Compassion In Medicine Garrett Preston Clark, D.O

Compassion In MedicineCompassion In Medicine

Garrett Preston Clark, D.O.Garrett Preston Clark, D.O.

Case # 1Case # 1 A 32 y/o male presents to your clinic as a new A 32 y/o male presents to your clinic as a new

patient. He complains of rectal pain and difficulty patient. He complains of rectal pain and difficulty with bowel movements. During your history with bowel movements. During your history taking, you discover that he is HIV positive taking, you discover that he is HIV positive (diagnosed 1 year ago) and he also admits to IV (diagnosed 1 year ago) and he also admits to IV drug use. He confesses that he has had drug use. He confesses that he has had unprotected sexual intercourse with multiple male unprotected sexual intercourse with multiple male and female partners. He asks if you can just and female partners. He asks if you can just “hook him up” with some “free samples” because “hook him up” with some “free samples” because he has no money to pay for prescription he has no money to pay for prescription medication. You ask him if he has applied for medication. You ask him if he has applied for medical assistance. He replies: “My posse hooks medical assistance. He replies: “My posse hooks me up with whatever yo”.me up with whatever yo”.

Case #1Case #1 On physical exam you note an anxious, thin male On physical exam you note an anxious, thin male

who is diaphoretic. Vital signs denote tachycardia who is diaphoretic. Vital signs denote tachycardia at 106 bpm and a fever of 100F. There are trace at 106 bpm and a fever of 100F. There are trace crackles in the B/L lower lung fields. The B/L crackles in the B/L lower lung fields. The B/L forearms denote multiple track marks. The rest of forearms denote multiple track marks. The rest of the physical exam is otherwise normal with the physical exam is otherwise normal with exception of multiple inoculations of condyloma on exception of multiple inoculations of condyloma on opposing surfaces of the anus, as well as a broad-opposing surfaces of the anus, as well as a broad-based condyloma with numerous projections on based condyloma with numerous projections on the surface of the shaft of the penis.the surface of the shaft of the penis.

Case #1Case #1

As you are concluding the exam, you ask As you are concluding the exam, you ask the patient about his sexual practices the patient about his sexual practices (notifying contacts, safe sex measures, the (notifying contacts, safe sex measures, the need for abstinence, the risks of spreading need for abstinence, the risks of spreading disease to others, etc) when he then disease to others, etc) when he then interrupts you and states: “Look if you ain’t interrupts you and states: “Look if you ain’t gonna hook me up, I’m out a’ here”.gonna hook me up, I’m out a’ here”.

Please Rate Your Compassion Please Rate Your Compassion Level:Level:

1 = Absolutely NO compassion for this patient.1 = Absolutely NO compassion for this patient. 2 = I feel bad for the patient but hey, that’s life.2 = I feel bad for the patient but hey, that’s life. 3 = I feel bad for the patient and feel that I must 3 = I feel bad for the patient and feel that I must

work to portray empathy for this patient’s work to portray empathy for this patient’s condition. I will display at least an illusion of condition. I will display at least an illusion of compassion to make the patient feel better.compassion to make the patient feel better.

4 = I genuinely feel for this patient. I will offer 4 = I genuinely feel for this patient. I will offer counsel and monitor his/her physical & emotional counsel and monitor his/her physical & emotional progress.progress.

Case #2Case #2 A 14 y/o female presents to your office A 14 y/o female presents to your office

accompanied by her mother. She complains of accompanied by her mother. She complains of symptoms of dizziness, fatigue, SOB, and symptoms of dizziness, fatigue, SOB, and generalized bone pain. An initial CBC showed generalized bone pain. An initial CBC showed extremely high WBC and thrombocytopenia. After extremely high WBC and thrombocytopenia. After follow up, evaluation of peripheral blood smear, follow up, evaluation of peripheral blood smear, and subsequent bone marrow aspirate with and subsequent bone marrow aspirate with immunohistochemistry and flow cytometry immunohistochemistry and flow cytometry confirms a diagnosis of Acute Lymphoblastic confirms a diagnosis of Acute Lymphoblastic Leukemia (ALL). Her mother calls your office a Leukemia (ALL). Her mother calls your office a couple of weeks later because her daughter has couple of weeks later because her daughter has been “distant and depressed looking” and she been “distant and depressed looking” and she feels her daughter may be suicidal. feels her daughter may be suicidal.


1 = Absolutely NO compassion for this patient.1 = Absolutely NO compassion for this patient. 2 = I feel bad for the patient but hey, that’s life.2 = I feel bad for the patient but hey, that’s life. 3 = I feel bad for the patient and feel that I must 3 = I feel bad for the patient and feel that I must



Case # 3Case # 3

A 42 y/o white male convicted child sex offender A 42 y/o white male convicted child sex offender reports to your psych clinic for evaluation of reports to your psych clinic for evaluation of feelings of hopelessness and depression. Upon feelings of hopelessness and depression. Upon further evaluation you discover that he has further evaluation you discover that he has admitted to suicidal ideation with plans for follow-admitted to suicidal ideation with plans for follow-through. He does have a history of prior suicide through. He does have a history of prior suicide attempts as well as positive assaultive and attempts as well as positive assaultive and homicidal ideations. You obtain the necessary homicidal ideations. You obtain the necessary petition for admission to the psych ward under 302 petition for admission to the psych ward under 302 basis. basis.


1 = Absolutely NO compassion for this patient. 1 = Absolutely NO compassion for this patient. 2 = I feel bad for the patient but hey, that’s life.2 = I feel bad for the patient but hey, that’s life. 3 = I feel bad for the patient and feel that I must 3 = I feel bad for the patient and feel that I must



Compassion Is?Compassion Is?

Webster defines compassion as Webster defines compassion as “sympathetic feeling : pity, mercy”.“sympathetic feeling : pity, mercy”.

Is there more to compassion?Is there more to compassion? How much compassion is enough?How much compassion is enough? Does compassion = love?Does compassion = love? Should all people receive the same amount Should all people receive the same amount

of compassion, whatever the circumstance?of compassion, whatever the circumstance?

Your compassion rating score?Your compassion rating score?

If we can all agree that compassion in some If we can all agree that compassion in some way equates to love, then we must ask way equates to love, then we must ask ourselves how much love do we have to ourselves how much love do we have to give to our fellow man.give to our fellow man.

The ancient Greeks defined agape as The ancient Greeks defined agape as unselfish, unconditional love for another.unselfish, unconditional love for another.

Is this level of compassion attainable?Is this level of compassion attainable?

“ “ Do not think that love, Do not think that love, in order to be in order to be genuine, has to be genuine, has to be extraordinary. What extraordinary. What we need is to love we need is to love without getting tired.”without getting tired.”

-Mother Teresa -Mother Teresa

Compassion in MedicineCompassion in Medicine

-The -The bodybody hurts. The hurts. The personperson suffers. suffers. As physicians, we have taken an oath to As physicians, we have taken an oath to

ameliorate the ailments in our fellow man.ameliorate the ailments in our fellow man. This means much more than prescribing a This means much more than prescribing a

medication or casting a broken bone. This medication or casting a broken bone. This means we must feel and means we must feel and empathize empathize with our with our patients. We must show patients. We must show compassioncompassion..


In his 1993 book, In his 1993 book, Healing and The MindHealing and The Mind, Bill , Bill Moyers interviews Thomas Delbanco, M.D. Moyers interviews Thomas Delbanco, M.D. founder and past President of the Society of founder and past President of the Society of General Internal Medicine. Dr. Delbanco’s General Internal Medicine. Dr. Delbanco’s projects have focused on the enrichment of projects have focused on the enrichment of the doctor-patient relationship. When asked the doctor-patient relationship. When asked what a good doctor does in relation to what a good doctor does in relation to feelings that help the healing process, he feelings that help the healing process, he says: “First of all, a good doctor listens to says: “First of all, a good doctor listens to you-and then addresses what you’re you-and then addresses what you’re feeling”.feeling”.


How often do we How often do we trulytruly listen to our patients? listen to our patients? Do we chose to listen more carefully if the patient Do we chose to listen more carefully if the patient

is a child? If the patient is of higher is a child? If the patient is of higher socioeconomic class?socioeconomic class?

Do we listen less if the patient is homeless, is a Do we listen less if the patient is homeless, is a criminal, or worse?criminal, or worse?

Do we show more or less compassion depending Do we show more or less compassion depending on the patient’s insurance?on the patient’s insurance?

What keeps us from showing utmost compassion What keeps us from showing utmost compassion to everyone?to everyone?

“ “ You must unlearn what you have You must unlearn what you have learned.”learned.”

“ “ Fear leads to anger, Fear leads to anger, anger leads to hate, anger leads to hate, hate leads to hate leads to suffering.”suffering.”

- Yoda- Yoda

“ “ You must unlearn what you have You must unlearn what you have learned.” learned.” - Yoda- Yoda

Do we fear being compassionate? Why?Do we fear being compassionate? Why? Loss in office time?Loss in office time? Loss of personal time?Loss of personal time? Loss of financial benefit?Loss of financial benefit? Loss of patience?Loss of patience?

“ “Deem me worthy of seeing in the sufferer Deem me worthy of seeing in the sufferer who seeks my advice – a person – neither who seeks my advice – a person – neither rich nor poor, friend or foe, good man or rich nor poor, friend or foe, good man or bad, or a man in need, show me only the bad, or a man in need, show me only the man.”man.”

Prayer for the PhysicianPrayer for the Physician- Maimonides - Maimonides

1135 -12041135 -1204


To be truly compassionate, one must free To be truly compassionate, one must free oneself from lables.oneself from lables.

““Man has a pretty static picture of the world, Man has a pretty static picture of the world, accidentally or forcibly imprinted upon him accidentally or forcibly imprinted upon him by means of chains of conditioned by means of chains of conditioned associations. Man believes his imprint associations. Man believes his imprint board is reality.”board is reality.”

- Timothy Leary- Timothy Leary

How do I Attain Compassion?How do I Attain Compassion?

“ “ Your love & compassion towards Your love & compassion towards your friends is in many cases your friends is in many cases actually attachment. This feeling actually attachment. This feeling is not based on the realization is not based on the realization that all beings have an equal that all beings have an equal right to be happy & overcome right to be happy & overcome suffering. Instead, it is based on suffering. Instead, it is based on the idea that something is ‘mine’, the idea that something is ‘mine’, ‘my friend’ or something good for ‘my friend’ or something good for ‘me’. That is attachment.” ‘me’. That is attachment.”

-Dalai Lama-Dalai Lama

How do I Attain Compassion?How do I Attain Compassion?

“ “ Genuine compassion is based on a clear Genuine compassion is based on a clear acceptance or recognition that others, like acceptance or recognition that others, like oneself, want happiness and have the right oneself, want happiness and have the right to overcome suffering. On that basis one to overcome suffering. On that basis one develops some kind of concern about the develops some kind of concern about the welfare of others, irrespective of their welfare of others, irrespective of their attitude to oneself. That is compassion.”attitude to oneself. That is compassion.”

- Dalai Lama- Dalai Lama

How do Attain Compassion?How do Attain Compassion?

“ “ Do unto others as you Do unto others as you would have done unto would have done unto you.”you.”

- Jesus Christ- Jesus Christ


Compassion in medicine is more than an Compassion in medicine is more than an altruistic view of humanity in the world.altruistic view of humanity in the world.

Compassion in medicine has become part of Compassion in medicine has become part of a larger whole in healthcare accountability.a larger whole in healthcare accountability.

Healthcare workers, and the hospitals they Healthcare workers, and the hospitals they work in, are soon to be rated on -yes- work in, are soon to be rated on -yes- their their compassion.compassion.


In 2002 the Centers for Medicare & Medicaid In 2002 the Centers for Medicare & Medicaid Services (CMS) requested an instrument to Services (CMS) requested an instrument to measure patient perceptions of care.measure patient perceptions of care.

A survey called the Hospital Consumer A survey called the Hospital Consumer Assessment of Healthcare Providers and Systems Assessment of Healthcare Providers and Systems (HCAHPS) was devised.(HCAHPS) was devised.

This is a This is a public reporting instrumentpublic reporting instrument!! National implementation of HCAHPS is expected National implementation of HCAHPS is expected

to be October of 2006 with public reporting to take to be October of 2006 with public reporting to take place in 2007 or early in 2008.place in 2007 or early in 2008.


TRANSLATION: The public will know if you TRANSLATION: The public will know if you don’t care.don’t care.

For Doctors and Nurses, lack of compassion For Doctors and Nurses, lack of compassion may lead to lack of income.may lead to lack of income.

Will your patients have compassion for Will your patients have compassion for you?you?

Questions:Questions:

1) During this hospital stay, how often did 1) During this hospital stay, how often did doctors treat you with doctors treat you with courtesy and courtesy and respect?respect?

A.A. NeverNever

B.B. SometimesSometimes

C.C. UsuallyUsually

D.D. AlwaysAlways


2) During this hospital stay, how often did the 2) During this hospital stay, how often did the doctors doctors listen carefully to you?listen carefully to you?

A.A. NeverNever

B.B. SometimesSometimes

C.C. Usually Usually

D.D. AlwaysAlways


3) Would you recommend this hospital to 3) Would you recommend this hospital to your friends and family?your friends and family?

A.A. Definitely noDefinitely no

B.B. Probably noProbably no

C.C. Probably yesProbably yes

D.D. Definitely yesDefinitely yes

Conclusion:Conclusion:

We are in the business of healing, and We are in the business of healing, and healing involves compassion.healing involves compassion.

We We cancan work on our own to increase our work on our own to increase our level of compassion toward others.level of compassion toward others.

Those who lack compassion may indeed be Those who lack compassion may indeed be a detriment to their institution.a detriment to their institution.

What would the world be like without What would the world be like without compassion?compassion?

Any Questions?Any Questions?

References:References: yoda.jpg 77 x 360 pixels - 28k – jpg www.tk421.net

Dali Lama outside City Art Centre.38x43pixels-23k–jpg ww.baxterphotography.co.uk

SACRED HEART OF JESUS 264 x 369 pixels - 29k – jpg www.jesus-passion.com

Mother Teresa188 x 240 pixels - 7k - jpgcharityfocus.org

holocost.jpg 200 x 185 pixels - 15k – jpg www.weltkrieg.ru

Members of the Nazi Party marched 186 x 269 pixels - 11k – jpg homepage.eircom.net

1D. Reproduction Nazi party banner 200 x 274 pixels - 11k – jpg www.tridentmilitary.com

Nazi Party Congress. Nuremberg, 240 x 282 pixels - 56k – jpg www.ushmm.org

Twin Towers 390 x 354 pixels - 60k – jpg www.californiaconservative.org

Osama's not yet been heard from,300 x 225 pixels - 18k – jpg www.villagevoice.com

http://www.tk421.net/

http://www.baxterphotography.co.uk/

http://www.jesus-passion.com/

References:References: Moyers, Bill. Moyers, Bill. Healing and The Mind.Healing and The Mind. New York: Bantam Doubleday Dell Publishing New York: Bantam Doubleday Dell Publishing

Group, Inc., 1993.Group, Inc., 1993.

Lama, Dali. Lama, Dali. The Dali Lama’s Little Book of Wisdom.The Dali Lama’s Little Book of Wisdom. New York: Barnes & Noble Inc., New York: Barnes & Noble Inc., 2002.2002.

Buscalia, Leo. Buscalia, Leo. LOVE.LOVE. New York: Ballantine Books, 1972. New York: Ballantine Books, 1972.

HCAHPSHCAHPS. Erie: Millcreek Community Hospital, 2006.. Erie: Millcreek Community Hospital, 2006.

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Compassion In Medicine Garrett Preston Clark, D.O