Stephen Trzeciak's obsession with compassion started with his son's seventh-grade cultural geography assignment three years ago.
The son asked the father, a critical-care doctor at Cooper University Hospital, for help with a speech that would count for half his grade. Trzeciak saw a father-son bonding opportunity. Then he read the formidable question his 12-year-old was expected to answer: What is the most pressing problem of our time?
His son had made a good start, but Trzeciak knew young Christian's heart wasn't in the topic he'd picked. If he didn't really believe this problem was important, his classmates wouldn't either, Trzeciak advised him. His son gave it more thought, picked a different problem and won his audience.
That wasn't the end of it for Trzeciak, though. A "research nerd," his own work had centered on topics like surviving blood infections and heart attacks or life after intensive care. Important, yes, but these things were not, Trzeciak admitted to himself, the most pressing problems of our time. What could he be more passionate about?
After months of mulling, he concluded the biggest problem in medicine was obvious: "We have a compassion crisis."
Burnout, characterized by depersonalization of patients and emotional exhaustion, was rampant in medicine. It was affecting quality as well as how patients felt about their care. At its core, he thought, the problem started with the emotional connection between health professionals and their patients. What was needed was for someone to bring science to the study of compassion and its impact on medical quality and cost.
"Why waste another moment of my career working on anything else?" Trzeciak thought. "This is what I need to do right now."
He has spent the years since Christian's assignment poring over more than 1,250 research abstracts and papers, trying to answer the question Does compassion really matter? The available evidence is that it does and that there isn't enough of it in health care. (He suspects there isn't enough of it in a lot of other places, too, but that's not his "wheel house.")
Last fall, Trzeciak, Anthony Mazzarelli, a physician who just became co-president of Cooper University Health Care, and Brian Roberts, a Cooper emergency physician, laid out their case for a new area of study, Compassionomics, in an essay in the journal Medical Hypotheses. It is obvious that health-care providers "ought" to be compassionate, they wrote. That's a moral imperative rooted in the art of medicine. But the team said that compassion may also be "an evidence-based intervention with measurable beneficial effects belonging in the science of medicine."
Cooper is just starting its first compassion studies. The team will look at how caregiver compassion affects PTSD among critically ill patients, at whether compassion training — yes, you can train people to be more compassionate — affects the development or course of provider burnout, and at how to model costs related to compassion training. Burnout "just fuels the compassion crisis," said Trzeciak, who has been invited to speak at TedX Penn next month.
A system that works against caring
James Doty, a neurosurgeon, founded the Stanford Center for Compassion and Altruism Research 10 years ago. It remains the nation's only academic center devoted to the topic, he said, but growing numbers of researchers are studying compassion. "I think it's a very hot topic," he said.
Doty edited The Oxford Handbook of Compassion Science, which was published late last year. The center, whose interest in compassion goes well beyond medicine, will host its third conference on compassion in health care in March 2019.
Doty said compassion can have a powerful effect on both patients and medical professionals, but the roots of burnout and depression are deeply embedded in a system that can work against caring. The values of professionals, who entered their fields to help, often clash with those of the commercial, profit-seeking health institutions they work for.
"They feel that what they signed up for is not what they got," he said.
Mazzarelli is also interested in the role of organizational culture. He wants to test the impact of more compassionate leadership.
Trzeciak said there's already evidence that very little of the time doctors spend with patients — less than 1 percent — is devoted to expressions of empathy or compassion. Empathy, he said, is feeling another's pain. Compassion goes beyond empathy to include taking action to help.
There's also evidence that patients are more likely to follow doctors' instructions and doctors are less likely to order unnecessary tests when there is a compassionate relationship. Doctors who are burned out are more likely to make mistakes. These relationships all potentially affect the cost of care, an area that Trzeciak thinks needs more study.
"Ultimately, payers drive change in health care," he said.
When Trzeciak, 47, was in medical school, students were told not to get too emotionally invested in patients because it would raise the odds of burnout. "I can't find any data to support that," he said. "But there is compelling data to the contrary."
Most studies, he said, found an inverse relationship between compassion and burnout. That doesn't mean that lack of compassion causes burnout. It does mean that the association is ripe for more study.
Trzeciak isn't suggesting that compassion is a substitute for a solid grounding in science. "If a physician doesn't technically know what they're doing, there is no amount of compassion in the world that's going to make up for that," he said. "Clinical excellence is the primary driver of health-care outcomes."
Once he started diving into the data on compassion, Trzeciak had to admit that he needed to make some changes in his own approach to patients. After 20 years of meeting people on the worst day of their lives, he had "every symptom of burnout." Much of what he read suggested he'd get better if he tried various forms of what he labeled "escapism," stuff like nature hikes.
But, to him, the data said that "leaning in, rather than escapism, is good for the provider."
He had been especially impressed by a 1999 Johns Hopkins University study on the impact that scripted, videotaped expressions of compassion had on cancer patients. If doctors spent just 40 seconds saying they and patients were on this difficult journey together, patients had less anxiety.
Trzeciak decided to do an experiment on himself. He would give his 40 seconds of compassion to patients every chance he got. "I connected more. I cared more, not less," he said. "That's when the fog of burnout began to lift, so it changed everything for me, too."