Helen: Welcome to Health Literacy Out Loud. I’m Helen Osborne, president of Health Literacy Consulting, founder of Health Literacy Month and your host of Health Literacy Out Loud.
In these podcasts, you get to listen in on my conversations with some really remarkable people—hearing what health literacy is, why it matters and ways all of us can help improve health understanding.
Today I’m talking with Dr. Beth Lown, who is a general internist at Mount Auburn Hospital in Cambridge, Massachusetts, and also associate professor of medicine at the Harvard Medical School. Dr. Lown teaches learners across the spectrum of medical education.
Among her many accomplishments, she is the first medical director of The Schwartz Center for Compassionate Healthcare, a nonprofit organization dedicated to strengthening the relationship between patients and care providers and creating more compassionate healthcare systems. Welcome, Beth.
Dr. Lown: Thank you, Helen. I’m glad to be with you.
Helen: You and I met many years ago at a conference about physician-patient communication.
Dr. Lown: That’s right.
Helen: Obviously that topic has stuck with both of us since.
Dr. Lown: Absolutely.
Helen: I know your focus today is really about compassion. Start from the beginning with the word compassion. What is it you really mean?
Dr. Lown: That’s a great question. I’ll define it briefly, but what I really want to do is tell you a story because it brings it to life.
Helen: I love stories. You know that.
Dr. Lown: Absolutely. In brief, compassion is all about recognizing, validating and then addressing the concerns, distress and suffering of others. People often ask what the difference is between empathy and compassion. Before my story let me explain that. I think empathy is coming to understand and to some extent sharing the thoughts and feelings of another person as if you were in that person’s shoes.
Helen: Like, “I feel your pain.”
Dr. Lown: Exactly. By the way, we do feel other people’s pain. We have new information from neuroscience about mirror neurons in the brain.
Dr. Lown: It’s absolutely true. If that person happens to be experiencing distress, this wakens something we call empathic concern for that person. If you have this empathic concern and you actually value that other person’s wellbeing, it awakens compassion. Compassion then causes motivation and intention to help.
Compassion is feeling for another person and acting. Empathy is feeling with that person as if you were in his or her shoes.
Helen: Thank you for the distinction there.
Dr. Lown: Let me just light this up a little bit. You may know this story, but I want to tell this story because I have found it incredibly moving and inspiring over the years.
I’ll tell you a story about a man who was 40 years old when he became quite ill with persistent fatigue and cough. He had a low-grade temperature. He just felt terrible.
He could not get into see his primary care physician. He saw various other covering people in the practice, but ultimately he just couldn’t connect with his primary care doctor and he was feeling pretty sick. He was also feeling uncared for, so he switched care.
Shortly after seeing this new physician, he was diagnosed with advanced lung cancer. That happened in 1997. The patient was Ken Schwartz, who was a healthcare attorney. He went in for his initial biopsy. There was a nurse doing his screening there. She was really curt and brusque. The room was crowded, hot, noisy and chaotic. He happened to mention that he had just learned he had advanced lung cancer. The nurse clearly heard something in his voice and she looked up. She saw the fear, concern and worry in his face and she stopped.
She said, “How are you doing?” Then they struck up a conversation. The next day he was waiting to be rolled into the operating room and that nurse came down looking for him. She sat next to him, held his hand and wished him well.
With that little act of compassion, she went out of her way to demonstrate her concern and to try to alleviate some of his fear before he was rolled into the operating room. That’s something very small. These little acts can occur in moments. We know that longer acts occur over the course of relationships.
Helen: That’s the essence of compassion, even just holding his hand.
Dr. Lown: It can happen in the moment. It’s not something that necessarily has to take a long time. That’s what people remember. If somebody has a really complicated condition and there are many difficult decisions to make, that requires compassion sustained over time and is based on continuity of relationships and caring.
Helen: Thank you so much for telling that story. You and I both live in the Boston area. We probably both read The Boston Globe Sunday magazine years ago with that article either by or about Ken Schwartz.
Listeners who are worldwide may not know about The Schwartz Center. Could you just ever so briefly tell everybody what that is?
Dr. Lown: We’re a national nonprofit and we’re housed under the nonprofit status of Mass. General Hospital here in Boston. As you said at the beginning, we’re dedicated to strengthening the relationships and the human connection in healthcare and to fostering more compassion in healthcare organizations and systems. That’s what we’re all about.
Two days before Ken died, he asked his family and friends to create The Schwartz Center for Compassionate Healthcare. He was worried that in this era of highly technologized, economically pressured and time pressured care that he was starting to see even in the mid-90s, compassion was going to be extinguished.
He charged his family and friends with trying to think of ways to really sustain compassion in healthcare.
Helen: Thank you. From that small moment when he didn’t feel compassion and when someone he felt did give him compassion, look how that has grown. I know its impact is across the US, if not around the world.
Dr. Lown: It is around the world because we started something called The Schwartz Center Rounds, which are spreading not only in the United States. We’re in well over 300 to 350 places in the United States, but they’re also spreading throughout England, Scotland and Wales.
Helen: A little dose of compassion goes such a long way. Thank you for making that so vivid for our listeners of Health Literacy Out Loud. We all care about good, clear, health communication, but we might be coming at it in different ways.
Some of us are clinicians and others are in public health. Some people are teachers, librarians or professors. We all care. What can we do to bring compassion into our communication about health?
Dr. Lown: That’s a great question Helen. I think of compassion as a process. It emerges as a result of the interaction, sometimes with a patient and a family and sometimes among a patient, family and the clinical team. The very first thing you have to do is to notice that someone has concerns or is in distress.
You have to be able to focus your attention. That’s no small request, by the way. When you think about it, we’re now typing in computers. Especially in healthcare, we’re responding to pagers and multitasking. There are always so many different things going on. It’s hard to focus, but we have to do that.
Helen: How can someone focus? There’s so much going on. What can we do?
Dr. Lown: I have this little strategy that I call the doorknob strategy. Before I go into an exam room or a hospital room, and I do it metaphorically no matter where I am, I put my hand on the doorknob for a minute and consciously set aside everything that I’m thinking about so that when I walk through the door, I can fully receive the patient or the family on the other side of that threshold.
It takes discipline and conscious re-centering and refocusing so you can actually look into the eyes, make good eye contact, and see what’s in the eyes and the facial expressions of the people on the other side of that door.
Helen: Thank you for that. That’s not just a metaphor. You’re telling me that I can almost have that tactile feeling too. What a great reminder. First we have to make this commitment to listen and pay attention. What else can we do?
Dr. Lown: I’ve been so interested in interpersonal communication skills for so many years. I’ve watched thousands of video tapes and listened to many audio tapes of doctor-patient communication. What you hear is that for various reasons, we don’t pick up on the verbal and nonverbal cues about concerns.
You can train yourself to look and listen for that, but you do need to pay attention to that. Doctors in particular need coaching because doctors are trained to listen for differential diagnosis clues and symptoms.
They sometimes unintentionally filter out clues about underlying emotional issues or social contextual issues that are really important in understanding who the patient is as a person and what kind of treatments are going to be okay for them.
Helen: Beth, you’re a storyteller. Give me an example.
Dr. Lown: For years I’ve taught medical students. Medical students are just starting to learn what we call the medical interview. It’s taught in a very stylized way, if you will. Somebody might be expressing something that has emotional content and a tear might well up in the eye.
The student might see it but not know how to deal with it, or because they’re trying to get through their process that they know they have to complete, they’ll go on to some other thing like, “Do you have any allergies?” and the tear is dripping down the face.
It’s not to criticize because they’re just beginning to learn. They need to learn from experienced role models that it’s possible to integrate the social, emotional, psychological, and all of these affective and relational aspects of care while you’re listening to medical content that you need in order to be a competent clinician.
Helen: That almost sounds the opposite of what you’re talking about. We have to pay attention and clear things away so we can really listen to the person.
Now you’re saying in conversations that we not only have to listen for our agenda, but we have to look all around, really notice and be very sensitive to what else is happening, such as just a little tear. Thank you for that.
Now we’re paying attention to everything about the other person. What else is part of compassion that we can bring?
Dr. Lown: I said at the beginning that compassion kicks in in the presence of empathic concern if you value the welfare of that other person. Sometimes we are in such a hurry to get on with the diagnosis, the treatment plan, or implementing treatment that we don’t always pay attention to how our assumptions are influencing our interactions.
Sometimes assumptions, misperceptions or not fully understanding a patient’s context can drive us to ignore other kinds of issues that might be important in creating a differential diagnosis. We need to learn how to bring conscious awareness how our assumptions, stereotypes and unconscious bias may actually be leading to errors in diagnosis and bias in treatment.
We know that exists. We can train ourselves to stop and ask ourselves a few questions like, “What do I think is going on here and why do I think it’s going on? Why am I thinking that X is the proper diagnosis or Y is the proper treatment?
“Could there be another alternative? Is the patient, by telling me these symptoms and concerns in a particular way, really trying to tell me something else about who they are and what’s worrying them?”
As another example, I have often taught from this transcript of a conversation where a young woman is coming in concerned about some headaches and she’s just had a little baby. The clinician just doesn’t hear her concerns that this could be something serious and that she’s alone with this baby.
None of the questions include, “Why are you alone? Do you have any support? Is there a partner around? Are you trying to manage all of this yourself? Why are these symptoms so significant and problematic to you?
“Of course, the symptoms could be significant because they’re painful or uncomfortable, but what else could be happening that might be important for me to know?” It’s important because this compassionate conversation may illuminate a completely different diagnostic possibility or a more patient-centered treatment plan.
Helen: I hope that we can all add a dose of compassion to our teaching. There’s obviously so much to it. You’ve been working at this for years. You talk about teaching others, and you watch a lot of videos and study this. We can’t capture everything about compassion in these few minutes. How can people learn more and improve their practice of their communication?
Dr. Lown: There are several options. First of all, people can go to Schwartz Center Rounds if their hospital, community center or whatever their group is offering them because it is a place to hear the perspectives of other colleagues and peers. Anyone who touches the care of a patient in a given organization can go to these. It’s very helpful and you can learn strategies there.
Helen: Thank you. We will have the link to The Schwartz Center on the Health Literacy Out Loud website.
Dr. Lown: There are other programs and courses available. The American Academy on Communication in Healthcare offers courses and there are wonderful online resources available. There are classic textbooks on patient-centered medicine and the patient-centered method of interviewing. I think also looking for role models, watching, and getting some coaching and feedback on your communication style and approach is extremely helpful.
Helen: Thank you. You are a role model for all of us lighting the way about demonstrating concern, acting on it and championing what Ken Schwartz said was so important. Thank you so much for speaking with us in Health Literacy Out Loud.
Dr. Lown: Thank you for having me, Helen. As always, I appreciate the work that you do.
Helen: Thank you. I learned so much from Dr. Beth Lown about compassion and how it fits into great health communication. But health literacy and good communication like this isn’t always so easy. For help clearly communicating your health message, please visit my health literacy consulting website at www.HealthLiteracy.com.
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Did you like this podcast? Even better, did you learn something new? If so, tell your colleagues and friends. Together, let’s let the whole world know why health literacy matters. Until next time, I’m Helen Osborne.