If Kindness Were a Drug, the FDA Would Approve It
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VA Palo Alto Center for Innovation to Implementation, Stanford School of Medicine, Stanford, CA, USA; 2Private Practice, New York City, USA; 3VA Greater Los Angeles, UCLA School of Medicine, Los Angeles, CA, USA.
J Gen Intern Med DOI: 10.1007/s11606-020-06343-7 © Society of General Internal Medicine (This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply) 2020
the secret of quality is love,” declared “U ltimately, Avedis Donabedian, a pioneering systems thinker
and the father of modern quality assurance.1 Few in health care would dispute that compassion is an ethical requirement for good practice, and for most that provides enough motivation to act kindly towards patients. But does it work? To put it more dispassionately, what is the evidence that kindness improves medical care? The evidence is surprisingly strong. Patients who perceive their doctor as empathic (empathy is distinguished from kindness or compassion in that it is an attitude rather than an action) have better outcomes. They take their medications more regularly, have higher self-efficacy, and have better control of their chronic diseases. Many view patient satisfaction as an end in itself of medical care, and kind doctors certainly engender more satisfied patients. Empathic doctors even practice more cost-effective medicine. And of course, as patients near the end of their journey, kindness may be medicine’s main offering. Moreover, the benefits of kindness redound to the provider as well. Acting kindly lights up the reward centers of the brain, and kind physicians experience less burnout. Perhaps even more impressively, the relationship between kindness and these outcomes is not just cross-sectional. Several kindness-promoting interventions are supported by randomized controlled trials. Two recent books summarize this line of work, the War for Kindness by Zaki and Compassionomics by Treziak and Mazzarelli.2, 3 If kindness were a drug, no doubt the Food and Drug Administration would approve it. Yet compassion is on the decline, and not just in medical care. Surveys have shown that contemporary polarized Americans value empathy less than a generation ago4. The rise of corporate and bureaucratic processes in medical care, often exemplified through electronic medical record documentation requirements and productivity measures, have left many physicians feeling that their leaders do not value empathy either. Certainly, modern mass media portray physicians less as the
kindly family doctor in Norman Rockwell’s portraits and more as the irascible Dr. House. The declining emphasis on empathy may provide a clue to the solution. For if kindness is diminishing, it cannot be immutable or innate. Years of psychological research reveal that kindness is more like a muscle that one can exercise and build.5 For example, ancient meditative practices can build compassion, with demonstrable results on brain scans.6 While selecting more empathic medical students who will survive the well-known empathic dr
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