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Revisiting an Old and Underappreciated

Medicine

Richard R Szuster MD

Medicine is Forward Looking:

Research: 170 billion dollars/yr. 120,000 medical scientists.

New understandings, new treatments.

But like the Roman god Janus -we want to look both ways.

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An Old and Under-

appreciated Medicine

Therapeutic Effects

• Blood pressure: Better control.

• Surgery: Less post-operative

meds, better wound healing.

• Trauma: Improved outcomes.

• Terminal Illness: Longer survival.

• Back Pain: Reduced pain intensity.

• Migraine: Reduced Frequency.

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Therapeutic Effects

• Irritable Bowel Syndrome: Reducedsymptoms.

• Diabetes: Better glucose control,less metabolic complications.

• Common Cold: Shorter duration,more robust immune response.

• Depression/anxiety: Improvedoutcomes.

• Response to antidepressants:Improved.

Compassion

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The patient, though conscious that their condition is perilous, may recover their health simply through their contentment with the goodness of the physician.”

Hippocrates, 400 BCE

“In God we trust; all others must bring data”

W. Edwards Deming

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Compassion is an integral part of medical care

The physician’s presence matters

Compassion

I Am (2011) – Tom Shadyac

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Compassion Satisfaction:

Uplifted feeling when we are compassionately engaged with

helping others.

Brain: Increased ventral striatum and septal area activity - reduced

amygdala activity.

Net result: Less stress, better health and more satisfaction.

Burnout

Demands Resources

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Burnout

Emotional Exhaustion

Depersonalization

Low Satisfaction

The Medical Journey

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Undergrad

Better than average physical and mental

health

Burnout

Med School: 40 %

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Burnout

Residency: 60 %

BurnoutPractice: 50 %

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Burnout Compassion

Sorrowing Old Man (At Eternity’s Gate)

Vincent Van Gogh

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Coping with

Suffering

Responses to Stress

Overwhelm

Emotional DistressWithdrawal

Depersonalization

Mindful Presence

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Mindful Presence:

“Moment to moment purposeful attentiveness to

one’s mental processes during every day work with the goal

of practicing clarity and compassion”

Mindful Practice

Ronald M Epstein; JAMA1999

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How to develop the capacity for mindful

presence?

Mindful Presence

Settled body

Clear mind

Open heart

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Burnout Compassion

Compassion Burnout

Compassion is not a zero sum game.

It helps both the receiver and the giver.

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Horowitz CR (2003), Ann Int Med

RelationalEcology:

What Sustains Doctors in

Their Careers?

Meaningful connections with their patients.

Making a difference in patients’ lives.

Experiences that underscore the profound nature of life and being

human.

Compassion

Altruism

A Segue

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Danbrun (2017), PeerJ

Self-centeredness:

Fluctuating happiness

Selflessness:Authentic – durable happiness

The Happiest Person in the World

Matthieu Ricard

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An Old and Under-

appreciated Medicine:

• Remember it and administer it liberally

• Do this forever

• Everyone benefits