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The compassion crisis in U.S. health care

Drew Remignanti, MD, MPH
Physician
April 25, 2024
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No, I am not suggesting a new medical diagnosis, but I am merely pointing out a society-wide ailment in our U.S. culture. In support of my contention, I point to Compassionomics, the superb 2019 book by Drs. Stephen Trzeciak and Anthony Mazzarelli. In their compelling science-based presentation, the authors state, “Specifically, the hypothesis is that providing health care in a compassionate manner is more effective than providing health care without compassion by virtue of the fact that human connection can confer distinct and measurable benefits.”

It is a mere coincidence that I am composing this argument for the harmony of science and religion/spirituality on Easter Sunday, 2024. Though I am a theist (and a medical scientist like the above authors), I have never been a member of any Christian denomination.

But it is definitely more than a coincidence that Jesus Christ, the apotheosis of compassion, gave us this guidance more than 2000 years ago:

“It is more blessed to give than to receive” (Acts 20:35)

“Thou shalt love thy neighbour as thyself” (Matthew 22:39)

I consider those the most effective pieces of pre-scientific health advice ever given. Just a sampling of the scientific support for these statements appears here, here, and here.

Why, then, is the U.S. health care system currently so lacking in recognition of and support for the critical role of compassion in caring for our fellow suffering humans?

Does that sound like too harsh a judgement on my part? See the following business of health care comments and sources:

From the CEO of an over $2 billion hospital system, “People need primary care but not necessarily a physician relationship.”

From the CEO (chief experience officer) of a large midwestern physician practice, “I want that Disney-like experience, the Ritz Carlton experience.”

From a Goldman Sachs analyst, “Is curing patients a sustainable business model?“

From a 2017 Wall Street Journal article, Aetna CEO could make $500 million from CVS merger.

Dr. Shakeel Ahmed proposes a more forward-looking solution to these appalling considerations: “At some point on the Venn Diagram of business ledgers, profits and patients have to diverge. Managing that divergence through a delicate balance of business and humanity is only possible if the CEO is attuned to his clients’ sufferings and does not merely see them through the prism of money.”

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Do science and religion/spirituality appear to the reader as strange bedfellows? I would argue that business and health care are currently demonstrating greater bedroom incompatibilities and require intensive marital therapy!

Regarding science and religion’s interdependence, I stand with Albert Einstein’s comment that “Science without religion is lame, religion without science is blind.“

I also stand with similar more recent religious guidance, shortly over 100 years ago, from ‘Abdu’l-Bahá (promulgator of the Baha’i Faith, as revealed by his father Baháʼu’lláh) that:

“If any religion rejected Science and knowledge, that religion was false. Science and Religion should go forward together; indeed, they should be like two fingers of one hand.“

I am very aware that religion is anathema to a substantial number of us, both medical and non-medical. In that light, it is surprising that a survey of hospitalized Americans found that “94 percent of patients regard their spiritual health and their physical health as equally important.” This is a pretty big number compared with the fact that only 84 percent of Americans believe that the earth is round (down to just 66 percent among millennials)!

Like my fellow skeptical science types, I find it particularly challenging and deeply unsatisfying not to be able to fully comprehend the existence of such enormous worldwide suffering occurring under the purview of an all-knowing, all-loving, and all-powerful divine creator (recent considerations being Gaza and Ukraine, and perpetual ones being birth defects, chronic pain, and other diseases).

I stand amongst those not having mastered that challenge, but take some consolation from Einstein again, saying:

“The most beautiful and deepest experience a man can have is the sense of the mysterious. It is the underlying principle of religion as well as of all serious endeavour in art and science. He who never had this experience seems to me, if not dead, then at least blind. To sense that behind anything that can be experienced there is a something that our minds cannot grasp, and whose beauty and sublimity reaches us only indirectly and as a feeble reflection: this is religiousness. In this sense I am religious. To me it suffices to wonder at these secrets and to attempt humbly to grasp with my mind a mere image of the lofty structure of all there is.”

‘Abdu’l-Bahá’s historically earlier comment had been:

“The difference in station between man and Divine Reality is thousands upon thousands of times greater than the difference between vegetable and animal. And that which a human being would conjure up in his mind is but the fanciful image of his human condition; it does not encompass God’s reality but rather is encompassed by it.”

In my 40-year career as a board-certified emergency physician and 50-year “career” as a chronic autoimmune disease patient, I find a parallel comprehension caution here for us as patients as we try to grasp, trust, and follow through on the treatment plans that we devise in partnership with our physicians. As a concise (and I would propose applicable to healthcare decision-making) summary related to both Einstein’s and ‘Abdu’l-Bahá’s above observations on the ‘unknowability’ of “the lofty structure of all there is,” there is this caution. Alister McGrath, the former atheist, professor of science and religion at Oxford University, and Anglican priest (dual doctoral degrees in molecular biophysics and divinity) writes in his book The Big Question:

“The danger—and it is a real danger—is that we reduce our vast and complex world to the intellectually manageable and treat this impoverished and truncated mental representation of reality as if it were reality.”

Drew Remignanti is an emergency physician.

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