In This Episode: The medical profession is starting to realize that it’s been missing a very important element of patient care. It’s likely that you’ll be very surprised to hear what it is, but then when you think about it, it’ll make total sense — and you’ll be mad that you didn’t get it.
073: The Missing Element
- Help support Uncommon Sense: — yes, $5 helps!
- The story about Rosaura Quinteros, who helped save Col. Jason Denney, which brought me to this subject.
- Dr. Trzeciak’s TEDx talk is embedded in the transcript.
Welcome to Uncommon Sense. I’m Randy Cassingham.
What’s the biggest problem in healthcare today? I mean in the actual practice of healthcare, not the cost or doctor shortages, but what medical professionals do on the job. I suspect most healthcare providers would probably say “burnout” — they have too much to do, too much paperwork, too much administrative duties, and thanks to that doctor shortage, a never-ending line of patients needing care, but they’re so busy there’s never enough time to provide all the care that’s needed.
Enter Dr. Stephen Trzeciak. He’s not just a professor of medicine at Rowan University in Camden, New Jersey, he’s the Chairman and Chief of Medicine at Cooper University Hospital. He’s board certified in internal medicine, emergency medicine, critical care, and neurocritical care, all particularly heavy-hitting specialties. He works as an intensivist — the doctor who treats patients in intensive care. People only get admitted to the ICU when they’re critically sick or injured, so he has to be able to deal with it when, despite all his efforts, many of his patients die anyway.
So it’s probably no surprise that with all of that, he was burned out.
Trzeciak says that the typical “treatment” for burnout is to get away for awhile — detatch from the job, go on vacation. He said he felt intuitively that detachment was probably the wrong thing to do. He probably noticed that detachment didn’t help him, and didn’t do much for his colleagues, either.
Meanwhile, he says, we are “in the midst of a compassion crisis.” He’s not talking about sympathy or empathy: he says scientists define compassion as “an emotional response to another’s pain or suffering involving an authentic desire to help.” Sympathy and empathy are “the understanding components,” but compassion involves taking action.
Dr. Trzeciak tells the story of a 2007 highway crash in Sweden: two buses collided head-on. Amazingly, only six people were killed; 56 were saved. Researchers followed up with those 56 people five years later to ask what they specifically remembered of their ordeal. Two things stood out as their strongest memories. The first thing, no surprise: pain. The second thing: a lack of compassion from the people who cared for them during their hospitalization. Besides pain, that’s the biggest thing they remembered. Not fear, not the impact on their families, but rather that the doctors and nurses just didn’t seem to care.
But, Dr. Trzeciak continues, the big question is, “Does compassion really matter?”
Being a research geek, he dove into the studies: there are a lot of studies about compassion in a medical setting. He reviewed more than a thousand study summaries, and read in detail the studies that stood out to him — around 200 of them. He found that two-thirds of patients surveyed by researchers said they could think of a medical encounter where they felt no compassion at all from their doctor. I’m frankly surprised that number isn’t higher!
As he read study after study, it was obvious they formed a very strong conclusion: compassion does matter — a lot. Not just because of the moral imperative, but it turns out that the effect on healthcare providers of expressing compassion for their patients is significant: it leads to more attentive and effective care, which obviously benefits patients. In fact, studies of compassion find the patients have much better medical outcomes if they feel their doctors actually care. When doctors feel compassion for patients, they’re less robotic: they order fewer tests, make fewer referrals to specialists, order fewer unnecessary hospitalizations, and, I’d guess, make fewer mistakes — all factors which significantly lowers the cost of care.
This doesn’t mean that doctors and nurses have to spend an hour looking deep into your eyes to make sure you know they care. So then the obvious question is, how long does it take to provide a “meaningful expression of compassion” — the amount of time it takes patients to say yes, they felt their doctor treated them with compassion; they felt their doctors cared what happened to them. So researchers studied that, too.
The results are stunning: it only takes 40 seconds to let the patients know their doctor understands that this is a scary and stressful time, that he or she will work hard to get them through it, and will be there for them. They also encouraged patients to interrupt to ask questions if they’re confused or unclear. All that actually only took 35 seconds in the study. At the end of the appointment all of that is reinforced with the I’ll be there for you part, which accounts for the other 5 seconds.
Johns Hopkins University came to that conclusion after studying cancer patients having their first consultation with their new oncologists, about the most stress-inducing doctor’s visit someone can have. They used rigorous study protocols: a randomized, controlled trial with actual doctors and patients. And the answer was just 40 seconds! What doctor really doesn’t have 40 seconds to connect at a human level with their patients? Especially when it leads to significantly improved outcomes? That’s what they’re there for: the best possible outcome! It’s their job!
But the real clincher is, the doctors benefit too, with reduced stress, better health, and less burnout. That’s the kind of win-win we often see when Uncommon Sense is used to drive change.
After reading that study, Dr. Trzeciak realized that maybe that was a better “treatment” for burnout — instead of detaching, maybe they should actually “attach” more by making it a point to spend that 40 seconds to convey compassion purposefully. Maybe, he thought, doctors could benefit as much as the patients to ease their burnout. He didn’t find a study for that, so he did his own study, using just himself as a test subject, and making sure that he spent at least 40 seconds of each patient visit to engage compassionately with them.
And the more he did it, the less burnout he felt. He says it changed his life. And, by the way, it helped his patients too: outcomes improved.
What brought my attention to Dr. Trzeciak wasn’t finding an article about him. It was an article about Rosaura Quinteros, who works at the Dr. P. Phillips Hospital in Orlando, Florida. One of the patients she visited daily was Jason Denney, a 52-year-old U.S. Air Force colonel who was near death from COVID-19. He was in such bad shape that a priest even gave him last rites.
Maybe because of his military background, Denny had refused sedation, and refused a ventilator to help him breathe. He put his energy and attention into surviving for the next 5 minutes. And then the next 5, and the next 5.
Quinteros was in a group of hospital employees who was asked to spend just a few minutes talking with patients on a personal level. The person who made that request was the hospital’s manager of chaplains, Melinda Plumley, because chaplains were being kept out of COVID patients’ rooms to reduce the chance of spreading the virus. “We put together some material of easy, open-ended questions for staff to get the patient talking,” Plumley said.
The interesting thing here is that Quinteros isn’t a doctor. She isn’t a nurse or even a nurse’s aide. She’s a janitor. In a hospital, sanitizing patient rooms is a critical function, so she saw patients every day. Plumley had realized the hospital custodians were the perfect people to engage the patients with some human contact on a daily basis: they could spare a few minutes when the overworked doctors and nurses probably didn’t need any other work dumped on them.
Can that possibly work? I mean, a non-medical person doing the compassion contacts with patients to help them recover?
Colonel Denney thinks so. “It was really nice to talk about something other than my illness,” he said. “I was sick and tired of hearing about what bad shape I was in.” And, he said, “I don’t think she realized at the time what she was doing for me. She was saving my life.”
Because Denney had lost hope. Using Facetime on his phone, he had even said goodbye to his family. But Quinteros saw his fear and knew she had to engage with him, even though English isn’t her first language — she’s from Guatemala. That didn’t seem to matter. “When a patient is treated with compassion and love,” she said, “language is not a barrier.”
As they talked a little each day, they found common ground. Quinteros is married and has two children. Denny is married and has three. They’ve both traveled to other countries, and they’re both Catholic.
Denney did recover. “People don’t realize that in their brief engagements with other people, the words you say matter,” he said. “And in the situation I was in, they really matter.” After he got home he asked the hospital for Quinteros’s phone number, and then sent her a text to say thanks. When they can do it safely, he wants their two families to meet, and to take her family out to dinner so he can say thank you in person.
Working in emergency medicine myself, even just as a volunteer medic, I think the medical staff mostly does care, but they might not be very good at showing it. I know I’m not. But I realized that if a hospital custodian can do it in a language she’s not fluent in, I sure as hell can.
Not that I never do. One of the most poignant times I remember wasn’t actually a patient: it was the patient’s husband. I had to tell him his wife was dead. When I arrived, he was doing CPR on her, and I was experienced enough to know she couldn’t be revived, and that he could stop doing CPR. And as that sunk in, I told him I’d step out of the room so he could be alone with her for one last moment.
But I’ve failed in it too. Again, not with a patient! That time, I was the closest medic to a grammar school, and heard a dispatch to there for a kid who was injured on the playground. Another kid had jumped on him, and the school staff thought he might have a broken neck. I got there first, but the troops were pretty close behind me. I took the job of holding traction on the kid’s head, to keep it in line with his body as they packaged him for transport. If his neck was broken, we wanted to make sure he didn’t end up paralyzed. Sure, odds were his neck wasn’t broken, but if it was, the risks were catastrophic.
After putting the kid in the ambulance, I was about to jump into my car to leave when I spotted the other kid — the one who jumped on the boy. His mom was leading him to their car to go home, and he was crying. I looked at that for a moment, couldn’t think of anything I should say, and left. And that decision haunts me to this day, because within 10 or 15 minutes, I realized what I should have said to him.
I should have stopped mom, gotten down on my knee so I’d be at his level, look him in the eyes, and tell him I know what just happened was scary. It looks like his friend is really hurt, but he’s probably not. He just needs to go to the doctor to be checked to make sure of that, and he’s probably going to get to go home in time for dinner. He’ll probably be sore tomorrow, but he’ll be OK. OK? And then let him talk or ask any questions he had.
You know, all that would probably only take around 40 seconds. I’ll submit that’s likely the most important 40 seconds in medicine, and you better believe I’m going to spend those few seconds with every patient I interact with, now that I know about this missing element in healthcare. I hope your doctor has learned about it too.
The Show Page for this episode is thisistrue.com/podcast73, where I’ll link to the story about Quinteros and Denney, and to Dr. Trzeciak’s TEDx talk. Also there, I’d love for you to leave a comment if you’ve felt compassion from your doctor — or a medic! — in a serious health incident: I’d like to how you feel about it now that you know how important it is.
I’m Randy Cassingham … and I’ll talk at you later.
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