Is modern treatment of mental health lacking compassion?
By Liz Lockhart
When my life was first turned up-side-down by poor mental health I didn’t know where to start to put things right. I turned to my doctor as my first port of call for help. He was kind but seemed to lack the specialist knowledge required to put me back on the right path.
The specialist care which I eventually received was adequate at best but there were two occasions where an utter lack of compassion left me reeling. One of these occasions was when, during a hurried appointment, a specialist told me outright that I had chosen to be affected by phobic anxiety and I could choose to stop having it. The other time was when I went to see a psychiatrist and had the mother of all panic attacks on his couch. He called for two colleagues to come and observe my distress as they had never actually seen anyone in the throes of this level of distress. Not one of them offered me one ounce of compassion but observed me as if I was an object and not a suffering human being.
It was, therefore, with particular interest that I read about the Schwartz Centre for Compassionate Healthcare which has proposed an agenda for interjecting compassion back into the healthcare system.
‘For most clinicians, compassionate care matters because it is fundamental to the practice of medicine, ethically sound and humane,’ according to Beth Lown M.D., the lead author.
‘However, there is also strong evidence that compassionate care improves health outcomes and quality of life, increases patient satisfaction, and lowers health care costs. Particularly as our health care system faces such intense pressure to reduce costs, we must make sure that this critically important element of health care is not lost,’ Lown added.
To ensure that all patients receive compassionate care, the Schwartz Center recommends that:
- The federal government include compassionate care measures in national quality standards and create a Compassionate Care Index (CCI) to measure the level of compassionate care being delivered by health care institutions and individual providers;
- The Patient-Centred Outcomes Research Institute created by the Affordable Care Act fund comparative effectiveness research to determine which aspects of compassionate care have the greatest impact on health outcomes, quality of life, and patient satisfaction;
- New health care payment systems, including the Centres for Medicare and Medicaid Services’ proposed value-based purchasing system, reward providers for the compassionate care they provide to patients and families; and
- Comprehensive training programs be developed to help health care professionals and trainees develop the necessary skills required for compassionate care.
The Schwartz Centre conducted a national survey of 800 patients and 510 doctors in 2010. The survey found that only 53% of patients and 58% of doctors consider the U.S. health care system to be a compassionate one. This is despite strong agreement among patients and doctors that compassionate care is important to successful medical treatment. They also feel that it can make a difference to whether a patient lives or dies.
The survey also found that 67% of patients and 55% of doctors are concerned that the changes taking place in the U.S. health care system will affect the compassionate care which is needed from doctors, nurses and other health care professionals.
The participants in the survey are particularly concerned that the heightened emphasis on controlling costs will decrease the time which physicians can spend with their patients which will build additional barriers and diminish this important relationship. 53% of doctors who were surveyed said that they were already spending less time with patients than they would like.
According to the Schwartz Centre, compassionate care is defined by the following four essential characteristics:
1. Empathy, emotional support, and a desire to relieve a patient’s distress and suffering
2. Effective communication at all stages of a patient’s illness and treatment
3. Respecting patients’ and families’ desires to participate in making health care decisions
4. Knowing and relating to the patient as a whole person, not just a disease
‘There is a great deal of emphasis in health care these days on providing ‘patient-centered’ care, but care without compassion cannot truly be patient centered,’ Lown said.
Lown and her co-authors write ‘Health care providers need time to listen to their patients, education in the skills of compassionate care, feedback based on measures of their performance, and leaders and systems that support healing relationships with patients and families.’
Lown concluded ‘Compassion is as important in helping patients manage chronic and acute conditions as it is at the end of life. To improve quality and reduce costs, compassion should be present in all aspects of our health care systems.’
Source: The Schwartz Centre for Compassionate Healthcare
