Compassion in medicine: It’s not just the right thing to do—it also makes the most cents

I had to reread his email a few times. I could not even remember who this patient was. I wondered how he had tracked me down to message me. Years later, he wanted to discuss his experiences during his inpatient psychiatric hospitalization for acute mania with psychosis.

Intrigued, I asked the patient to tell me more about his experience, and what specifically stood out to him. For those of you not in psychiatry, this is a commonly used approach to either: buy us time while we are trying to figure out what’s next, or to provide additional context in hopes the patient will guide themselves toward a common theme for greater understanding or healing. In my case, it was the first—I had no idea who this patient was. That I had some profound impact on his experience was even more baffling.

He described being placed on an involuntary hold, multiple chemical restraints during episodes of agitation and being diagnosed with bipolar mania that led to a multiple-day inpatient psychiatric hospitalization. While I had only seen him for two days during my university weekend call schedule, he talked about how he felt no one wanted to speak with him. He felt isolated and alone.

My response to his saying this was to candidly explain that during mania, a person speaks incredibly quickly, and oftentimes in disjointed sentences. To him, this may have felt like a normal speed, but he was speaking so quickly that it was difficult to follow what he was saying.

I invited him to speak so incredibly slowly that it might be almost painful to do so. When I saw him the next day, he thanked me for my candor. Soon after our exchange, he was discharged from the hospital—in my clinical opinion, not because I was this brilliant psychiatrist, but because that was right around the time his medications would have taken effect for acute manic symptoms.

Through a ‘business’ lens

When asked to write about compassion in medicine as a business decision, this patient’s case immediately came to mind. When he reached out to me years later, this patient described finally feeling heard after days of intense frustration and loneliness. When I invited him to speak more slowly, I also explained the perspective of nurses and physicians—that we really are just all doing the best that we can with what we have.

In the book “Compassionomics: The Revolutionary Scientific Evidence That Caring Makes a Difference,” Carla Keirns, MD, states that “every patient who files a malpractice suit can tell you the moment they felt unheard or dehumanized.”

At the time, my candor was a strong element of my direct approach to meeting patients where they are at, while doing my best to help them make good decisions to start solving the challenges they can change. I had no clue until years later that this approach may have averted litigation.

I became very curious about compassion, and its impact not just on patients but on the economics of medicine. At the end of the day, I can create and teach hundreds of classes on compassion and joy in medicine, but it won’t deeply impact our profession unless there is an economic motivator or deterrent.

We have seen similar models in health care. For instance, reimbursement analysis has demonstrated that preventive care decreases total emergency care visits. Once the data showed a decrease in costs, primary and preventive care visit reimbursement rates were increased by the health insurance companies.

One could presume patient adherence to physician care plans is directly linked to perceptions of compassion—and there is greater reimbursement for things like reduction of symptoms for chronic conditions.

The relationship between a patient’s perception of lack of compassion and litigation has been well-documented. Physicians who show empathy overall have fewer malpractice complaints and better patient satisfaction scores and treatment adherence, as stated in “Compassionomics.” Of course, reducing malpractice claims would lead to reduced health care costs, which would be in the best interest of patients, physicians and hospitals. This also takes out of the equation a social dynamic of “us against them” for either the physicians or patients themselves. With this cost-profit analysis of compassionate medicine, everyone “wins” both by profitability as well as improved medical care.

Higher profitability overall, for all parties, becomes a side benefit of kindness and compassion. Further, there are areas in the United States (U.S.) where the cost of malpractice insurance has become so prohibitive, it is causing physicians to leave medicine. In a Deloitte study, average high ratings of patient satisfaction throughout a hospital were correlated with higher hospital profitability.

Compassion drives positive reinforcement on all sides

A patient’s experience of compassion and empathy from their physician doesn’t just put them at ease—it changes the brain’s response to stress and increases pain tolerance. In a study of pain perception coupled with fMRI imagining, patients who interacted with physicians who provided a “patient-centered” interview demonstrated decreased perception of pain and decreased activity in the anterior insula on fMRI imaging. 

Physicians with higher ratings of compassion have been found to provide fewer specialist referrals and order fewer tests. Less referrals reduces overall cost per diagnosis/chief complaint. This, in turn, taxes hospitals less with fewer referrals and increases patient satisfaction.

Another study found that when physicians were provided with positive reinforcement, they were 50% more accurate at diagnosing patients.

Self-compassion among physicians is another piece of this puzzle. Physicians who are compassionate toward themselves are better-positioned to be more empathetic with their patients. There is indeed a correlation between burnout, patient perceptions of compassion and medical errors. Symptoms of burnout include decreased compassion for others, depersonalization and, in more severe cases, hostility and agitation.

The more self-compassion we can manage to practice for ourselves, the less likely we are to make medical errors and alienate our patients. Most of you reading this article have likely experienced burnout at some point in your career. When we take care of ourselves, we are able to take better care of our patients.

Call to action

My hope is for hospitals and insurance companies to directly reward and financially compensate physicians for compassion, whether that’s through patient surveys, evaluations or other communications.

Compassion is not only good business—it has led to good medicine, not just for our patients, but also for us. The happier and more compassionate we are as physicians, the more profitable, healthy and happy we will find our hospitals and patients.

Related reading:

The benefits of learning another language for patient care

The ‘window mirror’ approach to patient care: What we can learn from it