Compassion, community, health & longevity – can the learnings and insights of “Compassionomics” & “Outliers” make a difference in the veterinary sector?

At the beginning of this year, I had the opportunity of catching up with a VetStaff locum for lunch.

We solved all the problems currently facing the veterinary sector and the world.

Over lunch, Dr Sam shared a book she’d read called Compassionomics – a book designed to answer a few questions – one of which was “does taking time for compassion make doctors better at their job?”

I’m a Kindle woman, so I bought the Kindle version.  It’s also available in paperback and Audible versions.

Kindle edition

Audible / Audio edition

Paperback edition

If you want to ask your favourite bookshop (mine is Penny’s at Chartwell Square, Hamilton) to secure you a copy here’re the ISBNs they’ll want to know:

ISBN-13: 978-1622181063

ISBN-10: 1622181069

The full, official, title is “Compassionomics:  the revolutionary scientific evidence that caring makes a difference.”

I like meaty books and at 375 pages, this sure gave me something to get my teeth into.  The book was published in 2018 by Fire Starter Publishing.

Dr Stephen Trzeciak | Dr Anthony Mazzarelli

Compassionomics was written by two human medical doctors – Drs Stephen Trzeciak and Anthony Mazzarelli.

Dr Trzeciak

Dr Trzeciak, MD, MPH, is a physician scientist, professor, and chair of medicine at Cooper Medical School of Rowan University, and the chief of medicine at Cooper University Health Care in Camden, New Jersey.

Dr. Trzeciak is a practicing intensivist – meaning he specialises in intensive care medicine – and, as you’ll hear him say later – you only get to meet him when it’s come to down to life / death for you.  He’s a National Institutes of Health-funded clinical researcher with more than 100 publications in scientific literature, primarily in the field of resuscitation science.

He’s no lightweight when it comes to research and writing – Dr. Trzeciak’s publications have been featured in the Journal of the American Medical Association (JAMA), Circulation, and The New England Journal of Medicine.

His scientific program has been supported by research grants from the National Institute of General Medical Sciences and the National Heart, Lung, and Blood Institute, with Dr. Trzeciak serving in the role of Principal Investigator.

Dr Anthony Mazzarelli

Dr Anthony Mazzarelli, MD, JD, MBE, is a practicing emergency medicine physician, who’s co-president of Cooper University Health Care and the associate dean of clinical affairs for Cooper Medical School of Rowan University.

Prior to his current role, Dr Mazzarelli served as Cooper’s chief physician executive, where he oversaw the physician practice, as well as quality/patient safety and continuous process improvement efforts for the health system, the same topics he teaches within the medical school and residency programs.

Dr. Mazzarelli has been named one of the 50 most powerful people in New Jersey health care and was awarded the Halo Award for leading a team of health care providers from Cooper into Haiti in the days immediately following the 2010 earthquake.

Dr. Mazzarelli’s also received numerous commendations for his leadership.

Both of these guys know their stuff.

Compassionomics is aimed at the non-specialist non-academic reader primarily interested in human healthcare delivery.

Apart from the fact Dr Sam said it was a good book, I bought it because I wondered whether there might be any crossover from human health care to animal health care.

While I was reading, there was always a little part of my brain wondering just how much could be transferred to the animal health care sector.  I’m sure that plenty could – just in a different way.

Some musings I had, for example, were:

• Could veterinarians, for example, positively impact the health outcome of sentient animals through compassion? 
• What difference would the expression of compassion to the patient’s owner make to the health outcome of the patient?  
• If the client felt more compassion towards them, would they be less aggressive towards the veterinarian?  
• Would animal doctors hear fewer emotional blackmail and accusations about not caring otherwise they’d work for free?

All these thoughts were going through my head while I was reading.

If you’ve read the book, I’d be especially keen to hear what your thoughts were from a veterinarian point of view.  Please leave your thoughts in the comments section wherever you’re listening to this podcast or send me an email to julie@vetstaff.co.nz.   Thanks!

Ethos

Dr Trzeciak insists his conversion to “compassionomics” transformed his life given he wasn’t that particularly enthralled with the idea of writing it to start with.  He was a self-proclaimed not touchy-feeling man.  Give him science and hard facts and he’s in his element.  But touchy-feely “soft” stuff, not his thing.

The book came into being because Dr Trzeciak’s new boss – Dr Mazzarelli – came to him with a mission – he wanted Trzeciak to prove or disprove that “treating patients with medicine and compassion makes a measurable difference to the wellbeing of both patients and doctors“

Tzreciac expected the answer to be ‘no – compassion made no difference whatsoever”.

He got that compassion was a good thing to have but he expected to report back that caring had no quantitative rationale.

However, after trawling through over 1,000 scientific extracts and 250 research papers and having his former beliefs disproved, he’s now a true and passionate convert taking his message to a wider medical audience.

His message seems like one people are ready and wanting to hear.

The pair concluded that compassion does has the power to transform medicine.

When health care providers take the time to make human connections that help end suffering, patient outcomes improve, and medical costs decrease.

Among other benefits, compassion:

• reduces pain,
• improves healing,
• lowers blood pressure, and
• helps alleviate depression and anxiety.

Compassion and the role it plays in medicine isn’t new.

However, Compassionomics takes a novel approach:   this book looks at compassion from a scientific perspective rather than a moral or ethical one.

Using already obtained scientific evidence, the authors were able to prove the importance of compassion as measurable.

The data show that health care outcomes are dependent not only on how much health care providers know but on how much they care.

Happier & healthier patients | lower health care costs

Compassionate, patient-centred care leads to happier, healthier patients and lower health care costs.

The bit that interested me was that there’s evidence that compassion may protect health care providers from burnout.

I wondered how that might cross pollinate into animal health care providers – veterinary doctors, nurses, surgeons and technicians.

I don’t know the answer to that but, if you’re like Dr Sam, who believes in the power of compassion as a veterinarian, I’d love for you to be able to share your experiences so other veterinarians can benefit.

As Dr Trzeciak says: “Once you realise how powerful you are just through the act of caring, you’ll want to get better at compassion every day.”

When you think about it, it doesn’t take any more time to be compassionate than it does to be dispassionate.

Time is money in business and all businesses are doing their best to get their teams to be more efficient.

The pressures in the healthcare system to provide better care while minimising rising costs against spending cuts, just adds more pressure to otherwise stressful jobs. Most healthcare workers believe they just simply don’t have the time to treat patients with compassion.

Researchers from John Hopkins University performed a randomised controlled trial on cancer patients as they interacted with an oncologist.

The researchers found that the patients who received enhanced compassion intervention had significantly less anxiety at the end of the consultation.  With a selected use of words and meaning, the impact of this consultation was timed to be just 40 seconds.    So, when you think about it, we all really can find the time.

As I said earlier, compassion doesn’t just benefit the recipient.   It seems to benefit the giver as well.

Compassion helps the giver too

Researchers at the Wharton School of the University of Pennsylvania found that when people spent time doing good for others – in this case by writing an encouraging note to a gravely ill child – it actually changed their perception of time to make them feel they had more of it.

I wonder if veterinarians are like doctors?  Apparently, 56% of doctors say they don’t have time to be empathetic.

According to Trzeciak, the evidence shows that when you invest time in other people, you actually feel that you have more time, or that you’re not so much in a hurry.  He says that “when 56 percent say they don’t have time in that survey, it’s probably all in their heads.”

The same study found that for the doctors who said they were too busy to be empathetic, after a short training session in the neuroscience of empathy, those doctors then started to interact with patients in ways the patients rated as more empathetic.

Because compassion also seems to prevent doctor burnout – can it prevent veterinarian burnout as well?

Med students are often warned about getting too close to their patients, because too much exposure to human suffering is likely to lead to exhaustion.

But the opposite appears to be true: evidence shows that connecting with patients makes physicians happier and more fulfilled.

“We’ve always heard that burnout crushes compassion. It’s probably more likely that those people with low compassion, those are the ones that are predisposed to burnout,” Trzeciak said. “That human connection — and specifically a compassionate connection — can actually build resilience and resistance to burnout.”

Trzeciak and Mazzarelli hope their evidenced-based arguments will spur medical schools to make compassion part of the curriculum.

Imagine if veterinary schools included compassion as part of their training for doctors, nurses and technicians too.

For those outside the human health care system, acting with compassion can be a kind of therapy as well, both authors say.

They refer to the phenomenon of the “helper’s high” – the good feeling that comes from helping others, and explain how giving to others benefits the givers’ brains and nervous systems.

Dr Trzeciak had his own epiphany while writing the book.  He didn’t realise at the time he was going through his own form of burnout.  One of the things that triggered this realisation was when his son asked for help with his homework.   He wanted help with the question:  “what is the most pressing problem of our time?”

He believed his work to that point was meaningful, but it was definitely not the most pressing problem of our time.

Along the way, he says, he realised he was feeling burned out after 20 years of practicing medicine. So, armed with data from his book research, he decided to test his own hypothesis.

The recommended prescription is what he calls ‘escapism’ — where we’re told to get away, detach, pull back, go on some nature hikes or whatever.

He decided instead, to apply the techniques he’d been studying, including spending at least 40 seconds expressing compassion to patients.

He said he connected more, not less; he cared more, not less; he leaned-in rather than pulled back.

It was only by doing those things – not heading off into the bush – that he noticed the fog of burnout lifting

He prescribes the same for anyone, not just health care providers, suffering from mental or emotional exhaustion.

Compassionomics is written in three sections – the first is the Case for Compassion which refers to a bus crash in Sweden.

From here, the authors share a pretty strong argument that compassion matters.

They reference research from a University of Chicago study that found primary care physicians missed 79% of emotional cues from patients that indicated a need for a compassionate response.

They also describe a Johns Hopkins ICU study that found 74% of health care providers showed no evidence of compassion for patients or families.

Compassion improves outcomes for patients

The second section, Compassion Improves Outcomes for Patients examines research showing that medical outcomes, parasympathetic responses, psychological well-being of patients, self-care by patients, and even patients’ sense of purpose, are all affected by physician compassion.

One study cited a 370 patient primary care setting study. The researchers found the strength of the doctor-patient relationship was associated with a 34% increased likelihood of the patient adhering to prescribed medications.

In one aged care study, researchers found that when the residents felt their caregivers actually cared about them as individuals, the residents were less likely to be depressed.

increased revenue & reduced costs

The third section, Beyond Patients examines how compassionate care increases hospital revenue, cuts costs, and how even physicians who’re not naturally warm and intuitive can learn to demonstrate compassion.

One of the studies cited was the one Dr Trzeciak referenced in his Tedx talk clip earlier – where 40 seconds made a difference to patient care.

In case you didn’t pick up the phrase used in the study it was:

“I know this has been a tough experience to go through and I want you to know that I’m here with you. We’re here together, and we’ll go through this together. I’ll be with you each step along the way.”

If you’re into books with lots of research, then you might enjoy this one.  Because there’s a lot of research backing it up.   The research and data is heavy and solid.

I also, mistakenly, thought that because there was a derivative of the word ‘economics’ in the book’s title, that it would have more case studies from a business growth and improvement perspective.  There wasn’t and because of that I was a bit disappointed.

The Roseto Effect

One of my own conclusions is that, apart from the lack of compassion we seem to be heading towards today, is also the lack of community.  I think the two are interrelated and with that in mind, I’d now like to introduce you to the Roseto effect.

If lockdown last year did one thing for me – and a lot of other people – is that it got us to slow down.  For some, we almost went back to life similar to the 1950s.   Families had meals together.   Bread, baked at home, was shared with many.  Meals were made from scratch and eaten slowly.

All of that reminded me of the benefits of living like Rosetans.

The Roseto effect is the phenomenon by which a close-knit community experienced a reduced rate of heart disease.

The effect is named for Roseto – a tiny Italian-origin town in Pennsylvania with a population of about 1,600.

The Roseto effect was first noticed in 1961 when the local Roseto doctor and the then head of Medicine of the University of Oklahoma, got to chatting over a couple of beers about the unusually low rate of myocardial infarction in Roseto compared with the rest of the United States at the time.

Roseto bucked the then-US health trend:  They smoked like trains, drank like fish, ate a high fat diet and worked in a very lung-unhealthy environment.

But why weren’t they suffering heart attacks like everyone else in America at the time?

In addition, the crime rate in Roseto was almost non-existent and almost no one received welfare.

Why?   

Researchers came to the conclusion it was because they had community.

Here’s an excerpt by Malcolm Gladwell his book Outliers – The Story of Success – where he describes the Roseto Effect.

Kindle Edition

Audible / Audio Edition – narrated by Malcolm Gladwell

Hardcover Edition

Sadly, not long after the research mentioned above was made public, life in Roseto began to follow the trends of the rest of America.

Beginning around the mid-1960s all the strong traditions that kept Rosetans living longer, began to fall apart.

American life meant fences were erected between houses.

People stopped going to church and having long family get togethers afterwards.

Kids left town to go to university and grandparents were put into rest homes.

The three-generational homes became a thing of the past.

The introduction of the western American lifestyle – not too different to what we’re experiencing here in Godzone, meant long hours of work, social isolation, increased stress, and a processed food diet, produced a quick jump in heart attacks and deaths due to atherosclerosis.

Roseto has now joined the melting pot of western life and suffers all of its chronic diseases.

So.  Back to compassion being good for you as well as being good for others.

Lean into compassion

The next time you get to chat about the health of your client’s fur baby, connect with them in a meaningful way as well.

You don’t need to get all of their life history like you need their pet’s, but I’m sure you can take 40 seconds to look after yourself by connecting with another human being.

I’m interested to hear what compassion and/or connection practices … strategies you have in place in your clinic that help your team stay head and heart healthy… I’m also pretty sure that other clinics would love to know what you do and what results you’ve had.

Please – send me an email or connect with me – julie@vetstaff.co.nz – so we can help other clinics benefit as well from your experiences.

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Tedx Talk

life’s most urgent question is “what are you doing for others?” – Martin Luther King

Malcolm Gladwell’s narration of the chapter in his book referring to the Roseto Effect