COMPASSION WITHOUT BURNOUT Effectiveness of empathy in General Practice A systematic review published

  • View
    0

  • Download
    0

Embed Size (px)

Text of COMPASSION WITHOUT BURNOUT Effectiveness of empathy in General Practice A systematic review...

  • COMPASSION WITHOUT BURNOUT

    Copyright © PRIME 2017 www.prime-international.org

    Prof Richard Vincent BSc AKC MD FRCP EFESC

    Emeritus Professor of Cardiology, BSMS and PRIME Trustee

    Dr John Geater MBE MB ChB DRCOG DTM&H

    International Consultant PRIME Partnerships in International Medical Education

    Dr Rachel Hennessy

    Deputy Medical director

    SURREY AND BORDERS PARTNERSHIP NHS FOUNDATION TRUST

    Dr Shakil Malik, MBBS, DPM,MCPS, FRCPsych

    Dr John Caroe MA, MB, BChir, MRCP.

    Chair of Trustees PRIME & Volunteer Chaplain EDGH

  • When I started as a doctor, I’d go to work brimming with pride. But the system soured the love I felt for the NHS.

    Every time students achieve what looks like a successful milestone it is, to some of them, the opening of another door to a haunted house, behind which lie demons, suffocating uncertainty and unimaginable challenges.

  • COMPASSION WITHOUT BURNOUT

    for possible discussion:

    1. Exploring compassion as a fundamental foundation for our work with benefit for all, both patients and staff.

    2. Maintaining cohesive working, mutual respect and support between all who deliver health care, whatever their role.

    3. Examining the causes of growing stress in health-care personnel, sharing practical solutions for protecting against its adverse effects.

    4. Discerning the subtle signs of damaging stress in our work colleagues and how best to act in supportive response.

  • COMPASSION WITHOUT BURNOUT

    1. Exploring compassion as a fundamental foundation for our work with benefit for all, both patients and staff.

  • In becoming a health professional...

    I want to help people, to heal people, to relieve suffering.

  • COMPASSION WITHOUT BURNOUT

    1. Exploring compassion as a fundamental foundation for our work with benefit for all, both patients and staff.

    Why did you enter the health care profession?

  • The Doctor (1891) Sir Luke Fildes, National Gallery

  • The Enlightenment -The great divide

    Humanities (BA) Religion,

    Music, Literature, Art

    Communication

    “Spiritual”

    Science (BSc) Medicine

    Physics, Chemistry, Biology

    Investigative

    Material – “the real world”

  • With thanks to the Robert Pope Foundation

  • “….medical training seems to be focussed on how to deal with things – a liver, an MRI scan – rather than how to deal with people, such as patients and colleagues.

    This lack of training on how to deal with people could mean doctors are ill equipped for this vital part of their jobs and explains much of their subsequent stress”

    British Medical Journal, August 28th 2004

  • .

    The student/junior doctor

    Medical students and residents loose compassion during training Newton B et al. 2008, Acad Med: 83 244-249

    Callousness was seen as bad, but students saw it in their mentors 20% of the time in years 3 and 4, California, USA.

    Rentmeester et al. 2007, Med Teacher 29:358- 364

    Also: Neumann M, Edelhäuser F, Tauschel D, Fischer MR, Wirtz M, Woopen C, et al. Empathy decline and its reasons: a systematic review of studies with medical students and residents. Acad Med:2011;86:996-1009.

    http://www.bmj.com/content/347/bmj.f5455?sso=#xref-ref-8-1

  • A New Enlightenment -The great reunion

    Humanities (BA) Medicine

    Science (BSc) Medicine

  • ‘The greatest challenge facing contemporary medicine is for it to … regain its humanity, its caritas — without losing its essential foundation in science … to find a middle way.’

    Willis JAR. The sea monster and the whirlpool. Keynote address. Birmingham: Royal College of General Practitioners; 2002

  • A New Enlightenment -The great reunion

    Humanities (BA) Medicine

    Science (BSc) Medicine

  • A New Enlightenment -The great reunion

    Humanities (BA) Medicine

    Science (BSc) Medicine

  • fMRI scans showing brain activity in pain and empathy responses. Tania Singer / University College London

    Neuronal mirroring

  • A part of your brain the right supramarginal gyrus recognizes a

    lack of empathy and autocorrects.

    When this brain region doesn't function properly—or when we

    have to make particularly quick decisions—the researchers found

    one’s ability for empathy is dramatically reduced. This area of the

    brain helps us to distinguish our own emotional state from that of

    other people and is responsible for empathy and compassion.

    https://www.psychologytoday.com/blog/the-athletes-way/201310/the-

    neuroscience-empathy

  • Findings related to oxytocin and vasopressin research, plus the role of monoamines and endogenous opioids, suggest a tight coupling with attachment processes and love phenomena: happiness, pleasure, compassion and desire.

    Dopamine, as a critical part of the biologically important reward process, is a central instrument for

    the neurobiology of love.

    Med Sci Monit. 2011; 17(3): RA65–RA75

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3524717/

  • The impact of patient-centred care on outcomes from the Journal of Family Practice, 2000

    • 39 family physicians at random, and 315 of their patients

    • Consultations were audio-taped and scored for patient- centered communication.

    • In addition, patients were asked for their perceptions of the patient-centredness of the visit.

  • The Impact of Patient-Centred Care on Outcomes

    Results

    Patient-centered communication was correlated with the patients’ perceptions of finding common ground.

    Positive perceptions were associated with better recovery from their discomfort and concern, better emotional health 2 months later, and fewer diagnostic tests and referrals.

    Conclusion

    Patient-centered practice improved health status and increased the efficiency of care by reducing diagnostic tests and referrals.

    Stewart M, et al. The Impact of Patient-Centred Care on Outcomes. The Journal of Family Practice; September 2000 Vol. 49, No. 9

  • Observational study of effect of patient-centredness and

    positive approach on outcomes of general practice

    consultations

    Setting: Three general practices, 865 consecutive patients

    Outcomes: Patients' enablement, satisfaction, and burden of symptoms

    Doctor factors studied:

    Sympathy, interest in patients' worries & expectations, and readiness to discuss & agree about the problem and its treatment

    Understanding of the patient and her / his emotional needs

    Inclusion of health promotion in the consultation

    Positive approach (definite about the problem and when it would settle)

    Interest in effect on patient's life

  • Results

    Satisfaction was related to communication and partnership

    Enablement was greater with the doctors’ interest in the effect on life, and in health promotion

    A positive approach was associated with satisfaction, enablement and a reduced symptom burden at one month

    Referrals were fewer if patients felt they had a personal relationship with their doctor

    Conclusions

    Components of patients' perceptions can be measured reliably and predict different outcomes. If doctors don't provide a positive, patient-centred approach, patients will be less satisfied, less enabled, and may have both a greater symptom burden and higher rates of referral.

    Little P, et al. Observational study of effect of patient centredness and positive approach

    on outcomes of general practice consultations; BMJ 2001;323:908-911

  • Observational study of 839 non-pregnant adult women

    aged 18-70 presenting with suspected urinary tract

    infection in primary care

    ‘The most interesting finding from this study is the reminder of what is often forgotten—that it is not just what is done that matters but how care is provided.

    Symptoms were less severe and of shorter duration when the doctor took a positive approach to diagnosis and prognosis.

    Most importantly, in an age of protocols and targets, (this study) shows that the way a doctor provides care can enhance the effectiveness of treatments.

    Mangin D. Urinary tract infection in primary care. BMJ 2010; 340:c657

  • Effectiveness of empathy in General Practice

    A systematic review published in the British Journal of General Practice found seven papers (using strict inclusion criteria from an original tranch of 964) published in the last fifteen years, on the effectiveness of physician empathy in general practice.

    The effects of empathy in patient–physician communication in the studies included are described as:

    • Improvement of patient satisfaction and adherence to treatment,

    • De

Recommended

View more >