Evaluating Physician Value through Compassion

Dear Editor,

We read with keen interest the article by Dr. Timothy Aaron Zeller and colleagues, "What Are Doctors For? A Call for Compassion-Based Metrics as a Measure of Physician Value." The authors compellingly argue for the integration of compassion, empathy, and humanism into the metrics used to assess physician performance. As family physicians practicing within the Spanish public health system, we would like to offer reflections on how these values are embedded in our medical practice and evaluation.

In Spain, the public healthcare system places a strong emphasis on primary care as the main pillar of health services. Family physicians are often the first point of contact and maintain ongoing relationships with patients and their families. This continuity of care fosters a deep understanding of patients' social and emotional contexts, which is integral to delivering compassionate care. Studies have shown that such continuity is associated with improved health outcomes and patient satisfaction [1,2].

Our evaluation systems in Spain extend beyond quantitative metrics like productivity and clinical outcomes. They include qualitative assessments of patient satisfaction, qnd indireectly our communication skills, and the ability to build trusting relationships. Patient feedback is routinely collected and plays a significant role in performance appraisals. This patient-related approach aligns with the authors' call for compassion-based metrics and acknowledges the multifaceted role of physicians.

The challenges of burnout and imposter syndrome that Dr. Zeller et al. describe are indeed concerning and have been observed globally, including in Spain [3]. To address this, there has been a growing focus on professional well-being programs that emphasize emotional intelligence, resilience, and mindfulness. By reinforcing the importance of compassion and empathy, these programs aim to reconnect physicians with the core values of medical practice and reduce burnout rates [4], although the exceessive workload is the main cause of our burnout challenges.

Furthermore, the Spanish experience suggests that integrating compassion into college and residential medical education is essential. Medical schools incorporate humanities and ethics into their curricula, promoting a patient-centered approach from the outset of training [5]. This early emphasis on empathy and communication skills lays the foundation for future physicians to value and practice empathetic care.

The proposal by Dr. Zeller and colleagues to develop humane-based metrics is both timely and necessary. It resonates with the principles upheld in the Spanish healthcare system, where the humanistic aspects of care are considered essential to physician performance. Implementing such metrics might lead to improved patient outcomes, increased patient and physician satisfaction, and a reduction in burnout rates.

We support the authors' call for a reimagined approach to measuring physician value. The Spanish model demonstrates that when compassion and empathy are integral to both practice and evaluation, it benefits not only patients but also physicians themselves. We encourage continued dialogue and collaboration to develop and implement the proposed metrics globally.

References:

[1] Starfield, B. (1998). Primary care: balancing health needs, services, and technology. Oxford University Press.

[2] Schers, H., van den Hoogen, H., Bor, H., Grol, R., & van den Bosch, W. (2005). Familiarity with a GP and patients' evaluations of care. A cross-sectional study. Family practice, 22(1), 15-19.

[3] García-Campayo, J., Puebla-Guedea, M., Herrera-Mercadal, P., & Daudén, E. (2016). Burnout Syndrome and Demotivation Among Health Care Personnel. Managing Stressful Situations: The Importance of Teamwork. Desmotivación del personal sanitario y síndrome de burnout. Control de las situaciones de tensión. La importancia del trabajo en equipo. Actas dermo-sifiliograficas, 107(5), 400–406. https://doi.org/10.1016/j.ad.2015.09.016

[4] Ruiz-Fernández, M. D., Pérez-García, E., & Ortega-Galán, Á. M. (2020). Quality of Life in Nursing Professionals: Burnout, Fatigue, and Compassion Satisfaction. International journal of environmental research and public health, 17(4), 1253. https://doi.org/10.3390/ijerph17041253

[5] Fernandez-Olano, C., Montoya-Fernandez, J., & Salinas-Snchez, A. S. (2008). Impact of clinical interview training on the empathy level of medical students and medical residents. Medical teacher, 30(3), 322–324. https://doi.org/10.1080/01421590701802299