Cultivating Caregiver Compassion

 

Good doctors have excellent clinical and science-based problem-solving skills, but there’s increasing pressure on these care providers to improve their people skills, too.

A recent report on KaiserHealthNews.org (KHN) explained that many medical centers, and private practices, are trying to relate better to patients partly because it delivers better health care, and partly because patients increasingly expect to be treated as partners, not patronized customers.

Also, as doctor pay increasingly is based at least partly on patient reports, it’s in their best interest to be better listeners and more sensitive to their patients’ needs, which are about medical care as much as they are medical treatment.

Part of the Affordable Care Act calls for Medicare to subsidize hospitals partly on the basis of patient satisfaction surveys. And as patients share more of the cost of their care, they’re pickier about the quality of the whole experience, not just the health outcome.

Most doctors are sinking under the weight of an out-of-control medical records system, insurance demands and shrinking insurance reimbursement that force them to maintain a crazy schedule just to remain in business. Sometimes, amid all that stress, they can be short, condescending and inconsiderate.

Martha Hayward, a patient engagement professional at the Institute for Healthcare Improvement, told KHN, “We train people to ask the question, ‘What’s the matter?’ We train toward diagnosis. We don’t train toward lifestyle understanding.”

KHN referred to a study from 2011 that found that only about half of recently hospitalized patients said they experienced compassion during their treatment, even though both doctors and patients involved in the research said that kindness in such settings is valuable and important.

Some medical facilities, such as those at the University of Michigan, the Cleveland Clinic and the Duke University School of Medicine are trying to encourage physicians to be more responsive, according to Tim Vogus, an associate professor of management at Vanderbilt University. He studies the relationship between compassion initiatives and patient satisfaction scores.

His research shows that hospitals that promote compassion, especially by rewarding those who embrace it, are more likely to have higher patient satisfaction scores.

We need research to confirm this? If you’re nice to a dog, she’s likely to lick your hand; if you abuse her, she’s more likely to bite it.

More medical schools, like Duke’s, require students to take courses to help them be empathetic, they offer training to practicing physicians. Some of these programs encourage providers to enter personal details about patients in their medical charts to enhance communication over common interests. Some suggest that doctors send handwritten to patients and their families as part of follow-up care.

Such small gestures, according to Matthew Taylor, who was interviewed by KHN, are quite meaningful. After his daughter was prescribed new medication for her anxiety and depression, the doctor called to check up on her. The doctor’s office, he said, “considered it important — even if it’s only taking 30 seconds or a minute of time to say, ‘Are things going well? Is there anything we need to be concerned about?’ — shows that they’re paying attention to things they need to be doing,” said Taylor.

Doctors working in hospitals are on the frontline of this patient-awareness initiative, generally because of the patient surveys’ influence on Medicare payments. But it’s not just doctors, it’s the whole health-care team that must know how patients perceive them. Cleveland Clinic employees get regular feedback from patients’ reviews, and if there’s a pattern of things they do that patients dislike, they can adjust.

At the University of Rochester Medical Center in New York, doctors who demonstrate compassion are called out in messages the department head sends out to the hospital’s faculty. The information often comes from patient evaluations, and includes practices such as spending extra time at a bedside and answering questions in ways the patient can understand.

It’s not that difficult to connect, and it often pays off in better health outcomes. “If patients feel their doctors genuinely care,” according to the KHN story, “they’re more likely to take medications and comply with recommendations.”

Stephen Post, who directs the Center for Medical Humanities, Compassionate Care and Bioethics at Stony Brook University in New York to KHN that when physicians listen more carefully, they can to pick up patient cues and details they might otherwise miss, and consequently prescribe better treatments.

And when they don’t, the opposite can occur. One woman in the KHN report thought her new doctor was condescending and dismissive during an office visit. It was so upsetting that she forgot to ask about the problem that brought her in, and wasn’t exactly enthusiastic about getting follow-up care.

“I was feeling obstinate,” she said. “It was almost a way to get back at him.”

Their hectic schedules and the pressure to see ever more patients just make ends meet can make doctors forget to listen, or even offer a greeting on entering the exam room.

“It’s not that they don’t care,” one KHN interviewee offered. “But they forget.”

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