In 1992, the American Academy of Pediatrics (AAP) ad-hoc committee on the patient-centered medical home (PCMH) put out a policy statement highlighting, among other key attributes, the importance of compassionate care.
By 2007, a shared group comprised of the AAP, American Academy of Family Physicians, American College of Physicians and American Osteopathic Association developed and shared a statement of joint principles of the medical home, which also noted many of its key attributes.
As I reviewed the evolution of the policy statement and principles I was struck by the fact that by 2007, compassionate care was no longer set as one of the highest priority areas for the PCMH but rather included as a subset under quality and safety.
So why is compassion no longer a key focus of the PCMH?
When I posed this question to an expert in this space, the response and perspective was quite interesting:
"Pediatricians have tended to always practice this way, with compassion. As other organizations came to the table and the PCMH concept expanded beyond the pediatric office, more and more weight was placed on the technical aspects of care provision and less and less on compassionate care."
And when I step back and take a more global view of challenges within the healthcare system I find the further we move away from a focus on compassion the further we move away from our ultimate goal and responsibility of ensuring those we are blessed and entrusted to serve are well taken care of and kept safe.
Some examples:
- We hear more and more about the shortage of primary care physicians and yet we don't create a model of primary carethat allows physicians the opportunity to truly connect with their patients, develop relationship and trust, hear whole stories, share empathy, and show compassion, while also having the opportunity to truly connect with their own passionfor healing.
- We hear more and more about physician burnout and nurses suffering from depression and yet we continue to incentivize with money, continue to focus on productivity and continue tounder staff healthcare organizations (placing our patients and our staff at risk). We continue to move further and further away from our patients and compassionate care provision (while noting "technology will replace human connection") and wonder why we no longer have joy in healing (but rather burnout and depression).
- We talk more and more about improving health outcomes and doing so efficiently and yet we dismiss the empirical data that supports the view that compassion in healing improves health outcomes.
- Physicians pledge to honor the Hippocratic Oath, which includes the statement " ... warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug." Yet we do not create systems that allow for a focus on warmth and sympathy along with an appropriate balance of surgical, pharmaceutical and other medical /behavioral interventions.
The patient-centered medical home and its continued evolution is certainly a step in the right direction but we mustrefocus its principles to ensure compassionate care is elevated in the hierarchy of priorities.
"Medicine is not a job. It is not even a career. At its heart, medicine is a calling."
And as healthcare leaders (regardless of the model, e.g., PCMH, ACO, etc.) it is our job to best position healthcare professionals to honor their calling and care for their patients compassionately if we are to optimally serve all those entrusted to us.
Thomas H. Dahlborg, M.S.M., is Vice President for Strategy and Project Director for the National Initiative for Children's Healthcare Quality (NICHQ), where he focuses on improving child health and well-being.