The Roots of Compassion – Dr. Ralph Snyderman and The 14th Dalai Lama

Posted on | March 21, 2019 | Comments Off on The Roots of Compassion – Dr. Ralph Snyderman and The 14th Dalai Lama

Mike Magee

The issue of “doctor burnout” is front and center at the moment. It’s not a particularly new issue. I grappled with it way back in 1980, with soul-searching sessions at the Massachusetts Medical Society at the time. The focus then was on inadequate reimbursement, but the real issues were fear, depression, and isolation.

At the core of these debates are three elements: the caring professionals, the patients, and the system within which they encounter each other.

In 1999, working with social scientists, I set out to define what this encounter entailed, labeled then the “patient-physician relationship”. In a three month structured survey of both doctors and patients in the U.S., Canada, U.K., Germany, South Africa and Japan, I discovered surprising unanimity across geographies and between those receiving care and those delivering it. More than 90% of individuals surveyed said that the patient-physician relationship was three things – compassion, understanding and partnership.

Defining what the relationship was proved easier than nailing down what ails it at any moment in history.

Ralph Snyderman MD, Past-President of the AAMC and Chancellor Emeritus of Duke Medical Center took the unusual step last year to visit the 14th Dalai Lama in India and explore what it takes to ignite compassion in health care. In a joint publication, Dr. Snyderman describes the Dalai Lama’s insights including:

1. “Compassion is a deep inborne emotion and the source of true happiness.”

2. “Compassion is an inherent trait, but it does not necessarily maintain its focus and intensity in a world with so many factors suppressing it.”

3. “An essential component of compassion is the feeling of interconnectedness with others, which naturally leads to engagement—a critical component of effective health care.”

Twenty years ago, I asked a simple question: “Are we choosing the right individuals for medical school – ones that could deliver compassion, understanding and partnership – along with knowledge, judgement, and required skills? We tested 188 physicians from across the nation that hospital CEO’s had identified as “role models” for physicians using a highly validated Psychological Profile tool called NEO-PIR to identify scores on 20 different personality traits. One of those traits was “arrogance”, scoring low in our “best doctors” but present in more than trace amounts in 1/3 of our incoming class of students.

So first insight: We could do better in our medical student selection process by deliberatly attempting to rejecting arrogant students and selecting compassionate ones.

Our second insight: Repeat testing of medical students and residents appeared to indicate that their capacity for compassion began to decline in the third year of medical school and continued downward through their years of residency. Conclusion: We could do better in designing training that did not systematically dehumanize future physicians.

Our third insight: Engaged and informed patients make better doctors. Expanding the time and quality of interaction expanded physician responsiveness, engagement and resilience.

Our final insight: Health system design inequities matter. Physicians and nurses are trained to take all comers without prejudice, no questions asked. The fundamentals of compassion, understanding and partnership don’t function very well in a dog-eat-dog environment where substanial portions of our citizenry are uninsured or underinsured; where major social determinants of health are largely ignored; where time devoted to patients is less than time devoted to billers; and where focus on patient care is substantially undervalued compared to profiteering research.

Compassion takes time and focus. Health systems that are equitable, accessible, and above all simple give the patient-professional relationship the opportunity to advance understanding and true partnership. Universality, solidarity, and compassion are one in the same.

Dr. Snyderman and the 14th Dalai Lama, Tensin Gyato, leave us with this challenge: “We must focus not only on developing the best scientifically driven care but also on creating delivery models that facilitate compassion, making them more personalized to the needs and capabilities of the patient and, hence, more cost-effective and humane than our current fragmented approach to care.”