Cultivating a Therapeutic Compassionate Relationship: The 3S Approach

Cultivating a Therapeutic Compassionate Relationship: The 3S Approach

An article published in Journal of Medicine and Life 12.4 (2019): 449.

Authors: Samoutis, George, Sophronia Samouti, and Pansemni A. Aristodemou

In the last decade, a plethora of healthcare research and literature was produced and, indeed, confirms the absolute need to cultivate a therapeutic and compassionate relationship between carer and patient/family, especially in the face of a long-term and /or life-threatening condition. We introduce the 3S model as an approach to cultivate a therapeutic relationship between the carer and the patient/family. It is based on some fundamental traditional skills which may be innate for some but may need to be awakened and cultivated for others, all for the benefit of each of the members of the involved triad: patients, family, and healthcare professionals. The 3S approach aids in developing a therapeutic relationship that involves compassion and can be easily applied with significant results, especially in the context of chronic disease management. However, more research is needed to quantify the impact of this 3S approach on the therapeutic relationship and chronic disease management.

PMID: 32025265 PMCID: PMC6993308 DOI: 10.25122/jml-2019-0045

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Doctors Who are Kind Have Healthier Patients Who Heal Faster

Doctors Who are Kind Have Healthier Patients Who Heal Faster

Which doctor would you pick: a physician who is kind and warm, or one who is cold but graduated at the top of the class in medical school?

A new book makes a strong argument for the ones who are kind and warm, not just because they’re more pleasant, but because they have better patient outcomes.

Compassionomics: The Revolutionary Scientific Evidence That Caring Makes a Difference,” written by physician-scientist team Stephen Trzeciak and Anthony Mazzarelli, provides overwhelming evidence for the healing power of compassion.

Kindness brings longer, healthier lives not only for patients, the book argues, but also for health-care professionals. When a physician is compassionate, patients heal better and faster, and the doctors are happier and less burned out.

Trzeciak is chair of medicine at New Jersey’s Cooper University Health Care and Cooper Medical School of Rowan University, and Mazzarelli is co-president and associate dean of clinical affairs there. The authors share their research on the art of healing. This conversation has been condensed and edited for clarity.

How do you define compassion?

Trzeciak: Compassion is an emotional response to another’s pain or suffering involving a desire to help. Compassion is often confused with a closely related term, empathy. While empathy is feeling and understanding another’s emotions, compassion also involves taking action.

Mazzarelli: There is neuroscience research using MRI scans to support this. When a person experiences empathy, the pain centers in the brain are activated. But when a person is focused on compassion — the action component of trying to alleviate another’s suffering — a different area of the brain, a “reward” pathway, is activated.

In your book, you show that compassion can increase patients’ healing potential. Please explain.

Trzeciak: About 30 million Americans have diabetes. The estimated health-care costs of this is $327 billion annually. What happens if a health-care provider is compassionate? Research shows that the odds of patients having optimal blood-sugar control is 80 percent higher, even after controlling for age, socioeconomic status and gender. It also shows 41 percent lower odds of serious complications from diabetes.

How? One mechanism is better patient self-care and adherence to their treatment regimen. Research shows that when health-care providers care deeply about patients, and patients feel that, they are more likely to take their medicine.

Mazzarelli: Another example is patients undergoing surgery. Studies show that warm, supportive interactions from either doctors or nurses right before going in for surgery resulted in patients being more calm (with better achievement of adequate sedation) at the start of surgery and a decrease in the need for opiate medication following surgery. Patients also spent less time in the hospital.

Are physicians and nurses aware of how their behavior can affect healing?

Trzeciak: We believe most underestimate the power of compassion. We curated the data from more than 1,000 research abstracts and 250 research papers published in medical journals to answer one question: Does compassion really matter?

When you look at the scientific evidence, you come to realize that compassion matters in not only meaningful ways but also measurable ways.

What advice would you give someone about selecting a physician with compassion?

Mazzarelli: Here are some behaviors to look for in a medical provider:

  • Sitting (versus standing) while speaking with you.
  • Facing you and making eye contact.
  • Caring about your emotional and psychological well-being.

Stay away from physicians who interrupt patients when they are speaking.

A 2018 study from the Mayo Clinic found that when patients are first describing their main medical concern, physicians interrupt patients within 11 seconds on average.

By the way, researchers have found that patients only need, on average, 29 seconds to fully describe their main concern.

Burnout rates are high among health-care providers. You say compassion is also protective for those who care for patients. How and why is this the case?

Mazzarelli: Compassion for others is a positive experience that increases one’s fulfillment in the practice of medicine and builds resilience and resistance to burnout.

Trzeciak: The historical view is that too much compassion may lead to burnout. However, research shows that an inverse relationship actually exists between burnout and compassion among health-care providers.

Health-care systems have financial incentives that are not necessarily aligned with exceptional caring. How do you transform medicine from within given these challenges?

Mazzarelli: Compassion for patients is associated with lower medical expenditures. Patients who feel their primary care doctors practice patient-centered care are less likely to utilize excessive health-care services. They also had lower medical bill charges, by about 50 percent.

Another study explains why this is the case: Patients who receive compassionate care recover more quickly from the symptom that brought them to the doctor, have fewer visits, tests and referrals. The proportion of these patients who are referred to specialists is 59 percent lower, and diagnostic testing is 84 percent lower.

Do people really want compassion from a surgeon? If I’m operated on, I’d prefer the doctor who can do the surgery most expertly rather than the one who is kind to me.

Mazzarelli: Research shows that physicians who are suffering from “depersonalization”— thinking of patients as objects rather than human beings — are prone to making major medical errors. This is also true for surgeons.

In fact, in a Mayo Clinic study of 7,905 United States surgeons, researchers found that over a three-month period, the proportion of surgeons who committed a major surgical error was three times higher among those with the highest levels of depersonalization. The researchers found that the number one reason for these major surgical errors was a lapse in clinical judgment. Perhaps you should think about that before you go under the knife?

Taken from Faculty of Medicine

Making Empathy Central to Your Company Culture

Making Empathy Central to Your Company Culture

In Tim Cook’s 2017 MIT commencement address, he warned graduates, “People will try to convince you that you should keep empathy out of your career.  Don’t accept this false premise.” The Apple CEO is not alone in recognizing and emphasizing the importance of empathy — the ability to share and understand others’ emotions — at work. At the time of his remarks, 20% of U.S. employers offered empathy training for managers. In a recent survey of 150 CEOs, over 80% recognized empathy as key to success.

Research demonstrates that Cook and other leaders are on to something. Empathic workplaces tend to enjoy stronger collaborationless stress, and greater morale, and their employees bounce back more quickly from difficult moments such as layoffs. Still, despite their efforts, many leaders struggle to actually make caring part of their organizational culture. In fact, there’s often a rift between the culture executives want from the one they have.

Imagine a company whose culture is defined by aggression and competition. The CEO realizes he and his colleagues can’t go on this way so he hastily rolls out empathy as a key new corporate value. It’s a well-intentioned move, but he has shifted the goal posts, creating distance between the organization’s ideals — prescriptions for how people ought to behave — and its current social norms—how most members of a group actually behave. He might hope this will put employees in an aspirational mood, but evidence suggests the opposite. When norms and ideals clash, people gravitate towards what others do, not what they’re told to do. What’s worse, people who adhered to the previous culture might feel betrayed or see leadership as hypocritical and out of touch.

Thankfully there’s a way to work with the power of social norms instead of against them, and consequently change cultures. As I describe in my book, The War for Kindness, people conform not just to others’ bad behaviors, but also adhere to kind and productive norms. For instance, after seeing people voteconserve energy, or donate to charity, people are more likely to do so themselves. My own research also demonstrates that empathy is contagious: people “catch” each other’s care and altruism. Here are a few ways leaders can leverage this insight to build empathy in their workplace.

Acknowledge the potential for growth. When people think of empathy as a trait that people either have or don’t have, it may seem out of reach. If you can’t learn something, why bother trying? Carol Dweck, Karina Schumman, and I have found that people who have this kind of “fixed mindset” around empathy work less hard to connect with others. If such beliefs permeate an organization, encouraging empathy as a collective value will fall flat.

The good news is that our mindsets can change. In a follow-up study as part of the research I mentioned above, my coauthors and I presented people with evidence that empathy is less like a trait and more like a skill. They responded by working harder at it, even when it didn’t come naturally. In other words, the first step towards building empathy is acknowledging that it can be built. Leaders should start by assessing the mindsets of their employees, and teaching them that they can indeed move towards their ideals.

Highlight the right norms. The loudest voices are seldom the kindest, but when they dominate conversations, they can also hijack our perceptions. Hard-partying college freshmen brag about their weekend exploits, and their peers end up thinking that the average student likes binge drinking more than they really do. When one team member loudly expresses a toxic attitude, colleagues can confuse theirs for the majority opinion. Such “phantom norms” can derail positive change when people conform to them.

Leaders can fight back against phantom norms by drawing attention to the right behaviors. At any moment, some individuals in an organization are acting kindly while others are not. Some are working together while others are competing. Empathy often belongs to a quiet majority. Foregrounding it — for instance through incentives and recognition — can allow employees to see its prevalence, turning up the volume on a positive norm.

Find culture leaders and co-create with themEvery group, whether it’s a NBA team, a corporate division, or a police department, has people who encourage team cohesion even though it’s not part of their formal role. These individuals might not be the most popular or powerful, but they are the most connected. Information, ideas, and values flow through them. They are their groups’ unsung influencers.

In a recent study, Betsy Levy Paluck and her colleagues used this wisdom to change culture in middle schools. They deputized students to create anti-bullying campaigns which were then spread around campus. The student deputies varied in how socially well-connected they were. Levy Paluck found that peer-led anti-bullying campaigns worked but were especially effective when they were helmed by the most connected students.

To build empathic cultures, leaders can begin by identifying connectors, and recruiting them for help championing the cause. This not only increases the likelihood that new ideals will “take”; it also allows employees to be recognized for connecting with others — highlighting another positive social norm at the same time.

Empathy deserves its buzzy status, and leaders are wise to desire it for their businesses. But to succeed in making it part of their organization’s DNA, they must pay close attention to how cultures build and change — organically, collectively, and often from the bottom up.

Jamil Zaki is a professor of psychology at Stanford University and author of The War For Kindness: Building Empathy in a Fractured WorldHis writing has appeared in The New York Times, The Atlantic, The New Yorker, and The Wall Street Journal.

The article is taken from Harvard Business Review.

Effects of High vs. Low Glycemic Index of Post-Exercise Meals on Sleep and Exercise Performance: A Randomized, Double-Blind, Counterbalanced Polysomnographic Study

Effects of High vs. Low Glycemic Index of Post-Exercise Meals on Sleep and Exercise Performance: A Randomized, Double-Blind, Counterbalanced Polysomnographic Study

The aim of the current study was to investigate the effect of the glycemic index of post-exercise meals on sleep quality and quantity, and assess whether those changes could affect the next day’s exercise performance. Following a baseline/familiarization phase, 10 recreationally trained male volunteers (23.2 ± 1.8 years) underwent two double-blinded, randomized, counterbalanced crossover trials. In both trials, participants performed sprint interval training (SIT) in the evening. Post-exercise, participants consumed a meal with a high (HGI) or low (LGI) glycemic index. Sleep parameters were assessed by a full night polysomnography (PSG). The following morning, exercise performance was evaluated by the countermovement jump (CMJ) test, a visual reaction time (VRT) test and a 5-km cycling time trial (TT). Total sleep time (TST) and sleep efficiency were greater in the HGI trial compared to the LGI trial (p < 0.05), while sleep onset latency was shortened by four-fold (p < 0.05) and VRT decreased by 8.9% (p < 0.05) in the HGI trial compared to the LGI trial. The performance in both 5-km TT and CMJ did not differ between trials. A moderate to strong correlation was found between the difference in TST and the VRT between the two trials (p < 0.05). In conclusion, this is the first study to show that a high glycemic index meal, following a single spring interval training session, can improve both sleep duration and sleep efficiency, while reducing in parallel sleep onset latency. Those improvements in sleep did not affect jumping ability and aerobic endurance performance. In contrast, the visual reaction time performance increased proportionally to sleep improvements.

Authors: Angelos Vlahoyiannis, George Aphamis, Eleni Andreou, George Samoutis , Giorgos K. Sakkas and Christoforos D. Giannaki 

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