Living Well Integrative Health Center

2176 Windsor Street, Halifax, Nova Scotia, Canada. (902) 406-1500

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LOVE BEGINS WITH THE LETTER "C" repost see newsletters Winter 2017

LOVE BEGINS WITH THE LETTER C

BY DR. MARIA PATRIQUIN MD CCFP

( published in APPC) 

I send my Christmas cards after Christmas. I write about love after Valentines Day and so it goes. Let’s celebrate “love month”. Much has been written this month bestowing the health, emotional and longevity benefits of loving relationships (Vaillant, 2012) but little is spoken of the forbidden “L” word that is woven through our work as health care providers. We would never attribute such meaning, devotion, energy and purpose to anything other than what we Love.

Limited time, budgets, shrinking resources, an aging population, stressed kids, epidemic levels of depression and anxiety coupled with increasing expectations in a “not well” health care system has led to expanding roles and responsibilities for providers. “Burnout” and “compassion fatigue”  and are common in our language around how care is being impacted (McCray, 2008).

Our professional roles have evolved along with advances in technology (e.g. easier access to current information and more effective and efficient treatments). There is a push for technology to fill in the health care gaps, we will gain, but we stand to lose a lot as it can never replace human connection. With it comes a cost of losing opportunity and eventually ability to connect on a human level. We stand to lose our role as “healers” and that which creates our meaning, satisfaction and contentment with our work.

Healing necessitates a human connection and nothing can replace what happens when we are fully present. Space, time, words, gestures and touch permit expression and sharing of pain, suffering and similarly joy, love, hope and triumphs. Compassion is an emotional response to suffering that is accompanied by a desire to help. It differs from empathy, the emotional experience of another’s feelings (Sinclair, 2016).

Emerging research points to us possessing a “compassion instinct”. Observations of human infants and chimpanzees show they engage and are attentive when they themselves are helping and similarly when they witness others helping. This suggests that the body responds not just based on reward (Wareneken & Tomasello, 2006).

Despite the numerous YouTube videos capturing people not coming to the aid of others in need, professors at Harvard have shown that helping is a primary impulse for both children and adults (Rand, Greene and Nowak, 2013). Empathy and compassion are natural, they are inborn “pro-social drives” to connect to other human beings and we don’t just want this, we need this to survive.

Compassion creates physiological and emotional changes that we experience as pleasant and positive. Neural imaging studies (Green , 2013) showed that the pleasure centers in the brain are activated when we see someone give similarly as when we receive. In fact, it appears that we experience more pleasure and happiness from giving than receiving and this has even been shown in children as young as two years of age. (Dunn, Aknin & Norton, 2008, AkninHamlin & Dunn, 2012)

Research is compelling that feeling connected by a meaningful life full of altruism, empathy and compassion leads to better physical and mental health, aids in healing, enhances immune function and decreases inflammation in the body (a process we know underlies the development of disease). (Diener & Seligman, 2004. Fredrickson et al, 2008).

Strong social connections increase longevity, increase mood, decrease anxiety, depression and make people more trusting and cooperative which causes a reciprocal effect making it a positive feedback loop (House, Landis & Umberson, 2003). Kindness and compassion are contagious.

In order to truly care for our patients and support them we need to show empathy and demonstrate compassion in our care. Often the lines blur for us as our training creates an artificial “us/them” divide (there is only we). Legitimately we need to maintain certain boundaries, ones we can only establish if we are mindful of our own emotional experiences. Often we are taught to suppress our own emotions in an effort to cope. Ironically in asking this of ourselves we inhibit the instinct that allows us to elicit an empathic response.

Research supports the practice of compassionate care as it improves patient satisfaction, adherence, decreases anxiety and stress feelings and enables patients. (Kelm et al, 2014) Some studies have actually shown improved Diabetic Hb AIC levels and lower LDL levels when patients were cared for by a family doctor they felt to be empathic. (Derksen et al 2013). The postulated mechanism is that empathy and compassion increase trust and this itself promotes honesty in reporting, better alignment in treatment plans (patient engagement), follow up and then the ability to “stick with it” (CMA, 2007).

TAKE HOME MESSAGE: All you need is love and compassion.

What can we do as front line workers?

Have self-compassion. Take Care. Eat well, sleep, exercise, socialize, take time off and emote. Without space for our emotions in the care of others we cannot authentically hold any suffering and joy with compassion (Neff, 2007). I like to think of compassion as the “antidote to burnout”.

Through compassionate exchange of stories we create the circumstances to help heal others and ourselves. It is an emotional, cathartic, inspiring and validating experience we can have with each other (Pennebaker ,1997, 2000. Jain, Manoj, 2015).

Mindfulness and loving kindness meditation is another means to self-care and emote. Loving kindness meditation increases mood, decreases stress, depression and self-criticism. It increases empathy, compassion and makes us more helpful (Fredrickson, 2008).

Listen and Tell stories. Our encounters often start with the recounting of a story. The narrative offers a personal account of experiences (symptoms, feelings, thoughts) and holds the possibility of being understood by the listener. Our input changes the narrative and it becomes a shifting, changing and co-created narrative. Be sensitive, choose kind, non-judgemental words, gentle gestures and give the time and safe space for it to unfold. We have great therapeutic potential by being supportive, compassionate and responsive to our patients, their experiences and perspectives (Launer, 2006). The lovely thing is that in this co-creation of narrative, this enabling of emotions and compassion there is mutual influence and benefit. We are in this together. Compassion is win-win experience (Coulehan, 1991).

Show compassion to other health care professionals. Our stress fosters resentment and blame. That is not healthy space from which to care. Showing compassion to other health care professionals enables us to collaborate in a constructive manner, we need this. “Compassion is an antidote to crisis”. Collaboration does not merely require a systems review and detailed budget, it too is natural and results when everyone feels they are deserving of compassion and kindness. We are all human, and care is “better together”. This collaboration will serve all of us well. It contributes to a culture of wellness within our health care model that we all desire and need.

Compassion can be taught. There are a growing number of programs aimed at teaching and fostering compassion and a “Triple C” model than encompasses compassion is being put forward. The best lessons are shared when we practice what we preach (Lown, 2015, Branch et al 2012).

When all else fails reflect and remember those we admire most and that with compassion they not only lived happy content lives but also contributed significantly to humanity…

 “The greatest disease is not TB or leprosy; it is being unwanted, unloved and uncared for”. We can cure many diseases with medicine, but the only cure for loneliness, despair, and hopelessness is love. (Mother Theresa, 1995).

Darwin actually spoke to the strength of social and maternal bonds… “communities, which included the greatest number of sympathetic members, would flourish best…” He didn’t state “survival of the fittest” as we all believe, he said it’s about “survival of the kindest”. Some things evolve, some thing always remain true. You can never go wrong with Love. And in our professions, Love begins with the letter “C” for compassion.

 

 

References:

 

Aknin LB, Hamlin J, Dunn EW. (2012). Giving leads to happiness in young children. PLOS 1. 7.

 

Branch W, Davis K, Weng M. (2012). Teaching Compassion. Patient Educ & Counseling. Oct, 2012. Vol. 89, Issue 1, 3-4.

 

Coulehan JL (1991). The word is an instrument in healing. Lit Med 1991; 100:111-29.

 

Diener E, Seligman MEP. (2004). Beyond money: Toward an economy of well-being. Psychological Science in the Public Interest, 5, 1-31.

 

Dunn EW, Aknin LB, Norton MI. (2008). Spending money on others promotes happiness. Science, 319, 1687-1688.

 

Darwin, CR. 1871. Descent of man, and Selection in Relation to Sex. London: John Murray. Vol. 1st edition.

 

Decety J, Fotopoulou A. (2014) Why empathy has a beneficial impact on others in medicine: unifying theories. F 457.

 

Derksen F, Bensing T, Largo-Janssen A. (2015). Effectiveness of empathy in general practice: systematic review. Br J Gen Prac. 2013. Jan; 63 (603) e76-84.

 

Fredrickson BL, Cohn MA, Coffey KA, Pek J, Finkel SM. (2008). Open hearts build lives: positive emotions, induced through loving-kindness meditation, building consequential personal resources. J Pers Soc Psychol. 2008. Nov; 95(5):1045-62.

 

Green S, lambon R, Moll MA, Zakrewski, J Deakin JF, Grafman J, Zahn, R. (2013). The neural basis of conceptual-emotional integration and its role in major depressive disorder. Soc Neurosci, 8(5), 417-433.

 

House JS, Landis KR & Umberson D. (2003). Social relationships and health. Social Psychology of Health. (218-225). New York, NY, US: Psychology Press.

 

Kelm Z, Wormer J, Walter J, feudtner C. (2014). Interventions to cultivate physical empathy: a systematic review. BMC Med Educ 2014; 14. 219.

 

Launer J. (2006). New stories for old narrative-based primary care in GB. Families, systems and health. 2006. Fall; 24(3): 336-44.

 

Lown BA. (2015).Integrating compassionate collaboration into health Prof Ed. Acad Med 2015 Dec 29.

 

Jain, Manoj. Narrative Medicine. On line classes for health care providers. Found at https://www.creativeninfiction.org/narrative-medicine.

 

McCray et al. (2008) Resident Physician Burnout: is there hope? Fam Med; 2008 Oct; 40(9) 626-32.

 

Mother Theresa, 1995. A Simple Path. Balantine Books.

 

Neff KD, Kirkpatrick KL, Rude SS (2007). Self-compassion and adaptive psychological functioning. J Res in Pers 41; 139-154.

 

Nolte J. (2005). Enhancing Interdisciplinary Collaboration in Primary Health Care in Canada. EICP2008

 

Pennebaker JW (2000). Telling stories: the health benefits of narrative. Lit Med 2000. Spring;19(1) 3-18.

 

Pennebaker JW. Opening Up: the healing power of expressing emotions. New York, Guilford Press.1997.

 

Pennebaker JW. (1997). Writing about emotional experience as a therapeutic process. Psychol Sci. 1997; 8(3): 162-166.

 

Putting Patients First: Patient-Centered Collaborative Care A discussion paper July 2007, CMA.

 

Rand Dg, Green GD, Nowack MA. (2013). Spontaneous giving and calculated greed. Nature, 489. 227-430.

 

Shapira LB (2010). Benefits of self-compassion and optimistic exercising for individuals vulnerable to depression. Jour Pos Psych. 5; 377-389.

 

Sinclair S. (2016). Compassion: a scoping review of the healthcare literature. BMC Palliat care 2016:15.

 

Tannenbaum D, Konkin j, Saucier D, Shaw L, Walsh A, et al. (2011). Triple C competency-based curriculum. CFP 2011.

 

Vaillant GE. (2012). Triumphs of Experience. The Men of the Harvard Grant Study. Belknap Press. Oct 2012. 2008

 

Warneken F, Tomasello M. (2006) Atruistic helping in human infants and chimpanzees. Science. Science, 311, 1301-1003.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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