Can we teach empathy and compassion? This question formed the basis of a presentation given by Dr. Beth Lown, Chief Medical Officer at the Schwartz Center for Compassionate Healthcare and Associate Professor of Medicine at Harvard Medical School, during a fascinating members’ meeting of the Institute of Health Sciences Education.
The Schwartz Center for Compassionate Healthcare is a non-profit organization in Boston, MA that works to bring compassion to every healthcare experience through its programs, education and advocacy.
Dr. Lown described current research showing that distinct neural networks in the brain are activated when experiencing emotional empathy for another’s pain, mentally processing those emotions and experiencing compassion.
Experiencing empathy for another’s pain elicits negative emotions. If this happens on a regular basis it can become overwhelming. By contrast, experiencing compassion elicits positive emotions and activates networks in the brain that contribute to a sense of reward and meaning.
This research, her personal experiences and observations lead Dr. Lown to believe that empathy and compassion are “hard-wired” in the brain. But they also can be cultivated, nurtured and must be supported.
A patient developed an autoimmune disorder in her thirties with pronounced effects on her lungs. After multiple hospitalizations, she was distraught and did not want to be intubated should she decompensate again.
When this did happen again, a critical care doctor sat with her listening to her concerns, affirming her needs and promised to tailor her care based on what she expressed. This compassionate conversation led her to accepting the medical care that ultimately saved her life long enough for her to go into remission. She felt listened to. She felt heard. She survived.
“It is not always easy to understand the nature of someone’s distress because, even if a patient gives you a clue, it’s usually not directly expressed,” Dr. Lown said. “You have to understand what’s particular about this person’s suffering. You have to have good communication skills to understand that.”
Did the doctor make a promise that could be kept? How can that promise be transmitted to rotating staff? This becomes an act of team compassion.
Woven throughout this are complexities of power and agency, questions of who is in control along with pressures of the medical system itself, which exerts strain on patients and staff alike.
“The practice of compassion is in many ways contingent on the wellbeing of the person who’s attending to the patient because if we are depleted then it’s going to be impossible to share compassion,” said Dr. Lown. “This is a significant problem” given the rising statistics of burnout, anxiety and depression in the workplace.
Toward empathic and compassionate education
“We’re not all born with the same levels of empathy,” Dr. Lown said.
Education becomes essential in this respect, and Dr. Lown identified organizational culture as a key area of focus.
“One of the major things that impacts compassionate care is the organizational culture, the learning environment or the context of care,” Dr. Lown said. “It strongly influences ‘what is normal here,’ making organizational culture top of the list in terms of areas to focus on.”
But changing organizational culture to reduce barriers to the expression of empathy and compassion is no easy task.
Given this reality, how can healthcare practitioners collectively model and mentor empathy and compassion? What skills and habits should be taught? What barriers can be removed? How can empathy and compassion be nurtured within learners, deepened and sustained?
“I think to be really successful, we can’t pick one of these pieces,” Dr. Lown closed. “We have to address them on all levels, and the question is how to do that.”
November 1, 2019