Compassionomics: The Science and Practice of Caring

As in other fields of medicine, very little time is devoted during ophthalmic training programs to cultivating compassion, even though it's a key value in health care.

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Inês Laíns, MD, PhD, a clinical fellow in vitreoretinal surgery at Mass Eye and Ear, Taylor J. Johnson, a medical student at the University of Utah School of Medicine, and Mark W. Johnson, MD, professor of Ophthalmology at the University of Michigan, wish to raise awareness within the ophthalmology community about compassionomics—a new discipline defined in Medical Hypotheses as the scientific study of the effects of compassionate care on patient health, healthcare professionals, and the healthcare system.

In a perspective article in the American Journal of Ophthalmology, the group also discusses compassion as a trainable skill and outlines strategies for consistently communicating it to patients.

Benefits of Compassion in Health Care

In medical practice, compassion can be defined as an awareness of and emotional response to pain or suffering (empathy), coupled with the strong desire and intention to alleviate it. In a selective literature review, the authors identified numerous physiologic benefits of compassion that are directly relevant to important ophthalmic conditions:

• Enhanced parasympathetic activity, which calms the sympathetic nervous system and increases vagal tone, releases oxytocin, enhances immune function, and reduces inflammation and stress-mediated disease
• Modulation of pain perception
• Accelerated wound healing
• Improved metabolic control (higher odds of optimal blood glucose control and lower odds of serious diabetic complications)
• Increased immune cytokine levels with reduced severity and duration of viral symptoms

There is also robust evidence that compassion:

• Has substantial, measurable psychological benefits for patients
• Leads to better patient engagement and increased adherence to treatment plans
• Improves patient ratings of physician competence
• Associates with lower odds of major medical errors and higher quality of care
• Drives revenue and substantially lowers healthcare utilization and costs
• Reduces healthcare professional absenteeism, turnover, and burnout
• Lowers malpractice costs

Compassion Is a Measurable and Trainable Skill

Several tools to measure compassion have recently been validated:

• The 12-item Schwartz Center Compassionate Care Scale, applicable to both inpatient and outpatient settings
• The 5-item Tool to Measure Patient Assessment of Clinician Compassion, validated for the emergency department as well as inpatient and outpatient settings
• The 15-item Sinclair Compassion Questionnaire, validated for acute care, hospice, long-term care, and home care

Several meta-analyses have concluded that compassion meditation training programs are effective for improving compassion in physicians, including ophthalmologists, and in medical students, nurses and nursing students. A table in the article provides links to online courses for healthcare professionals.

Practicing Compassion

The authors view each patient encounter as an invitation to help someone in need and have developed the mnemonic RSVP to help clinicians respond:

• Recall the intention at the beginning of each patient interaction. Use a common action (e.g., opening the door or sanitizing hands) as a trigger to pause, take a breath, and remember the commitment to serve with compassion. Repeating a silent mantra (e.g., "I'm here to give kindness and compassion") can help induce a compassion mindset.
• See the patient as a human being with fears and emotions. Before examining a patient's eyes, smile, call them by name and make eye contact, giving complete attention and remembering to treat the person, not a disease.
• Validate the patient's spoken or assumed fears. Imagine how it would feel to be in their situation and make a simple statement such as, "This must be really hard for you" or "I can imagine this is very frightening."
• Provide a compassion statement that expresses empathy, caring and support. For example, "I know this is difficult for you and I really wish you didn't have to go through it. I want you to know that I'm here for you and we'll get through this together." Expressing compassion through body language (e.g., eye contact, warm smile, leaning toward the patient) has also been shown to improve physical and psychological outcomes.

Compassionate communication with patients requires only seconds of time and should be considered a key component of optimal medical care.

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