The Patient Experience: Compassion During a Digital Era

Sophia Martinez, Princeton University

With new social distancing protocols, Covid-19 has dramatically accelerated the shift to telehealth, forcing the healthcare community to evaluate the patient experience amidst these technologies. A study from the Cleveland Health Clinic’s patient satisfaction surveys from September of 2019 to April 2020 revealed that communication, inclusion on the care team, and a sense of compassion from physicians and nurses alike shaped a positive patient experience (Boissy, 2020). By forcing a re-examination of what matters most to patients, Covid-19 has created an opportunity for reflection on the critical need for compassionate care. This has also brought the challenge of delivering compassion through a computer screen and from behind a face mask. The face mask, especially, has become a dramatic symbol of the pandemic. Could these necessary measures intended to benefit societal health be creating a conflicting narrative by posing a challenge to the heart of medicine- compassion?

Challenges to Compassionate Care during the Covid-19 Pandemic

In order to mitigate the spread of Covid-19, hospitals have had to limit patient visits, shift to virtual appointments to comply with social distancing, and wear personal protective equipment. These measures have both generated a greater need for compassionate care while making it more difficult to show compassion. Virtual appointments prevent showing compassion through the physical touch and the personal protective equipment prevents communication through facial expression while also creating a very isolated environment for the sick patient.

However, while the face mask conceals the nose and mouth, human communication remains largely intact through the eyes, body language, tone of voice, and verbal communication, prompting the question of what value does revealing our face actually bring to healthcare. If communication remains intact, why has the face mask become such a frightening symbol of the pandemic? The answer may have to do with conveying warmth and acceptance of the patient. Healthcare workers use the mask to protect themselves from the virus, but when treating Covid-19 patients, the face mask becomes protection from the patient. The face mask thus becomes an unintentional barrier between the healthcare worker and the patient, not just the virus. This barrier may thus teach us that emphasizing togetherness with the patient is a critical part of delivering compassionate care during both the pandemic and in the post-pandemic world.

The pandemic has also brought challenges for non-Covid-19 patients.  Patients with chronic disease such as those suffering from cancer may experience significant anxiety related to delays in screening or the administration of drugs at home. With restrictions on visitors, both Covid-19 and non-Covid-19 patients alike have had to endure the challenge of recovering without family support. While virtual platforms like Facetime have assisted with this, the lack of family presence generates a greater need for physician compassion. This increased pressure may also exacerbate physician burnout, making compassionate care more difficult to deliver. 

Re-creating the Human Touch: Possible solutions

The delivery of compassionate care requires the healthcare community to focus on strengthening the physician-patient relationship, and therefore look specifically at ways in which to promote connection between them while protecting both the patients’ health as well as the physicians’. One unique perspective is that the pandemic has actually helped to alleviate physician burnout because people have rallied to support healthcare workers and have acknowledged their personal sacrifice (Hartzband & Groopman, 2020).  Citizens applauded from apartment buildings in cities nationwide, doctors played music, girl scouts delivered cookies to hospitals, and first responders drove by cheering and blaring their sirens (Mustard, 2020).  Such practices should thus be maintained even after the pandemic is over. For example, hospitals can partner with local volunteer organizations like Key Club and Scout Troops to donate cookies or plan drive byes to show appreciation and boost morale.

In order to improve compassionate care for patients, healthcare workers must ensure constant and consistent communication with patients at home, letting them know it is okay to reach out both during the pandemic and post-pandemic. They can also provide advice on what patients can do at home to manage treatment and create a healthy lifestyle routine (Berg, 2020). Both non-verbal and verbal communication can be emphasized in order to recreate connection. Compassion through nonverbal cues could be shown by exaggerating head nods and maintaining eye contact both virtually and with a facemask (Drees, 2020). Verbal communication should address patient concerns, and during the pandemic especially, make certain the patient understands why the healthcare worker is following specific protocol.  

Actionable Policies

Based on the challenges posed by the pandemic, healthcare workers should make small investments of time in verbal compassion that is focused on unity. A Johns Hopkins study which addressed the question of how long it takes to make a meaningful connection between cancer patients and their oncologist found that it only took 40 seconds, a result obtained by timing the oncologist’s statements of compassion (TEDxPenn, 2018). This minimal time investment can motivate physicians and combat the common idea that there is no time for compassion. Specifically, providers should verbally acknowledge and validate a patient’s feelings during both virtual appointments and in person ones (Houchens & Tipirneni, 2020). With Covid-19 patients during the pandemic, physicians should emphasize that they are with patients fighting the virus together.

Effort should be made in seeing the patient as a person, a practice which virtual appointments may actually improve. Physicians explain how with virtual appointments, doctors can meet their patient’s family, understand their lifestyle and home life, and “see the rug they trip on” (Unger, 2020). This helps to humanize the patient beyond their files, strengthening the relationship between the physician and the patient, and making it easier to empathize with them. Other physicians mention how the virtual experience feels more intimate and lets patients know that physicians are on their side by being available to provide care even with the new protocols during the pandemic (Garcia, 2020).  By providing more personal insight into the patient, virtual care allows physicians to better relate to patients, making it easier to deliver compassionate care. The benefits of a greater insight into home life prompt a different question: how can the healthcare community bring these positive aspects into the clinic appointments? Perhaps this means that physicians should ask more about a patient’s home environment during the history and physical examination in the post-pandemic world.

 Addressing Compassionate Care in Education

Because the shift to telehealth will likely remain, medical training must address creativity while delivering compassionate care. Throughout the pandemic, doctors have had to develop innovative ways of showing compassion. In palliative care units, doctors have sung and gathered around the patient in their final moments. Others have developed photographs of themselves that they can put on their personal protective equipment so that patients can see their faces (Houchens & Tipirneni, 2020). While medicine continually evolves with new technology and challenges like Covid-19, compassion remains at its heart, making it important that in education, doctors not only learn methods of delivering compassionate care with technology, but also the importance of innovation in its delivery. How have the methods of delivering compassionate care changed throughout the centuries? Understanding this may help healthcare workers continue to provide compassionate care in this rapidly changing field.      Medical schools must also emphasize an increased reliance on verbal compassion and nonverbal cues that cannot be obstructed by personal protective equipment, that compassion takes less than a minute, and that empathy is ingrained in human nature. In his book, The Power of Kindness, Dr. Brian Goldman shares how he learned that humans are hard-wired for empathy, but that the act of being empathetic is a choice made by weighing pros and cons, writing then “The choice is yours” (Goldman, 2018).  Doctors go into medicine with the primary calling of helping others; for medical students and senior physicians alike, it is important to emphasize that one cannot lose their compassion. It is a choice that at times may be harder to make.

Conclusion

While it has brought significant challenges, the Covid-19 pandemic has also taught us valuable lessons that can help the healthcare community going forward in delivering compassionate care both virtually and in the clinic. Through the dramatization of the face mask as a symbol of the pandemic, Covid-19 has taught that delivering compassion often means emphasizing unity between the physician and the patient. It has taught that delving more into a patient’s home life can strengthen the physician-patient relationship and improve patient care. It has also taught the importance of supporting healthcare workers in reducing physician burnout. These insights can improve the delivery of compassionate care moving forward both during the pandemic and in the post-pandemic world.  

References

Berg, Sara. (2020, May 6). Strengthening Long Distance Care for Chronic Disease Patients. American Medical Association. https://www.ama-assn.org/delivering-care/public-health/strengthening-long-distance-care-chronic-disease-patients.

Boissy, Adrienne. (2020). Getting to Patient-Centered Care in a Post–Covid-19 Digital World: A Proposal for Novel Surveys, Methodology, and Patient Experience Maturity Assessment. NEJM Catalyst Innovations in Care Delivery, vol.1, no. 4, https://catalyst.nejm.org/doi/full/10.1056/CAT.19.1106.

Drees, Jackie. (2020, April 21). How physicians can show empathy over virtual visits. Becker’s Hospital Review, https://www.beckershospitalreview.com/telehealth/how-physicians-can-show-empathy-over-virtual-visits.html.

Garcia, John. (2020, April 13). Doctor is in the House: Virtual Care during COVID-19. Gillette Children’s Specialty Healthcare, https://www.gillettechildrens.org/khm/the-doctor-is-in-the-house-virtual-care-during-covid-19.

Goldman, Brian. (2018). The Power of Kindness: Why Empathy is Essential in Everyday Life. Harper Collins Publisher Ltd. 

Hartzband, Pamela, and Groopman, Jerome. (2020). Physician Burnout, Interrupted. The New England Journal of Medicine vol. 382,26: 2485-2487. Published Online First May 1, 2020. doi:10.1056/NEJMp2003149

Houchens, Nathan, and Tipirneni, Renuka. (2020). Compassionate Communication Amid the COVID-19 Pandemic. J. Hosp. Med 2020;7;437-439. Published Online First June 17, 2020. doi:10.12788/jhm.3472.

Mustard, Ruth. (2020, May 11). Nurses are meeting Challenges of Covid-19 with courage, compassion and love. The State, https://www.thestate.com/opinion/article242645461.html.

TEDxPenn (2018). How 40 seconds of Compassion Could Save a Life | Stephen Trzeciak. Youtube,https://www.youtube.com/watch?v=elW69hyPUuI.

Unger, Todd (2020, June 11). AMA COVID-19 daily video update: How to maintain a human touch when using telehealth platforms. American Medical Association, https://www.ama-assn.org/practice-management/digital/ama-covid-19-daily-video-update-how-maintain-human-touch-when-using.