Professional Documents
Culture Documents
Compassionate Care
David S. Burstein
ADSARPS in Practice
You are suffering.
Perhaps you feel anxious about what lies ahead.
We are here.
We are going to do all that we can.
Introduction
As medical training intensifies, there is a nearly ubiquitous decline in empathy
amongst medical students and resident physicians19. A contributor to this phenomena is
the emotional demands of clinical practice9,19,21,25. Despite this, the Liaison Committee on
Medical Education has no certified standard for training medical students to navigate
emotional encounters18, leaving students to learn behaviors and coping strategies via
institution dependent formal and informal curricula14,22,23. As a result, patient-focused care
may be compromised. A formal approach to empathy is needed to protect physician wellbeing and promote compassionate care.
The following training module is believed to be the first of its kind15. Much like
the SPIKES method of sharing bad news, this model uses an acronym that trainees can
work through to establish a healthy connection with patients. Ideal for the current
landscape of medicine, it is intended to be efficient, sensitive, of high quality, repeatable,
moral and wholesome.
The ADSARPS Model
Assume that the patient is suffering
Determine the source of the patients suffering
Separate yourself from the patients condition
Affirm & Acknowledge the patients suffering
Reflect or Label the patients emotional state
Be Present
Self
Explanations & Rationale
Assume that the patient is suffering
Inattentional blindness: When given a complex task, one may fail to recognize
obvious irrelevant stimuli unless their attention is explicitly directed towards it8,26
Complex task Obtaining clinical information in short time frame
Obvious irrelevant stimuli Patients emotional disposition
fMRI has demonstrated perception of physical pain is diminished when attention
is directed elsewhere11
Determine the source of the patients suffering
Hojat found that perspective taking is the most important component of
empathy according to experienced physicians12
Compared against compassionate care and standing in the patients
shoes
Separate yourself from the patients condition
A certain amount of clinical distance is proper and needed for selfpreservation -Dr. Daniel Lazar
Do not confuse the patients suffering with your own -Dr. Arthur
Kleinman
12 out of 24 internal medicine residents agreed that empathy favors burnout
because of compassion fatigue in qualitative study21
Key Publications
Neumann 2011 Meta-analysis on decline in empathy during medical training
Picard 2015 Qualitative study of empathy and burnout as a resident physician
Detsky 2013 Commentary on changes in medical practice during technology era
Kleinman, The Lancet, 2008-2014 Essays on moral caregiving and burnout
Shapiro 2008 Philosophical discussion of cognitive and emotional distancing that
occurs during medical training
REFERENCES
1. Ahrweiler F, Neumann M, Goldblatt H, Hahn E G, Scheffer C. Determinants of
physician empathy during medical education: hypothetical conclusions from an
exploratory qualitative survey of practicing physicians. BMC Medical Education
2014;14:122.
2. Badger K, Royse D. Describing compassionate care: the burn survivor. Journal of burn
care & research 2012;33(6):772-80.
3. Beckman T J, Reed D A, Shanafelt T D, West C P. Resident physician well-being and
assessments of their knowledge and clinical performance. Journal of general
internal medicine 2012;27(3):325-30.
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Feldman L. In the wake of the 2003 and 2011 duty hours regulations, how do
internal medicine interns spend their time?. Journal of general internal medicine
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organizational factors that enhance or inhibit this behavior pattern. Social science
& medicine 1996;43(8):1253-61.
6. Colman AD. 1995. Up from Scapegoating: Awakening consciousness in groups.
Chiron publications. 162 p.
7. Detsky A S, Berwick D M. Teaching physicians to care amid chaos. JAMA: the
Journal of the American Medical Association 2013;309(10):987-8.
8. Drew T, V M L, Wolfe J M. The invisible gorilla strikes again: sustained inattentional
blindness in expert observers. Psychological science 2013;24(9):1848-53.
9. Gleichgerrcht E, Decety J. Empathy in clinical practice: how individual dispositions,
gender, and experience moderate empathic concern, burnout, and emotional
distress in physicians. PLoS ONE 2013;8(4):e61526.
10. Greene J. 2013. Moral Tribes: Emotion, reason and the gap between us and them.
New York (NY): Penguin Books. 422 p.
11. Gu X, Han S. Attention and reality constraints on the neural processes of empathy for
pain. NeuroImage 2007;36(1):256-67.
12. Hojat M, Gonnella J S, Nasca T J, Mangione S, Vergare M, Magee M. Physician
empathy: definition, components, measurement, and relationship to gender and
specialty. The American Journal of Psychiatry 2002;159(9):1563-9.
13. Jankowiak-Siuda K, Rymarczyk K, Grabowska A. How we empathize with others: a
neurobiological perspective. Medical Science Monitor 2011;17(1):RA18-24.
14. Kelly E, Nisker J. Medical students first clinical experiences of death. Medical
education 2010;44(4):421-8.
David S. Burstein
MS4, Rush Medical College
Chicago, IL
David_S_Burstein@rush.edu