Introduction
Anthony Mazzarelli here. But call me Mazz.
In 2013, I became the chief medical officer (CMO) of Cooper University Health Care—an academic health care system that includes an affiliated medical school, flagship hospital, a Level 1 trauma center, and one hundred other sites in southern New Jersey, now with $1.6 billion in annual revenue and around 8,500 employees. I was thirty-eight years old, which seems impossibly young in hindsight. Needless to say, I’d never been a CMO before, and Cooper had never had a practicing emergency medicine physician in the position before either. My qualifications were my experience as a doctor at the hospital, my law degree, and, I think, my ability to get along with others. I knew going in that the CEO and the board had taken a chance on me, and I dearly hoped they’d put their faith in the right person.
Shortly thereafter, in 2014, the CEO told me that she’d hired a top consulting company that deals with employee and physician engagement and patient satisfaction. “They’re the best, and they’re going to help us,” she said.
I was all for it. I’m not going to refuse help when it’s offered. So I met with the consultants and they gave me a list of things that we had to get our then five hundred physicians to do to make improvements. I remember jotting down “say thank you,” “introduce yourself,” “listen more,” “don’t interrupt,” and “nod a lot.” Boiled down, the message was that our faculty needed to show more compassion and to connect with patients and one another.
I listened and nodded (and didn’t interrupt once) through the presentation, but the whole time, I was thinking, “I’m never going to be able to get the physicians to do this mushy stuff.” Apologies to doctors, but we’re not always known for our soft skills or at least not known for changing our ways with those niceties. (I can practically hear my medical school professors who believed customer service wasn’t their responsibility, saying, “That’s what nurses and social workers are for.”) Our faculty were academic types, doctors who’d been doing it their way for thirty-plus years and, as the faculty of our medical school, have been teaching others that same way. If I gave them the new mandate, many, if not most of them, would roll their eyes and say, “I’m already compassionate” or “What a waste of time and energy.” They’d brush away the advice of this consulting group like lint off their shoulders.
Compassion: recognizing the suffering of others and then taking action to help.
When I started medical school, compassion wasn’t explicitly part of our curriculum. It wasn’t the title of any lecture. It wasn’t the answer on any test. As a student and as a doctor, I learned about compassion in the halls and patient rooms of our hospital. I’ve seen its power but felt its effects most deeply when I was on the other side of the equation.
In 2013, my pregnant wife, Joanne, and I rushed to the obstetrics (OB) department at Cooper in a panic. Joanne, a cardiologist, and I had reason to worry. Even though she was full term, days away from her due date, she hadn’t felt the baby move for hours. The nurse tried to find the heartbeat and couldn’t, but she never let on that she was worried. She remained calm and spoke to us in a soothing voice.
The OB physician came in rolling an ultrasound machine with her and introduced herself with the same calming, reassuring tone, somewhere between “I know this might be really bad” and “Everything’s going to be okay.” It seemed to strike the right balance, which was: “You’re in the right place, and you’re going to get the right care for right now.”
But it wasn’t going to be okay. Using the best technology we had, the physician couldn’t find a heartbeat either. It’s probably the hardest job an OB doctor has, telling the expectant parents that their worst nightmare was their new reality. My wife was pregnant with a fully formed baby, and there was no sign of life.
I’ll never forget the absolute sorrow at that moment. I’d been in the exact same situation as a caregiver, but it was entirely different to be on the other side of it, to say the least. I have relived it hundreds, if not thousands, of times in my mind since, and I’ll never forget or stop appreciating the compassion shown to us on that day. It reverberates and revisits and is more powerful than people (including doctors) realize. Every carefully chosen word, the reassuring tones, comforting touches, even the moment of silence when hope was lost, mattered deeply to us. It matters still. It will always matter. The pain of our loss is forever intertwined with gratitude, and it helps. When all is bleak, you search for any small light and focus on it.
Patients and families may not remember a doctor’s or nurse’s name or face, but they will remember the smallest comforts we offer. Those moments are part of the story. Kenneth B. Schwartz, cancer patient and founder of the Schwartz Center for Compassionate Healthcare in Boston, said that compassion “makes the unbearable bearable.”
If I hadn’t had the experience of losing a son, would I be as convinced that compassion always matters? I can’t say. But I knew I approved of the consultant’s recommendations, and that I needed to get our entire health care system on board. On a human level, I hoped to lead a team that always gave patients and their families the same care and compassion that my wife and I received that day. I also had a business mandate to make our system more efficient and profitable. Let’s face it: the bottom line does matter. And if compassion could help us be more profitable, it’d be a win-win. The powers that be at Cooper believed it would. They expected me, their brand-spanking-new CMO, the youngest on record, to make it happen. If I didn’t, they might want to kick themselves for hiring me.
I had a simple solution to a complicated problem: call Steve.
I wish that all of life’s problems could be solved by calling Stephen Trzeciak (maybe they can?). This one definitely would. Along with being the co-author of this book, Steve is an intensivist (intensive care specialist) and was the head of critical care medicine at Cooper. His reputation as “the science guy” is well earned; he was our number-one National Institutes of Health (NIH) research grant recipient, the most published faculty member, our star researcher, our very own Super Nerd. Not only that, when I was just out of med school and a resident (a doctor in training) at Cooper, Steve was my attending physician (my teacher). We went way back. But even if we didn’t have a professional history and friendship, I would have gone to him first to solve this problem.
My logic was, Who else can turn the minds of our academic staff but its most academic member? If Steve could harness his nerd power and get an avalanche of research that proved compassion would make our system run better than it had in decades, we’d have a stronger leg to stand on than just “the consultant said so.” I knew we had very strong physician leaders across the health system who would follow the data and lead their people to do the same. My intention was to weaponize scientific evidence. We had to build a data bomb and drop it on the doubters. Steve would be our Oppenheimer.
Stephen Trzeciak here. Steve is fine.
Mazz called me in to talk about a new research project, a deep dive on compassion, empathy, kindness—anything and everything that fell under the umbrella of Not Being a Jerk—in the realm of health care. He said, “You’re the science guy. Can you take this list of mushy recommendations and science it up, give me evidence that I can take to the medical faculty that being compassionate will help the bottom line?”
My first thought was: “Okay, I wasn’t expecting that.”
Second thought: “Do people really call me ‘the science guy’?”
I call myself a “research nerd” all the time, because I really do love to start with a hypothesis, do experiments, gather data, and draw conclusions. The scientific method is how I approach just about everything in my life, especially my work.
Copyright © 2022 by Stephen Trzeciak and Anthony Mazzarelli