Compassion in Medical Practice DR TONY FERNANDO PSYCHOLOGICAL MEDICINE UNIVERSITY OF AUCKLAND, NEW ZEALAND
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1 Compassion in Medical Practice DR TONY FERNANDO PSYCHOLOGICAL MEDICINE UNIVERSITY OF AUCKLAND, NEW ZEALAND
2 Gratitude ~1200 doctors, ~800 nurses ~400 + med students ~150 ED staff, 20 hospice patients University of Auckland, Mind and Life Institute
3 Definitions Empathy Recognising another being s emotional state Compassion Empathy + wanting to alleviate suffering Inferior parietal cortex (understanding others) Dorsolateral PFC and communication with nucleus accumbens (emotion regulation and positive emotions)
4 Why Bother with compassion? Because we benefit Self-compassion Makes us more attractive to future partners Good for the body and the brain Take stock?/ count the number of people we have helped? Feel connected Better immune response and lower inflammation
5 Why bother with compassion? Because patients benefit Patients need it Better outcomes for patients Glucose control
6 Why bother with compassion? We are in healthcare Expectation of medical regulatory bodies and doctors themselves Makes us feel good WHY DOES COMPASSION MAKE US FEEL GOOD?
7 Brain (and body) is wired to feel VERY good when we are connected/ compassionate Lighting up of our pleasure centres
8 Brain (and body) is wired to feel VERY good when we are connected/ compassionate Hugging someone you care for Oxytocin (love hormone?) Vasopressin
9 Urge to help
10 URGE to help Stranger rescues Altruistic impulse Volunteerism Medicine and Healthcare
11 Compassion = survival Caring of helpless young Caring of the weak (seen in other species too) Compassion is oxygen for our species
12 Interspecies caring
13 Compassion = survival for those communities, which included the greatest number of the most sympathetic members, would flourish best and rear the greatest number of offspring. Charles Darwin
14 Urge to connect is so strong... When disconnected, rejected, uncared for- worst human experience Feels like we have been dismembered
15 If the brain is wired for connection, caring, compassion---why is there so much conflict? hatred? killing?
16 Can only have one mind state at a time limited mind resources
17 Threats (external or internal) Connection Satisfy basic needs Defend from threats!
18 What prevents doctors from being compassionate?
19 Barriers to Compassion in Medicine (Fernando, Consedine PGMJ 2014) Burnout/ Fatigue Difficult Patient/ Family External Distraction Clinical Complexity
20 Patient Factors, Interruptions and medical compassion (Consedine, Skinner, Fernando 2015) Low responsibility/positive presentation High responsibility/positive presentation DAVID: teacher, IBS following chemo for lymphoma, grateful ALAN: asthmatic smoker, well-dressed and pleasant Low responsibility/negative presentation High responsibility/negative presentation BRENDAN: pain patient, tried rehab, wants more Tramadol; angry ERIC: obese, BP, dirty, smelly, non-adherent; has genital warts
21 Ongoing observations So, in the experimental setting, the best predictors of compassion were not found in the physician, but in the patient Negative presentation trumped responsibility and responsibility only matters for positive presenting Interruptions reduce compassionate responding for the most difficult patients
22 Transactional Model of Compassion Environmental and Institutional Factors Physician Factors Clinical Factors Patient & Family Factors *It s not all about the doctor Physician Compassion
23 Implications Compassion not as simple as turning on a switch by the doctor
24 Can we enhance compassion then? god given, either you have it or not? Very possible
25 Enhancing Compassion Seeing everyone as exactly like you- just wanting to be happy, free from suffering Motivation to be kind Instead of first do no harm May I be of highest benefit to myself and others beings Habits or Rituals of compassion in daily clinical practice
26 Enhancing Compassion Mindfulness Mindfulness induction in medical students (Fernando, Skinner, Consedine 2015 under review) Mindfulness effects similar to compassion meditation training in increasing response to suffering (Condon, Desbordes, Miller, DeSteno 2013)
27 Enhancing Compassion Acts of Kindness Easily flows with nice patients Minimal with tough patients Not expect recognition
28 Enhancing Compassion Compassion Meditation calm.auckland.ac.nz guided meditations
29 Enhancing Compassion Compassion Training Protocols Being with Dying- Upaya, New Mexico** GRACE model of compassion Roshi Joan Halifax Compassion Cultivation Training Programme- Stanford University Cognitively Based Compassion Training (CBCT) Emory University Mindful Self-Compassion Training Programme
30 Enhancing Compassion Modelling
31 Enhancing Compassion Dealing with anger
32 Enhancing Compassion Preliminary data Enhancing self-compassion Modifying perception of patient and work load Spending more time with hobbies
33 Enhancing Compassion Need to address systems--- NZ Doctors and barriers to compassion (Fernando, Consedine 2015 unpublished) Most barriers to compassion experienced: GP s and Gen Med > Paeds/ Surgery > Psychiatry
34 Imagine
35 Motivation
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