Ep 145 Physician Compassion – The Barbara Tatham Memorial Podcast

What do patients really care about and benefit from after an ED visit? Is it your correct decision to order a D-dimer or administer antibiotics within a given time frame? Or is it how you provide compassionate care? The literature clearly shows that compassionate care and physician compassion have steadfastly eroded in medical practice, and in EM in particular, over the past 30 years – with palpable consequences. Dr. Barbara Tatham, EM colleague and educator, died of metastatic sarcoma at the age of 32 in October 2019. During her last year of life, in between surgeries, ICU stays and rounds of chemotherapy and radiation, she gave lectures on compassionate care inspired by her journey as a patient. In August 2019 we met at my summer cottage to record this podcast. We explored the evidence that compassionate care improves patient outcomes and staves off physician burnout. We discussed how compassion can be learned and applied easily and efficiently in your practice. We talked about the do’s and don’ts of compassionate care and ended with a call to action. It is my hope that, through this podcast, her voice and vision will reverberate and she will continue to champion compassionate care into the future… Podcast production by Anton Helman and Barbara Tatham, sound design & editing by Anton Helman Written Summary and blog post by Anton Helman and Barbara Tatham August, 2019 and August, 2020 Cite this podcast as: Helman, A. Tatham, B. Episode 145 Physician Compassion - The Barbara Tatham Memorial Podcast. Emergency Medicine Cases. Augst, 2020. https://emergencymedicinecases.com/physician-compassion-barbara-tatham. Accessed [date] Depersonalization, burnout and trends in physician compassion On the front lines EM physicians face patients with extreme emotional lability, pain and suffering regularly. We take pride in our ability to withstand repeated traumatic events as humans have for thousands of years in wars and famines. Why do we do this? To protect ourselves. We use our innate ability to depersonalize after these events. We do this so we can execute a pediatric airway or thoracotomy without decompensating. But the person in the stretcher in front of us is more than a particular diagnostic puzzle or a disposition dilemma. They are often frightened, anxious, concerned or emotionally numb. Addressing their emotional states is paramount. Depersonalization may be adaptive, but it poses a major problem to quality patient care, and specifically, to compassionate care. Given this need to depersonalize, it makes sense that observational data show that doctors aren't very good at compassion. And the problem is compounded by the physician burnout epidemic. One of the key features of burnout is depersonalization, with an inability to be compassionate. The consequence is that we unfortunately routinely miss emotional cues from patients and miss opportunities to respond to patients with compassion. A University of Washington study found that one third of end of life discussions with families in the ICU had no statements of compassion by health care providers. A study of 1,300 patients out of Harvard found that nearly 50% of patients believe that providers in our health care system are not compassionate. When health care providers were asked about trends in compassion, about two-thirds said they have observed a decline in compassionate care in the past 5 years. The trend is similar in the UK. The NHS Foundation Trust found that there has been a widespread and striking lack of compassion from health care providers. You might be thinking that your EQ is high and that you do provide compassionate care. Well, it turns out that we are not very good at rating our own EQ. Evidence suggests that our self-rated EQ does not correlate with patients’ ratings of our EQ.