UNIVERSIDADE ESTADUAL PAULISTA
“JÚLIO DE MESQUITA FILHO”
Instituto de Ciência e Tecnologia
Campus de São José dos Campos
ORIGINAL ARTICLE DOI: https://doi.org/10.4322/bds.2023.e3694
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Braz Dent Sci 2023 Jan/Mar;26 (1): e3694
The importance of compassionate care
A importância do cuidado humanizado na Odontologia
Rebecca LINDOW1 , Mikaela GISCH1 , Leonardo MARCHINI1
1 - Case Western Reserve University School of Dental Medicine, Cleveland, OH, USA.
How to cite: Lindow R, Gisch M, Marchini L. The importance of compassionate care. Braz. Dent. Sci. 2023;26(1):e3694. https://doi.org/
bds.2023.e3694
ABSTRACT
Recently, studies have highlighted the importance of compassionate care in healthcare. Not only does it improve
patient outcomes and satisfaction, but it also improves the healthcare providers’ overall well-being. Furthermore,
it helps streamline the healthcare system by shortening hospital stays and rates or readmittance. Unfortunately,
patients report that they feel there is a lack of compassionate care provided to them, thus shedding light on the
compassion crisis. The compassion crisis seems to have its roots in healthcare professional education, as evidenced
by the high levels of burnout experienced by students, particularly in dental students. Compassion training,
however, not only equips healthcare professionals with strategies to more effectively treat their patients, but
also with coping mechanisms to better handle the stressors of their profession. Dentistry is no exception and has
some unique barriers to care as well such as communication, the physical barrier during treatment. This further
highlights the importance of compassionate care while providing treatment. Implementing compassionate care
to be taught in school will improve patient outcomes and provider well-being.
KEYWORDS
Empathy; Delivery of healthcare; Dental education; Compassion; Compassionate care.
RESUMO
Recentemente, estudos destacaram a importância da empatia na área da saúde. A empatia não só melhora
resultados e satisfação do paciente, mas também melhora o bem-estar dos prossionais de saúde. Além disso,
ajuda a diminuir o custo do sistema de saúde ao reduzir as internações hospitalares e as taxas de reinternação.
Infelizmente, os pacientes relatam que sentem falta de empatia, levando a uma atual crise de falta de empatia
nos servicos de saúde. A crise da falta de empatia parece ter suas raízes na formação dos prossionais de saúde,
como evidenciado pelos altos níveis de burnout experimentados pelos alunos, principalmente em estudantes
de Odontologia. Treinamento para empatia, no entanto, não apenas prepara os prossionais de saúde com
estratégias para tratar de forma mais ecaz seus pacientes, mas também com mecanismos de enfrentamento
para lidar melhor com os fatores de estresse da prossão. A Odontologia não é exceção e tem algumas barreiras
especícas, como a comunicação, que ca comprometida durante o tratamento odontológico. Isso destaca ainda
mais a importância da empatia durante o tratamento. Ensinando empatia nos cursos de Odontologia melhorará
os resultados para os pacientes e o bem-estar dos prossionais.
PALAVRAS-CHAVE
Empatia; Cuidados de saúde; Ensino odontológico; Compaixão; Empatia; Cuidado humanizado.
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INTRODUCTION
In recent years, there has been a strong
initiative in the healthcare eld for providers to
adopt more patient-centered approaches toward
care. Compassionate care is an imperative aspect
of doctor-patient interactions as it helps build
relationships in which the patients are more
comfortable sharing their feelings, concerns, and
symptoms [1,2]. In turn, this aids healthcare
providers in, diagnosing and treating patients
more effectively and efficiently [2]. Studies
suggest that patients are more compliant with
their treatment, thus experiencing better health
outcomes and report higher satisfaction in their
experience when they perceive their doctors
as being compassionate [2,3]. Interestingly,
patients who receive compassionate care
experience quicker recoveries and are less likely
to be readmitted to the hospital [4]. Thus,
compassionate care not only improves patient
outcomes, but it also improves the overarching
healthcare system as it saves time and resources
for other patients.
Physician burnout is a preeminent obstacle
in the healthcare eld. Indeed, greater than half
of US physicians experience burnout, which
negatively impacts the quality of care that they
are able to provide their patients [5]. Fortunately,
training providers in compassionate care benets
both the provider and the patient; it functions
as a coping strategy for providers, thus allowing
them to improve their patient care [6,7].
Unfortunately, compassion skills seem to be
lacking among healthcare profession students.
As healthcare students enter their clinical
training years, there is a marked downturn
in their compassion levels, which may be due
to burnout [8,9]. Furthermore, this lack of
compassion persists throughout students’
education [8]. This begets a reduction in the
quality of care that students provide to their
patients [2]. In dentistry, specically, patients
describe feelings of dehumanization when being
treated by their student doctors [10]. The authors
hypothesized that this is due to the requirement-
driven environment created by dental schools
that does not easily allow for students to view
their patients holistically [10]. Therefore, it seems
to be important that healthcare professional
students receive appropriate and intentional
compassion training.
Compassionate care is an essential
component of patient outcomes. Moreover,
it benefits provider’s mental health, and thus
their ability to provide quality care, as well as
the healthcare system itself. Notwithstanding,
healthcare professional students are lacking
compassion skills; and compassionate training
should be provided to these students. This review
highlights the importance of compassionate
care for health professions, especially in dental
education.
WHY COMPASSIONATE CARE IS
IMPORTANT
Compassionate or patient-centered care is
an essential aspect to providing quality care to
patients. It advocates for individualized medical
treatment for each patient and promotes a
pragmatic relationship between the physician
and patient [1] The doctor-patient relationship
is intrinsic to successful treatment as it bolsters
trust, a key component to patient compliance
and satisfaction [11]. In fact, patients receiving
compassionate care report higher levels of
satisfaction with their treatment, as well as more
improvements in their medical condition [1].
Hence, it is paramount for physicians to provide
compassionate care to their patients.
Dentistry is a unique field of healthcare
as it can feel invasive for the patient due to
the nature of the profession. During many
procedures, patients are unable to verbally
express themselves, thus eliciting the importance
of a robust, trusting relationship between
the doctor and the patient [12]. A practical
way to achieve such vigorous doctor-patient
relationships is through compassionate care.
By providing compassionate care, dentists are
able to reduce dental anxiety and even improve
treatment outcomes [9]. Accordingly, special care
should be supplied to dental providers so they are
able to best serve their patients.
COMPASSION vs EMPATHY
Compassion and empathy are intertwined
entities that are used as a means of providing
patients with more therapeutic care. Empathy
refers to awareness of other people’s emotions
whereas compassion is an emotional response to
empathy that generates an eagerness to help [4,13].
Additionally, empathy and compassion stimulate
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different pathways of the brain; empathy activates
pain-related neural networks while compassion
activates brain pathways for dopaminergic
reward pathways [6]. This links empathy with
negative states and distress whereas compassion
is associated with positive feelings of warmth
and concern for the patient [6]. Consequently,
there is evidence of empathy precipitating
burnout amongst physicians as it can exhaust
the emotions of the physician if there are not
appropriate coping mechanisms. In contrast,
encouraging positive emotions, even when in
adverse situations, is a key aspect of compassion
that explains why compassion is not associated
with physician burnout [7]. Although they are
similar concepts, compassion and empathy affect
the physician, and consequently the care they
provide, differently.
COMPASSION CRISIS AND ITS CAUSES
The compassion crisis describes the
current view of the healthcare system and
its providers. At present, the patients of the
American healthcare system often report not being
treated compassionately by their doctors, and
consequently, are not satised with their care [4].
Many patients have noted feeling as though their
doctors spend more time looking at the computer
than they do caring for them [14]. Meanwhile,
doctors report not having time to implement
compassionate care as the current healthcare
system is not conducive to it, thus they provide
more problem-focused care rather than patient-
centered care [15,16]. However, studies have
shown that providing compassionate care can
take less than a minute [17]. Alas, the compassion
crisis is deeper seated than the amount of time
the physician has to treat their patients.
There is a notable decline in compassion
that starts during health care professional
education and clinical years. Although many
professionals enter the healthcare field as a
means to help and care for people, there has
been a radical decline in compassion in the last
decades [10]. Unfortunately, some evidence
suggests that as healthcare students progress
through their education, there is a downtrend
in their compassion levels [10]. Furthermore,
this decline in compassion coincides with
the timing of students entering their clinical
training years [8,9]. In just a matter of months,
student doctors’ attitudes shift from eager
and compassionate to depressed and burnt
out [8,18]. These feelings persist throughout
the trainee’s education and might be related
to sleep deprivation and the lack of a healthy
workplace [5,8]. This elicits the prevalence of
burnout in the medical eld.
Communication skills also factor into
the compassion crisis. Various studies have
reported that there is a lack of standardization
in terms of training healthcare professionals on
how to communicate with their patients [4].
Consequently, doctors miss nuances regarding
the health status of the patient as they are
concentrating on problem-focused care rather
than patient-centered care [4,15]. Further,
physicians often interrupt patients, effectively
shutting down the conversation and limiting the
amount of information that can be derived from
the patient [4]. In doing so, diagnoses may be
overlooked, highlighting the gravity of effective
communication skills.
The compassion crisis presents a unique
challenge in dentistry. Dental anxiety is a fairly
prevalent condition that affects roughly 36%
of the US population and can have detrimental
effects on a person’s oral health [19]. Therefore,
it is necessary for dentists to provide patients
with compassion as a means of building trust
in such a way that levels of anxiety may be
lessened [20-22]. However, there is a noteworthy
devolution in compassion in dental students as
they reach their clinical training years [9]. This
decline is particularly damaging to patients as
they report feelings of dehumanization [10].
Thus, the compassion crisis urgently needs to be
addressed in dental education.
HOW COMPASSION CAN IMPROVE
PATIENT OUTCOMES, COMPLIANCE,
AND SATISFACTION
Compassionate care has many benets at
the patient level. Patients who are provided with
compassionate care build better rapport with
their healthcare providers, and consequently,
are more willing to trust and work with them
throughout treatment [2]. As a result, patients
experience better outcomes such as less severity
of illness, shorter recovery times, and increased
satisfaction with their care [23]. Providing
patients with compassionate care is an effective
method of improving the health of patients.
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Compassionate care positively inuences
patient outcomes
.
The emotional status of patients
inuences their existing disease, as well as their
recovery time [24]. Patients who experience
compassionate care report more extensively
about their symptoms and concerns, thus
allowing physicians to more accurately diagnose
and treat patients [2,25]. Accordingly, patients
receiving compassionate care experienced less
severe and shorter duration of their illness [23].
Indeed, patients provided with compassionate
care had more of their needs met and thus
averaged hospital stays two days shorter than
patients who did not experience compassionate
care [24]. Thus, compassionate care is remarkably
important for improving patient experiences.
Patients suffering from anxiety are
associated with slower recovery time and
greater postoperative pain. Using patient-
centered care strategies that allow the patients
to express their concerns, and doctors to tailor
information to the patients’ needs, has been
shown to be the most effective way to reduce
anxiety in patients [26]. In such cases, there is a
distinguished decrease in medical interventions
such as sedative prescriptions and medical
complications [26]. This elicits the function of
compassionate care as a means for doctors and
patients to more effectively communicate.
Compassionate care motivates patients to be
more involved in their health. Patient centered
care encourages patients to share more about their
current health status, allowing doctors to more
effectively diagnose and treat the patient [2,25].
When doctors foster a relationship with their
patients, patients participate more heavily, with
increased compliance, in their treatment [2].
In pediatric dentistry patients, fewer disruptive
behaviors were exhibited when the dentist
employed compassionate care [9]. Interestingly,
these methods improved patient compliance and
home care in orthodontic treatment [9]. Patients
are encouraged to participate more in their
healthcare when treated with compassionate care.
Compassionate care strategies promote a
safe, productive environment for patients to
share their feelings and concerns. Appropriately,
patients receive individualized care that prompts
patient compliance to treatment, and thus,
better health outcomes [3]. As a result, there is
a substantial increase in patient satisfaction [3].
Not only do patients recover and heal faster, but
they also feel as though their doctor listened to
them. By helping patients feel more relaxed and
comfortable with their dental treatment, there is
a notable improvement in patient satisfaction [3].
By taking the time to address patient fears,
significant changes in patient compliance to
treatment plans are observed, which results
in more positive treatment outcomes [3].
Implementing compassionate care in dentistry
can reduce dental anxiety, while also improving
satisfaction.
HOW COMPASSION CAN IMPROVE
PROVIDER WELLBEING
Burnout is a common problem amongst
healthcare professionals. More than half of
physicians in the United States experience
burnout, which impacts the quality of care that
they are able to provide to their patients [5].
Burnout often stems from the considerable weight
of negative emotions shared by patients [6,7].
Without proper coping mechanisms, this can
severely affect how physicians provide care to
their patients.
Compassionate care training is a means
of coaching healthcare providers to develop
interpersonal relationships with their patients.
Objectively, the primary intention of this
training is to better meet the needs of patients,
but compassion training is also beneficial for
healthcare providers as it functions as a coping
strategy to cultivate emotional health and
resilience [7]. The Cleveland Clinic, a major
hospital system, developed “Code Lavender” as
a means of providing care to stressed healthcare
staff in need of emotional support [27]. This
support system positively connects healthcare
providers to the hospital and, in turn, makes
them more likely to employ compassionate care
strategies [27]. Studies show that compassionately
supported healthcare providers felt they were
more effectively and accurately able to detect
and respond to patients’ suffering [2,27]. Thus,
providing healthcare professionals with the tools
necessary to cope with the stresses of their job
benets both the provider and the patient.
HOW COMPASSION CAN IMPROVE
THE HEALTHCARE SYSTEM
Compassionate care improves both patient
and provider well-being, but it also affects the
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healthcare system as a whole. While it is often
argued that the healthcare system has neither the
time nor the resources to take on the emotional
status of patients, it may be just the opposite as
patients who are provided with compassionate
care recover faster, experience shorter hospital
stays, and are less likely to be readmitted to the
hospital [4,24]. This, in turn, saves the hospital
time and resources.
COMPASSIONATE CARE IN DENTAL
EDUCATION
It has been shown that students who
enter dental school show a higher level of
empathy towards their patients than medical
students [9]. However, this has been shown to
drop as the student enters the clinical phases of
their education, which is then in line with the
lack of empathy shown in the medical students.
Of concern, is why would students do not show
empathy to their patients. One suggestion is that
dental school is “requirement” based, so students
set off to ll “requirements.” (i.e. Did I work on
a crown? A filling? A root canal?) Having to
focus on a check mark next to a requirement to
graduate, would have them chasing “cases” rather
than serving patient needs.
There has been very little research in the
areas of patient empathy in dental schools (and
hence dentistry in general). It is more usual
for people to avoid going to the dentist than
going to a doctor. It is very difcult to convince
adults to come in for preventative care, let alone
maintenance or remedial work. Physically, the
invasion of the personal space (oral cavity) of the
patient is a very intimate “face to face” encounter.
It is imperative that the patient is able to trust
this stranger who is nose to nose with them [10].
Knowing this, it would seem imperative that the
dentist go out of his/her way to make sure the
patient is welcomed, feels they are valued as an
individual, and that their concerns are addressed
with empathy and compassion. Any time options
are available for treatment, the dentist should
outline all possibilities, and working together
with the patient, let the patient know they have
control over the situation, and that the dentist is
for them, not against them.
Some strategies that can be implemented
to teach compassionate care during the dental
education coursework would be adding
role modeling training to faculty members,
standardized patient actors, poverty/disability
simulation clinics, and implementation of
evidence-based strategies in which the patient-
centered component is emphasized. However,
these initiatives should be vertically and
horizontally integrated in the curriculum and
have a systematic approach to intentionally
teach compassionate care across the multiple
departments/disciplines. This would result in
better communication skills and help to reduce
dental student burnout. Burnout is higher in dental
students than in medical students. It has been
suggested this is because medical school standards
recommend the teaching of compassionate and
empathetic care. Contrariwise, dental schools
usually do not have an intentional approach to
teach these topics, leaving it to (sporadic) role
modeling. The measurements used in medical
schools could be modeled in dental school [9].
The American Dental Education Association
recommends empathic care for all patients as its
second clinical competency.
One study found that faculty members had
higher levels of empathy than their students [28].
Perhaps maturity factors into empathy toward
others. Student burnout, and anxiety makes
students self-focused rather than patient-focused.
Thus making faculty members aware of this
and having it worked into discussions (and
modeled through empathic, compassionate
communications between faculty members and
students) throughout the coursework, could go a
long way to having this issue worked out before
clinical work begins.
COMMUNICATION - MAKE SURE
IT’S INTEGRATED: WHAT YOU
COMMUNICATE IS WHAT YOUR
PATIENT PERCEIVES
Communication skills are seen as the weakest
aspect of contemporary dentistry. The unique
nature of dentistry that requires the patient to be
silent so the dentist can work, sets up a physical
barrier to good communication between patient
and dentist. With verbal communication difcult,
non-verbal communication is imperative, and it
goes both ways. A lack of good dentist-patient
communication has been historically marked as
a source of anxiety for the patient, and it results
in occupational stress for the dentist. These
adverse issues of communication and trust must
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be addressed in the dental profession [12]. As far
as both preventative and remedial dentistry goes,
it has been indicated that good communication
between dentist and patient increases patient
compliance, while poor communication decreases
compliance. These unique factors require that
dental professionals learn to strengthen their
communication skills, both non-verbal and verbal.
The result of deficits in verbal and non-
verbal communication between dentist and
patient can lead to a lack of empathy, either
real or perceived, because of communication
misunderstandings. Empathic communication
is therefore crucial in dentistry and crucial
for dental students. Beattie et al. [29] found
that “female students have been shown to be
inherently more emotionally expressive and
sensitive, which has been correlated with better
communication skills.” It would be assumed that
clinicians who are able to communicate empathy
and compassion towards their patients would see
improved patient health outcomes. This could
be tracked when dentists see outcomes of better
patient diagnostic accuracy, increased patient
satisfaction and cooperation.
Negative empathic communication results
in patients who are more dissatised with their
interactions with their practitioners, and more
likely to be fault nding. It has been shown in
medical studies, that those who exhibit negative
communication with their patients are much more
likely to be sued than those who have positive
patient interactions [30]. If the patient feels they
are “invisible” or just a “number” or a “paycheck”
they will not believe that their provider cares about
them. The opposite happens when somebody looks
them in the eyes and asks them questions about
themselves, or if the dentist arrives late, he/she
apologizes and acknowledges that the patient’s
time is important. These types of things could be
discussed and practiced between dental students
in a controlled setting with standardized patient
actors. Striving to match more outgoing students
with more reserved students may also be a good
start to producing dentists who have better
empathic communication skills in clinic work.
FINAL CONSIDERATIONS
Compassionate care is imperative for
achieving excellence in health care, as it improves
patient outcomes, provider well-being and
optimizes health care system resources, offering
better health results to society. Dentistry is no
exception, and dental education needs to focus on
nding the appropriate strategies to intentionally
teach compassionate care skills to the future
workforce. Incorporating compassionate care
into dental education is crucial to ensuring dental
professionals are able to deliver proper empathic
care. Starting this dialogue and training in dental
education will drastically improve patient outcomes
and provider-well being earlier which may reduce
burnout further down the road. Compassionate
care is imperative to dental education and the
success of rising dental professionals, not only for
better patient outcome, but also for better provider
well-being. Compassionate care is a necessity for
obtaining excellence in healthcare.
Author’s Contributions
RL, MG, LM: Data collection, analysis,
drafting the manuscript, revising and approving
nal version.
Conict of Interest
The authors have no proprietary, nancial,
or other personal interest of any nature or kind
in any product, service, and/or company that is
presented in this article.
Funding
This research did not receive any specic
grant from funding agencies in the public,
commercial, or not-for-prot sectors.
Regulatory Statement
Not applicable.
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Rebecca Lindow
(Corresponding address)
Case Western Reserve University School of Dental Medicine, Cleveland, OH, USA.
Email: RCL87@case.edu Date submitted: 2022 Nov 14
Accept submission: 2023 Jan 05
