Compassionate Care

With our Center’s founding in July of 2008, we became the first program within a United States medical school to explicitly name compassionate care in our mission statement. We are now leading and developing a rigorous multidisciplinary research network of investigators from more than 40 universities nationwide to achieve our goals of better understanding and teaching compassionate care. We are committed to preparing new healthcare leaders both at Stony Brook and nationally who will ensure that compassionate care and altruism are at the center of medical practice.

Compassionate care is essential in the delivery of good healthcare, while its absence constitutes neglect. The “care” in healthcare too often includes only the application of medical technologies and treatments, without attention to the patient as a whole human person in need of empathic affirmation. We use the words “compassionate care” to convey just this kind of care that takes the whole patient into account.

That such care is lacking is expressed in frequent patient complaints of being dehumanized or even mocked - “the kidney in room 3,” or the “quad in bed 5.” We at Stony Brook University therefore take seriously the ethical imperative of training students and staff in the emotional and relational skills that allow patients to feel cared for at the most basic human level. We explicitly expect, model, and measure these skills in our students, with a consistent emphasis on curricular improvement. As Francis Peabody stated in his famous 1925 lecture to medical students at Harvard, “The secret to the care of the patient is in caring for the patient.”

While most medical schools make an effort to teach students that the optimal care of the patient requires compassion, several studies measuring these qualities in students show a significant decline in the third year, just as students move into the clinical clerkships. Some attribute this decline to a so-called “hidden curriculum” in which compassionate care is neither emphasized nor well modeled by faculty, nor is it adequately rewarded in student evaluations. The precise causes of this decline can be debated, but it is clear that the art of compassionate care is not being transmitted well to impressionable students just when it is most important to their professional formation.

The diminishment of compassionate care constitutes a crisis. Physicians who connect compassionately with their patients have been shown to make more accurate diagnoses and encourage higher levels of patient adherence to treatment. Furthermore, they typically need less time in patient interviews and learn more information when compared with physicians who lack compassion. They are more successful in encouraging healthy and responsible patient behaviors, and are themselves more satisfied and happy as medical professionals. (Women physicians are in general somewhat more empathic than male physicians.) Extensive biomarker research shows that patients who are treated with compassion experience less stress, and are therefore less subject to the physiologically damaging effects of the stress response. In addition, studies have shown that patients who feel cared for have better immune function, and somewhat faster wound healing. Patients who do not receive compassionate care may understandably seek an alternative healer and miss out on the benefits of standard scientifically proven treatments.

The Center for Medical Humanities, Compassionate Care, and Bioethics is a leading program when it comes to the serious study and pedagogy of compassionate care. From its very beginnings four decades ago, Stony Brook School of Medicine emphasized the medical humanities as a way to teach compassionate care. Peter Williams, PhD, JD and John L. Coulehan, MD, are among a small group of medical educators who have gained national attention for compassionate care curricula. This focus has been expanded on by Iris Granek, MD, who has devoted herself tirelessly to compassionate care education through the year long Foundations of Medical Practice course for Year One medical students. Also contributing to our efforts are Andrew Flescher, PhD, a philosopher/ethicist of altruism and compassion, poet-physicians Maria Basile and Richard Bronson, social scientist Catherine Messina, PhD, and Rev. Michael Vetrano, PhD. Joining us from the University of Michigan, Stephanie Brown, PhD, and Dylan Smith, PhD, are among the nation’s several leading researchers on the health impact of altruism and compassionate care, both given and received. Carla Keirns, MD, PhD, demonstrates in her work that compassionate care leads directly to a concern with justice and healthcare policies. Stephen Post, PhD, was recruited to direct the Center as a widely recognized as a leader not only in bioethics, but for his years of study in the field of altruism, compassion and health. Eva Kittay, PhD, a Center affiliated philosopher and perhaps the world’s foremost voice in articulating the framework for a feminist “ethics of care,” is also actively engaged with the Center.

Major Research Foci

For our students to leave this university and medical school motivated by the benevolent capacities that bring nobility, flourishing, and health to their lives and to the lives of others, we must model, teach, and investigate these human capacities. Just as we study the force of gravity or the energy of the atom, we can concentrate the collaborative resources of science, humanities, and professionalism on the origins and nature of compassionate care. How can we better understand exemplary clinical practitioners from Dame Cicely Saunders to Paul Farmer? How can we better instruct the attitudes and emotional intelligence of students so as to successfully inoculate them from the elements of modern healthcare that trivialize or even undermine compassionate care? “The Care of the Other” is one of two foci of our multi-disciplinary university-wide initiative devoted to the better understanding and promotion of the compassionate care dynamic.

However, a genuine understanding of compassionate care demands not only attention to “the care of the other” but also an understanding of the compassionate “care of the self,” our initiative’s other major focus. We do not romanticize compassionate care. Such tendencies neglect the complexities of the caring relationship and give the impression that healthcare professionals can and ought to be saints who do not experience “compassion fatigue” in the absence of adequate support. The care of the other and the care of the self often coincide, but neither can occur when the professional is overwhelmed. We are developing a network of researchers and scholars in the sciences and humanities who can engage in a truly synthetic endeavor with the goal of making deep progress toward a culture of self care among professionals and patients. We support a just healthcare system in which rights and responsibilities both are guiding principles.