Empathy and compassion are natural, they are inborn “pro-social drives” to connect to other human beings and we don’t just want this, we need this to survive.
Compassion creates physiological and emotional changes that we experience as pleasant and positive. Neural imaging studies (Green, Lambon, Moll, Zakrewski, Deakin, Grafman & Zahn, 2013) showed that the pleasure centres in the brain are activated when we see someone give similarly as when we receive. In fact, it appears that we experience more pleasure and happiness from giving than receiving and this has even been shown in children as young as two years of age (Dunn, Aknin & Norton, 2008; Aknin, Hamlin & Dunn, 2012).
Research is compelling that feeling connected by a meaningful life full of altruism, empathy and compassion leads to better physical and mental health, aids in healing, enhances immune function and decreases inflammation in the body (a process we know underlies the development of disease; Diener & Seligman, 2004; Fredrickson, Cohn, Coffey, Pek & Finkel, 2008).
Strong social connections increase longevity, increase mood, decrease anxiety, depression and make people more trusting and cooperative which
causes a reciprocal effect making it a positive feedback loop (House, Landis & Umberson, 2003). Kindness and compassion are contagious.
In order to truly care for our patients and support them we need to show empathy and demonstrate compassion in our care. Often the lines blur for us as our training creates an artificial “us/them” divide (there is only we). Legitimately we need to maintain certain boundaries, ones we can only establish if we are mindful of our own emotional experiences. Often we are taught to suppress our own emotions in an effort to cope. Ironically in asking this of ourselves we inhibit the instinct that allows us to elicit an empathic response.
Research supports the practice of compassionate care as it improves patient satisfaction, adherence, decreases anxiety and stress feelings and enables patients (Kelm, Wormer, Walter & Feudtner, 2014). Some studies have actually shown improved Diabetic Hb AIC levels and lower LDL levels when patients were cared for by a family doctor they felt to be empathic (Derksen, Bensing & Largo-Janssen, 2013). The postulated mechanism is that empathy and compassion increase trust and this itself promotes honesty in reporting, better alignment in treatment plans (patient engagement), follow up and then the ability to “stick with it” (CMA, 2007).
TAKE HOME MESSAGE:
All you need is love and compassion.
What can we do as front line workers?
Have self-compassion. Take Care. Eat well, sleep, exercise, socialize,
take time off and emote. Without space for our emotions in the care of others we cannot authentically hold any suffering and joy with compassion (Neff, Kirkpatrick & Rude, 2007). I like to think of compassion as the “antidote to burnout”.
Through compassionate exchange of stories we create the circumstances to help heal others and ourselves. It is an emotional, cathartic, inspiring and validating experience we can have with each other (Pennebaker, 1997; 2000; Jain, 2015).
Mindfulness and loving kindness meditation is another means to self-care and emote. Loving kindness meditation increases mood, decreases stress, depression and self-criticism. It increases empathy, compassion and makes us more helpful (Fredrickson et al, 2008).
Listen and tell stories. Our encounters often start with the recounting of a story. The narrative offers a personal account of experiences (symptoms, feelings, thoughts) and holds the possibility of being understood by the listener. Our input changes the narrative and it becomes a shifting, changing and co-created narrative. Be sensitive, choose kind, non-judgemental words, gentle gestures and give the time and safe space for it to unfold. We have great therapeutic potential by being supportive, compassionate and responsive to our patients, their experiences and perspectives (Launer, 2006). The lovely thing is that in this co-creation of narrative, this enabling of emotions and compassion there is mutual influence and benefit. We are in this together. Compassion is a win-win experience (Coulehan, 1991).
Show compassion to other health care professionals. Our stress fosters resentment and blame. That is not healthy space from which to care. Showing compassion to other health care professionals enables us to collaborate in a constructive manner, we need this. “Compassion is an antidote to crisis”. Collaboration does not merely require a systems review and detailed budget, it too is natural and results when everyone feels they are deserving of compassion and kindness. We are all human, and care is “better together”. This collaboration will serve all of us well. It contributes to a culture of wellness within our health care model that we all desire and need.
Compassion can be taught. There are a growing number of programs aimed at teaching and fostering compassion and a “Triple C” model is being out forward than encompasses compassion. The best lessons are shared when we practice what we preach (Tannenbaum, Kerr, Konkin, Organek, Parsons, Saucier, Shaw & Walsh, 2011; Lown, McIntosh, Gaines, McGuinn & Hatem, 2015; Branch, Davis & Weng, 2012).
When all else fails reflect and remember those we admire most and that with compassion they not only lived happy content lives but also contributed significantly to humanity.
Darwin actually spoke to the strength of social and maternal bonds… “communities, which included the greatest number of sympathetic members, would flourish best…” He didn’t state “survival of the fittest” as we all believe, he said it’s about “survival of the kindest”. Some things evolve, some things stay the same.
You can never go wrong with Love. And in our professions, Love begins with the letter “C” for compassion.
By Maria Patriquin MD CCFP
LIVING WELL INTEGRATIVE HEALTH CENTER Promoting compassion, communication and collaboration in health care, “better together”.
- Joan Halifax: Compassion and the True Meaning of Empathy. https://www.ted.com/speakers/joan_halifax.
- Kristen Neff: The Space Between Self-Esteem and Self-Compassion. http://tedxtalks.ted.com/video/The-Space-Between-Self-Esteem-a or see: http://self-compassion.org/
- Manoj Jain: Narrative Medicine. Online classes for health care providers. https://www.creativenonfiction.org/narrative-medicine.
Aknin, L.B., Hamlin, J., & Dunn, E.W. (2012). Giving leads to happiness in young children. PLoS ONE, 7(6), e39211. doi:10.1371/journal.pone.0039211.
Branch, W., Davis, K., & Weng, M. (2012). Teaching Compassion. Patient Educ. & Counseling, 89(1), 3-4. doi: http://dx.doi.org/10.1016/j.pec.2012.03.013.
Coulehan, J.L. (1991). The word is an instrument in healing. Lit.Med., 100,111-129.
Darwin, C.R. (1871). Descent of man, and Selection in Relation to Sex. London: John Murray.
Derksen, F., Bensing, T., & Lagro-Janssen, A. (2015). Effectiveness of empathy in general practice: Systematic review. Br. J. Gen. Prac., 63 (603), e76-84. doi:10.3399/bjgp13X660814.
Dunn, E.W., Aknin, L.B., & Norton, M.I. (2008). Spending money on others promotes happiness. Science, 319(5870), 1687-1688. doi: 10.1126/science.1150952.
Diener, E., & Seligman, M.E.P. (2004). Beyond money: Toward an economy of well-being. Psychological Science in the Public Interest, 5, 1-31.
Fredrickson, B.L., Cohn, M.A., Coffey, K.A., Pek, J., & Finkel, S.M. (2008). Open hearts build lives: Positive emotions, induced through loving-kindness meditation, building consequential personal resources. J. Pers. Soc. Psychol, 95(5),1045-62.
Green, S., Lambon, R., Moll, M.A., Zakrewski, J., Deakin, J.F., Grafman, J., & Zahn, R. (2013). The neural basis of conceptual-emotional integration and its role in major depressive disorder. Soc. Neurosci, 8(5), 417-433. doi: 10.1080/17470919.2013.810171.
House, J. S., Landis, K. R., & Umberson, D. (2003). Social relationships and health. In P. Salovey, A. J. Rothman, P. Salovey, A. J. Rothman (Eds.) , Social psychology of health (pp. 218-226). New York, NY, US: Psychology Press.
Kelm, Z., Wormer, J., Walter, J., & Feudtner, C. (2014). Interventions to cultivate physical empathy: A systematic review. BMC. Med. Educ., 14, 219. doi: 10.1186/1472-6920-14-219.
Launer, J. (2006). New stories for old narrative-based primary care in GB. Families, systems and health, 24(3), 336-44. http://dx/doi.org/10.1037/1091-75184.108.40.2066.
Lown, B. A., McIntosh, S., Gaines, M. E., McGuinn, K., & Hatem, D. S. (2015). Integrating Compassionate, Collaborative Care (the “Triple C”) Into Health Professional Education to Advance the Triple Aim of Health Care. Academic Medicine: Journal of the Association of American Medical Colleges. http://doi.org/10.1097/ACM.0000000000001077
Jain, M. Narrative Medicine [Online class for health care providers]. Retrieved from https://www.creativenonfiction.org/narrative-medicine.
McCray, L.W., Cronholm, P.F., Bogner, H.R., Gallo, J.J. & Neill, R.A. (2008). Resident Physician Burnout: Is there hope? Fam. Med., 40(9), 626-632.
Mother Theresa. (1995). A Simple Path. Great Britain: Random House UK Ltd.
Neff, K.D., Kirkpatrick, K.L., & Rude, S.S. (2007). Self-compassion and adaptive psychological functioning. J.Res. in Pers.,41, 139-154.
Pennebaker, J.W. (2000). Telling stories: The health benefits of narrative. Lit. Med., 19(1), 3-18.
Pennebaker, J.W. (1997). Opening Up: The healing power of expressing emotions. New York: Guilford Press.
Pennebaker, J.W. (1997). Writing about emotional experience as a therapeutic process. Psychol. Sci, 8(3),162-166. doi: 10.1111/j.1467-9280.1997.tb00403.x
Canadian Medical Association. (2007). Putting Patients First: Patient-Centred Collaborative Care: A discussion paper. Retrieved from http://fhs.mcmaster.ca/surgery/documents/CollaborativeCareBackgrounderRevised.pdf
Rand, D.G., Green, G.D., & Nowack, M.A. (2013). Spontaneous giving and calculated greed. Nature, 489, 427-430. doi: 10.1038/nature11467.
Sinclair ,S. Norris, J.M., McConnell, S.J., Chochinov, H.M., Hack, T.F., Hagen, N.A., McClement, S., & Bouchal, S.R. (2016). Compassion: A scoping review of the healthcare literature. BMC. Palliat. Care.,15(1),6. doi:10.1186/s12904-016-0080-0.
Tannenbaum, D., Kerr, J., Konkin, J., Organek, A., Parsons, E., Saucier, D., Shaw, L., Walsh, A. (2011). Triple C Competency-Based Curriculum. Retrieved from: http://www.cfpc.ca/uploadedFiles/Education/_PDFs/WGCR_TripleC_Report_English_Final_18Mar11.pdf
Vaillant, G.E. (2012). Triumphs of Experience. The Men of the Harvard Grant Study. Cambridge, MA: Belknap Press of Harvard University Press.
Warneken, F., & Tomasello, M. (2006). Altruistic helping in human infants and chimpanzees. Science, 311, 1301-1303.