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The Medical Professionalism Blog

Compassionate Care Requires Compassionate Systems

In the article, “An Agenda For Improving Compassionate Care: A Survey Shows About Half of Patients Say Such Care Is Missing,” published in Health Affairs (September 2011, Vol. 30 No. 9), Beth Lowen et al. make a good case for the connection between compassionate care and quality outcomes and patient experiences. The authors also conclude that providers who score higher on patient-centered communication generate lower expenditures for diagnostic testing. They recommend improvement of these skills on the part of health care professionals.

There is no doubt of the importance of compassionate care as defined by the following four essential characteristics:

  • “Relationships based on empathy, emotional support, and efforts to understand and relieve the patient’s distress and suffering
  • Effective communication within interactions, over time, across settings
  • Respect for and facilitation of patients and families’ participation in decisions and care
  • Contextualized knowledge of the patients as individuals within a network of relationships at home and community.”

I worry that “compassionate care” as a singular competency and focus­­—as suggested from some quarters—is not far-reaching enough. Medical professionalism goes beyond the compassionate care of patients to the creation and fostering of respectful relationships of physicians, clinicians and administrators with the industry, organizations and community.

The Physician Charter speaks to physicians’ obligation to:

  • Managing conflicts of interest
  • Clinical competence
  • Improving quality of care within the context of organizations
  • Acting as stewards of health care resources within the context of organizations and community

If these tenets are not considered as well, a text-book “compassionate” physician with high patient satisfaction scores could also have large payments for pharmaceutical consulting fees. This physician could also publish scientific articles on these drugs or overusing drugs and diagnostic tests.  The physician could be a poor clinical decision-maker, not participate in a maintenance of certification program and his or her quality of care could be below average.

Instead of just focusing on how to create physicians competent in “compassionate care,” we should also focus on how health care organizations, payers/purchasers and Federal and state government policies can support these healing, trusting and compassionate patient-physician relationships.  Health systems need to support a wide range of physician competencies, including communication skills, use of resources and knowledge, skills and attitudes in their specialty. Additionally, health care organizations need to have conflict-of-interest policies in place that don’t exploit patient relationships in pursuit of economic gain.

To have compassionate care as well as standards of patient safety, quality and affordability will require alignment of complex components of the health care system.  It will require all the parts of the system to support the patient-physician interaction.  Compassionate care requires a compassionate health care system.

2 Comments to Compassionate Care Requires Compassionate Systems

  • December 3, 2012 at 1:35 am | Permalink

    I agree with the first paragraph of this blog by Dr. Wolfson and Dr. Lown’s comments. I am a physician patient who feels compassionate care is missing. As I said in comment of another blog we need back to basics first.

  • November 2, 2011 at 6:09 am | Permalink

    We agree with Dr. Wolfson’s formulation and make the same point in our article – compassionate care requires compassionate systems – something both patients and physicians said are missing in today’s healthcare when we surveyed them (these survey results are reported in our article in Health Affairs). We also agree that the compassionate practice of patient-centered medicine requires many complex qualities, values, and behaviors in addition to knowledge and clinical expertise. The profession should create, assess and reinforce standards that encompass compassionate, patient-centered care, effective communication and healing relationships as well as professional “competency” and professionalism. None can stand alone.

    The IHI’s (and now CMS under Berwick) triple aim is better care for individuals, better health for populations and lower costs. Perhaps the triple aim for healthcare professionals should be clinical competency (I prefer the term clinical excellence), professionalism, and compassionate, patient-centered care.

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