Compassion is the hallmark of a good doctor

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Sir William Osler said, “Care more for the individual patient than for the special features of the disease. . . . Put yourself in his place . . . The kindly word, the cheerful greeting, the sympathetic look – these the patient understands.

Compassion is the hallmark of a good doctor. The question then arises – what is compassion?

Compassion is “a deep awareness of the suffering of another coupled with the wish to relieve it” and is based on the concept of helpfulness. Five elements of compassion have been described: recognizing suffering, understanding the universality of human suffering, feeling for the person suffering, tolerating uncomfortable feelings, and motivation to act/acting to alleviate suffering (Clin Psychol Rev. 2016 Jul;47:15-27).

Compassion and empathy are often used interchangeably, but they are not the same. Simply put, compassion is “feeling for another”, while empathy is “feeling as another”. Sympathy is a feeling of pity for the suffering of another.

A common man generally perceives God as a force for whom nothing is impossible. He is the final decision maker, whose decisions cannot be challenged, who can provide instant relief and who overcomes miseries. He can also answer the unknown as He is omniscient i.e. all-knowing.

A doctor is a healer and helps the patient overcomes his problems, and at times, saves the life of a patient. Almost all of us have faith in God and trust that He will do right by us. He does not discriminate and for Him, all are alike.

A trained qualified medical doctor who has his understanding based on the mind, body and soul has nearly similar characteristics. During illness or during any acute emergency, patients and/or their families repose the same faith and trust in the doctor. He overcome miseries as soon as he touches the patient, gives immediate relief which starts at the time he gives a healing touch to the patient. This is perhaps why doctors have always been regarded as next to God since Vedic times.

Hence, doctors are expected to be compassionate and empathetic. This is not just decreed in the code of conduct, but has also been corroborated by evidence.

Compassion science or “compassionomics” is an emerging field in health. It is the branch of knowledge and scientific study of the effects of compassionate care on health, healthcare, and healthcare providers (Med Hypotheses. 2017 Sep;107:92-97).

However, health care today is seen to be lacking in compassion and is a major factor contributing to doctor-patient disputes. Research has shown that less than one percent physician communications with patients are expressions of empathy or compassion (Med Hypotheses. 2017 Sep;107:92-97).

A survey conducted in 2013 in the US (https://www.dignityhealth.org/-/media/cm/media/documents/Press%20Releases/2013-11-13-Americans-Rate-Kindness-as-Top-Factor.ashx?la=en) on the power of human kindness in health care threw up some remarkable findings, which one should take note of:

“87% felt that kind treatment by a physician is more important than other key considerations in choosing a health care provider, including average wait time before appointments, distance from home, and the cost of care.
When people experience unkindness in a health care setting, 93% felt that their quality of care is negatively affected and 54% withhold information from their physician when speaking with health care professionals.
90% would feel like switching health care providers or physicians after receiving unkind treatment.
72% would be willing to pay more for a physician who emphasized kindness when treating patient.”
A study examining the effect of physician characteristics on placebo response found that the impact of expectations on allergic response was enhanced when the provider acted both warmer and more competent and negated when the provider acted colder and less competent. It suggested placebo effect as a psychological phenomenon that can be harnessed to improve treatment outcomes (Health Psychol. 2017 Nov;36(11):1074-1082).

It’s not just patients, health care providers too benefit. Those who practice compassion and have empathy for patients have less burnout, more resilience and superior well-being (Med Hypotheses. 2017 Sep;107:92-97).

Recently, the Supreme Court awarded an additional compensation of Rs 10 lakh to a poor woman from the hills in a medical negligence case for the “insensitivity” shown by the hospital and doctors … that when she was writhing in pain, doctors at a Shimla hospital insensitively chided her by saying “people from hilly areas make unnecessary noise” (Shoda Devi vs DDU/Ripon Hospital Shimla and Ors Civil Appeal No. 2557 of 2019 (Arising out of Special Leave Petition (Civil) No. 26789 of 2018)

“16.3 Such granting of reasonability higher amount of compensation in the present case appears necessary to serve dual purposes: one, to provide some succour and support to the appellant against the hardship and disadvantage due to amputation of right arm; and second, to send the message to the professionals that their responsiveness and diligence has to be equi-balanced for all their consumers and all the human beings deserve to be treated with equal respect and sensitivity.

We are impelled to make these observations in the context of an uncomfortable fact indicated on record that when the appellant was writhing in pain, she was not immediately attended at and was snubbed with the retort that ‘the people from hilly areas make unnecessary noise’. Such remarks, obviously, added insult to the injury and were least expected of the professionals on public duties.”

The doctor-patient relationship is in a fragile state today and is marked by much acrimony. Practicing compassion and empathy go a long way in building a healthy doctor-patient relationship.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

Both late night meals and skipping breakfast can be detrimental to health

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First meal of the day should be nutritious while the last one must be early and light

New Delhi, 20 April 2019: People who skip breakfast and eat dinner near bedtime may have worse outcomes after a heart attack, a study has warned. It found that people with the two eating habits had a four to five times higher likelihood of death, another heart attack, or angina (chest pain) within 30 days after hospital discharge for heart attack. It is also recommended to have a minimum two-hour interval between dinner and bedtime.

Skipping breakfast was defined as nothing before lunch, excluding beverages, such as coffee and water, at least three times per week. Late-night dinner eating was defined as a meal within two hours before bedtime at least three times per week.

Speaking about this, Padma Shri Awardee, Dr KK Aggarwal, President, HCFI, said, “Indians have a tendency of gaining more fat around the abdomen, which can lead to insulin resistance. One of the primary reasons for this is the lifestyle people lead today. On-the-go and fast-paced lives mean people skip their breakfast and end up eating unhealthy, quick-fix meals through the remainder of a day. It is important to understand that even a5% reduction in body weight combined with regular to moderate intensity exercise can reduce the risk of Type 2 diabetes by more than 50%. Those without diabetes or at a risk of developing this condition should focus on switching to a healthier lifestyle and maintaining an ideal BMI.”

Diet affects diabetes risk independent of a person’s weight. Type 2 diabetes is known as a silent killer. By the time a diagnosis is done, other associated health complications may already be present.

Adding further, Dr Aggarwal, who is also the Group Editor-in-Chief of IJCP, said, “People who are obese should aim at limiting the intake of complex carbohydrates as they tend to increase blood sugar levels and the production of insulin. In those with insulin resistance, this surge can lead to further weight gain. Apart from this, aim at getting about 30 to 45 minutes of physical activity every day, five times a week.”

Some tips from HCFI.

  • Exercise every day and consume a healthy diet.
  • Get your blood glucose levels monitored at regular intervals.
  • Do not consume refined sugar in any form as this can get absorbed into the blood stream more easily and cause further complications.
  • Reduce stress through activities such as meditation and yoga.