I had never heard of Robin Youngson before this conference, and so I have no expectations or preconceived ideas of what I can expect.
Robin is introduced as an anaesthetist by training, an honorary senior lecturer at Auckland University and co-founder of Hearts in Healthcare. He is an internationally renowned advocate for compassion and caring. He opened his presentation with a wonderfully warm and rich mihi and acknowledgment. Robin shared photographs of himself as a young boy, with his family and attending boarding school. Robin made the point that this history shaped and steered him towards his chosen profession. “Boarding school syndrome” and the “atypical” difficulty in forming intimate relationships proved an ideal background for an anaesthetist, with little need to interact with people.
This is the first time I’ve listened to a keynote – or in fact any speaker – address the topic of compassion and caring! A long wait – but I am starting to wonder, why so?
Robin shared the story of daughter’s experience of depression and borderline personality disorder, and the very human impact, on himself, his family and his daughter – the struggle and learning from this.
Robin described how his daughter, no longer able to bear seeing her parents suffering, asked to be taken to hospital. He described how he felt completely “naked” as a doctor; that he could not do anything to help his daughter or relieve her suffering. As Robin’s voice trembled, I’m sure every parent in the audience felt the tiny stings of tears welling up in their eyes. Such an emotional and human presentation.
Robin gave two examples of interactions with doctors. In one example, the doctor engaged by a challenging negotiation with Robin’s daughter; “You teach me the skills of being assertive, and I will teach you the skills of caring for yourself.”
In the other example, his daughter had carefully co-authored with her doctor a discharge letter; she was extremely happy with this. When she needed to be admitted again, another doctor refused to read the discharge summary, asked her instead to tell her story again – insisting that he needed to hear it in her own words. This was in spite of her saying how distressing she found it; the consultation was becoming difficult and potentially volatile. Robin had initially remained silent on his own background but intervened. He suggested that his daughter’s change in mood and demeanour was consequent to the doctor’s aggression. “I AM NOT AGGRESSIVE!” asserted the doctor.
Beginning as a high tech doctor; he now takes the time to meet every single patient as a human being – in spite of time pressure. He uses humour to put people at ease. He makes sure to engage as a human being; with permission will suit on the bed. He observes the patients wringing hands. “Did you get any sleep last night?” “No, I’ve been really worried about this process…”. “What are the thoughts that been running through you mind?”
Five minutes of caring can have the most profound positive effect on the outcome of the surgical process – reduction in pain and discomfort alongside enhanced healing. There is research now to support this assertion! The science of interpersonal connect – the brain and heart are connected across people interacting. When you are in hospital what the doctors say you will likely forget… you will not forget how you felt.
What the research tells us…
- Trauma patients who rated their surgeon “high empathy” are 20 times more likely to experience better subjective outcomes; e.g. very satisfied with care; belief that treatment is effective; improved quality of life….
- Supportive pre-op visit from anaesthetist halves the dose of post op opiates. Non-supportive pre-op visit by anaesthetist increased length of stay by 2.7 days.
We must transform empathy to compassion! Compassion saves money!
Medline search for the word compassion – just 600 hits! It is a word that by comparison with some other key medical terms is almost invisible.
Physician – patient relationship has a big positive effect on five year mortality – more than smoking cessation or taking aspirin. Diabetic patients of high empathy primary care physicians had 42 per cent fewer hospital admissions for metabolic crisis than patients of empathy physicians.
How much do we train our physicians to be compassionate?
Human touch has the power to reduce pain – yet touching is increasingly frowned upon in our Western community.
Compassion means honouring the whole person. Compassion also means supporting families – Robin’s daughter’s psychiatrist compassionately advised that she may not survive; suicidal illness can be dangerous.
We need to appreciate that health does not occur as an individual phenomenon but in relationship with others. Compassion also means sitting alongside patients in their darkest places. Robin told a story from an Australian doctor. His patient had advised that she had reached rock bottom and intended to kills herself. Her plan was to overdose on paracetamol. She knew it would not at all be a pleasant “straight forward” death. The doctor acknowledged that “if you are willing to end your life that, way your life must be pretty hellish right now.” Instead of the usual responses the doctor sat on the floor beside the patient with her… A place of profound brokenness – it is place where miracles can happen.
Robin told a story of a woman whose baby had died in her womb. He was to be the anaesthetist for the caesarean section. He decided that his priority was to assist the patient/mother in grieving well. He held her hand and sat on her bed; he said he understood that she had had very devastating news. He cried with her (not overcome by emotion). After the procedure, while holding her baby, she gave Robin feedback that she so appreciated his skill, his compassion but also his crying.
Finally, Robin presented the quite damning indictment (my words!) of our health care system. The recent New Zealand heath care strategy does not contain the word compassion. Rising to the challenge does not contain the word compassion.
He made a plea:
"Let our two nations measure our success not be the price of our houses, GDP, our riches, but how we care for our must vulnerable and we express compassion."
It is impossible to convey in this blog the moving power of this presentation. Robin connected deeply with much of the audience; for some of us our souls were both touched - and nurtured.
It was a presentation I will never forget.