Developing Compassion… In Medicine and in the Community

by Dr. Marcelo Bento Soares
University of Illinois College of Medicine Peoria

Compassion is a competence that needs to be developed and nurtured throughout our lives.

Whether you know someone who has lost a loved one, you received bad news yourself, or you were the bearer of bad news, not knowing what to say, what to think or how to respond can be paralyzing.

Compassion is an aspiration to alleviate the suffering of another, imbued with a sense of determination, urgency, responsibility, commitment, readiness and preparedness to act should the opportunity arise. There is ample scientific evidence that, just as with generosity, compassion benefits the giver as much—if not more—than the receiver.

Like learning to play a musical instrument, compassion is a skill that can be developed with training. In my view, compassionate care training needs to be part of medical education. It should not be viewed simply as desirable, but rather as a required skill. It is one of the competences a healthcare provider ought to have. But why?

Compassion vs. Empathy
Compassion is not the same as empathy. Affective empathy refers to a resonance with the others’ feelings, be those of joy and happiness or of sadness and suffering. Research shows that the same regions of the brain get activated when we experience pain ourselves, as when we empathize with the pain and suffering of another person.

Considering that healthcare providers are constantly exposed to the suffering of others, if they relate to these experiences with affective empathy, it will feel as if they lived with chronic pain. This is not a desirable or sustainable state, and it defeats the purpose of “caring” because soon enough, emotional exhaustion and feelings of depersonalization—the two chief characteristics of burnout—are likely to arise. Burnout may be conducive to depression, and more importantly, to a decrease in empathy.

Interestingly, research has shown that doctors who lack empathy are also less able to control metabolic complications that may otherwise arise in patients with diabetes. In other words, a doctor’s empathy has an impact on his/her patient’s clinical outcome. In addition, fears of stigmatization may prevent healthcare providers who are experiencing burnout, depression or anxiety from seeking mental health support.

Untreated, these conditions may worsen and on occasion result in fatalities. An estimated 350 to 400 physicians commit suicide every year. This is three times the average size of a graduating medical school class. Suicide is a leading cause of death for medical residents, second only to cancer. How can compassion training help improve this situation?

From Empathy to Engaged Compassion
Compassion training starts with self-compassion. As instructed every time we fly, we ought to place our oxygen masks on first before helping others. A truly altruistic motivation would be to place our “mask” on first for the very purpose of helping others. How many more people will we be able to help if we are well?

So, we begin with self-compassion, but with the underlying motivation to acquire the skills that might enable us to alleviate the suffering of others. Compassion training cultivates skills that enable the transformation of affective empathy—the feeling of “suffering with”—into engaged compassion to bring comfort, to heal, to alleviate suffering of another person. Research has shown that this aspirational mental state activates regions of the brain associated with motivation and reward—a sharp contrast with the activation of the pain centers when one experiences empathetic distress or affective empathy.

Patients are not composites of malfunctioning parts; they are people with feelings, fears, needs and hopes. Doctors, too, experience pain and have families, illnesses, problems and limitations, just as all human beings do. A genuinely caring and compassionate interaction between a doctor and a patient may be healing, fulfilling and energizing for both the patient and the provider. Irrespective of the outcome, which often is beyond the control of either, a doctor may always feel a sense of joy when he or she is able to provide a nurturing moment to his or her patient. The sense of purpose and meaning that is evoked in such moments is invaluable, providing motivation to continue to serve as a source of healing and nurturance throughout the day.

Educating the Community
With the motivation to bring compassion education and research to our medical school—and compassionate care training to our community at large—we have established a partnership with Emory University, where CBCT—Cognitively-Based Compassion Training—was developed by Dr. Lobsang Tenzin Negi, executive director of the Center for Contemplative Science and Compassion-Based Ethics.

CBCT was developed several years ago in response to Emory medical students’ request for interventions to help minimize their risks for depression, anxiety and suicide. It has since been implemented in several medical schools, including here in Peoria. CBCT has proven beneficial to numerous special populations, such as youth in foster care homes, cancer survivors and veterans with post-traumatic stress disorder, among others. CBCT as a secular training program is suitable to everyone, regardless of faith and religious tradition, or lack thereof.

Compassion is a competence that needs to be developed during medical education and nurtured through practice throughout our lives. CBCT is not the only program available to enable the cultivation of such skills, but it is among the best, most rigorously tested and widely adopted. Since February 2017, we have provided CBCT courses to medical students, physician residents, faculty and supporting staff at the College of Medicine here in Peoria; to physicians and nurses at OSF, Jump Simulation and UnityPoint Health; to teachers, principals and counselors in Peoria Public Schools; to the leadership of the Peoria Police Department; and to numerous members of the Peoria community.

I am thankful to the Susan G. Komen Memorial Peoria Affiliate and to the College of Medicine for supporting this initiative—and for enabling myself and my colleagues from UICOMP and Methodist College to pursue training to become CBCT-certified teachers and share this skill and its positive impacts. iBi

Marcelo Bento Soares, PhD, is professor and chair of the Department of Cancer Biology and Pharmacology and Senior Associate Dean for Research at the University of Illinois College of Medicine Peoria.

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