Embracing Compassion in Health Care: The Power of Being Present With Marcus Engel, MS, CXCP, CSP

Oncology Data Advisor: Welcome to Oncology Data Advisor. I'm Keira Smith, and today I have the pleasure of being joined by Marcus Engel, who is a renowned health care speaker, author, and compassion consultant. Marcus has written four books and hosts the Compassion & Courage: Conversations in Healthcare podcast. Marcus, it's such an honor to have you on the show today.

Marcus Engel, MS, CXCP, CPS: Thank you. Likewise, it's good to be with you.

Oncology Data Advisor: To start off, I'd love to hear a little bit about your story and your personal experience with receiving compassion in the health care setting. Would you like introduce yourself?

Marcus Engel: Sure. I'm 48 years old, I live in Orlando, Florida, and I'm a native of St. Louis. My work in health care doesn't come from any kind of clinical expertise. I entered the world of health care when I was an 18-year-old college freshman. My friends and I were going home from a hockey game one night and got broadsided by a drunk driver. That vehicle crash not only took 100% of my sight, instantaneously and permanently, but I also received what's called a LeFort III fracture, which if you're not a clinician, you may not know, means pretty much every bone from the hairline through the chin was fractured. There was a ton of damage and a lot of recovery and rehab until I could get back on my feet again.

My work these days revolves around compassionate care and presence in health care. The primary story, the foundational story, is the night that I was rolled into the emergency department, there was a 20-year-old tech who held my hand the whole night and gave me the most comfort I think I could have received in that time by simply saying, "I'm here, Marcus, I'm here." The meaning behind that is, "Marcus, you're not alone. You're in this vulnerable situation, but you are not alone, I'm here with you." My work these days is to remind health care professionals the power that they have to be present during a patient's time of suffering. And it's not just patients, because we know that illnesses and injuries don't just happen to patients, they also happen to families. I remind them to not only have that grace and compassion with their patients, but also with their patients' families.

Oncology Data Advisor: Amazing. Thank you so much for sharing your experience. "I'm here" is such a powerful thing to say and to hear, and it's incredible that it really served as a springboard for all this work.

Marcus Engel: When Jennifer said those words to me as she held my hand, this wasn't something that she learned in school. This was just a human being to a human being, witnessing another person suffering, being present for it, and trying to do something about it. That is what the definition of compassion is. That's the definition that I use with my pre-meds I teach at Notre Dame. It all comes down to, it's as complicated and as simple as just being there, being in the moment.

Oncology Data Advisor: Absolutely. Talking about compassion, you mentioned that you're a compassion consultant or a compassion expert. What exactly does this term mean?

Marcus Engel That's a good question because whenever you think of someone who's a compassion expert, I would immediately return to the thrilling days of yesteryear with some of our spiritual gurus, people we know who were super compassionate, such as Jesus or the Buddha. I certainly can't put myself in that same category with those folks, because as much as I am always striving to be compassionate, I am human, and I fail consistently. But what I think I do have is that expertise of having had these experiences, and I'm able to translate these experiences into something that people can learn from. That's always been my work, and I do it by going out and speaking around the country, always trying to bring more compassion into the workplace, more compassion into health care, so that if there are any patients out there who have to go through something as incredibly tragic and life-changing as I had to go through, they also have those empathetic present compassionate caregivers by their sides.

The other part of that compassion expertise comes from the fact that about 10 years ago, I got a Master's in a field called Narrative Medicine. At the time, it was the only Narrative Medicine Master's program in the country, and that was at Columbia University in New York. What we learned in Narrative Medicine is how to actively listen to the experiences of others and then to respond instead of reacting. We're listening to the experiences of others and being present for those. Between those personal experiences, the lived experiences and the academic background, and teaching these kinds of things around the country, I suppose that's where we get this idea of a compassion expert, but definitely don't put me in the same category with any gurus or anything like that.

Oncology Data Advisor: I find it fascinating that Narrative Medicine is a field of study and that it's something that people can really make a part of their education.

Marcus Engel: Absolutely. Probably 50% of my classmates were either MDs or they were going to become doctors. That lets me know that we're training up a whole new generation of doctors who are really listening to understand and fully provide that holistic care for patients, not treating it like a factory and getting patients in and out the door as quickly as possible, but actually being present for those patients.

Oncology Data Advisor: That's really amazing that it's something that can be incorporated into training and into patient care.

Marcus Engel: My focus has always been with nurses and teaching nurses how to use journaling and therapeutic reflective writing as a way to ward off compassion fatigue and burnout and to stay more present. That's always been my focus in Narrative Medicine, but my colleagues in the field are also teaching fine arts, film production, theatrical production, all different slants of the humanities and arts that mix with medicine and health care. It's just really interesting and fun work to be part of.

Oncology Data Advisor: It really is incredible. In all the considerations of the clinical setting, and obviously it's chaotic at times, I'm sure that compassion is something that can be kind of put on the back burner, so to speak, in light of all the considerations. To that point, can you tell us a little bit about what exactly the implications are of compassion in the health care setting and how it really affects patients and their care?

Marcus Engel: I know it affects patients like me, to think that their care team members are all working together hand-in-hand to create a seamless experience. As patients who go into hospitalization or into treatment of any sort, we are not privy to the ins and outs, the behind the scenes, of medicine. So how do we, as patients, as consumers, how do we go into this really vulnerable or fearful time? How do we go into it and feel held and secure?

Part of that is relying on the fact that we expect that we will get as good quality of health care as we can. Nobody goes into the hospital or into treatment thinking, "Well, I hope it only is half good, I'll be satisfied with half good." We want the absolute best quality, but we also need kindness and compassion built into that. That's for the patient, the user, the consumer experience, but it's also for the experience of the caregivers and the medical professionals. The more compassion they show to their patients, the more compassion they're going to have with our colleagues, subordinates, superiors, et cetera. And it's not just me saying this; I point to Stephen Trzeciak's book Compassionomics to make a great argument for why compassion shouldn't be put on the back burner in health care. It really should be front and center of everything that we do in health care.

Oncology Data Advisor: Absolutely, and like you said, it definitely trickles down the line and affects so many different levels.

Marcus Engel: Absolutely.

Oncology Data Advisor: My next question for you has to do with the fact that our audience primarily consists of clinicians, including physicians, nurses, pharmacists, you name it. How can our audience take some of these insights and these messages about compassion that you're sharing and apply it to their practice?

Marcus Engel: First of all, just remember that patients, unless it's just a routine appointment or something very, very minor, are typically in a vulnerable spot when they're seeing a clinician. Even if they're perfectly healthy and it's just an annual checkup to hear how good they're doing, patients are still vulnerable. We still go into a doctor's office and oftentimes we're not wearing our own clothing anymore. We're out of our element. We feel like people are judging us for our weight on the scale or the amount of medicine that we take, et cetera, et cetera.

So, how do we apply this? First and foremost, realize that patients are in a vulnerable state, and whenever we can, respond with kindness and compassion to that vulnerability as opposed to just going through the motions. Trust me, we're all human, and we all go through the motions from time to time. But if we can remember that patients are suffering and vulnerable and afraid, that's where I think we're staying connected to who we truly are as human beings when we respond appropriately to another human being's vulnerability.

Oncology Data Advisor: Absolutely, that's very important to keep in mind. The next question for you is kind of a unique one from your perspective as a Seeing Eye Dog handler. What has your experience been with having your dog, James, with you at doctor's appointments? For the most part, have you found providers to be welcoming, or have you encountered any barriers in receiving care? I'll also take that one step further to ask, for health care workers who may or may not be familiar with the rights of service dog users, do you have any particular advice for them for caring for a patient who comes in with a service animal?

Marcus Engel: This is a great question, and I'm not an expert in this field. This is really out of my realm of expertise, but I have had a Seeing Eye dog by my side for the last 25 years. I've been through a lot of doctor's appointments, and only one time have I ever had a barrier of a provider that did not want to treat me because I had a dog in the clinic. That was only one time, and of course, I never went back to that clinician. In fact, I don't think I even stayed at that first appointment. My idea was, "Well, if you don't want my dog, then you don't want my business either."

In the clinic, realize that these dogs, service dogs specifically, are doing a job. They're doing a specific job to help out someone who has a disability, and they've been specially trained to do this. I've never had my dogs in the hospital with me. I am very fortunate that I have a wide network of family and friends, and that makes things easier for me when I've been hospitalized. I've been able to leave my dog at home under the care of someone else who I trust. But I do know plenty of people who have had their dogs in the hospital with them, and oftentimes, nurses or doctors may be a little afraid of that. There could be dog phobias, there could be fear that this dog is going to urinate or defecate in the room, all kinds of fears.

But this is where trained service dogs don't do that kind of stuff. Trained service dogs have had months, if not years, of education to make sure that they are well-behaved in every scenario. Whenever I've taken a dog into a doctor's appointment, usually it's with a positive reception, if there's any reception for the dog at all. We know that the vast majority of Americans have dogs and love dogs, so there's not a real barrier other than one instance in nearly 30 years. Anywhere the public goes, the dog can go.

Oncology Data Advisor: As we wrap up, for health care providers who are listening today and who are interested in learning more about how they can embrace compassion in their practice or learning more about the different types of education that you provide, where do you recommend that they can go to delve into this topic further?

Marcus Engel: There are a lot of different places. For my information, go to MarcusEngel.com. You can learn a little bit more about the compassion training that I do with medical groups, hospitals, health care systems, and colleges and universities. The other thing that you can certainly do is just look up Narrative Medicine to learn more about this work. Then lastly, I would turn you to my podcast, which is Compassion & Courage: Conversations in Healthcare. On there, I interview experts like yourself, and I also interview survivors and those who have any kind of connection to compassion in a health care setting. I hope you'll check the podcast out and drop me a line when you do.

Oncology Data Advisor: Amazing. Well, this has been so wonderful hearing more about compassion and how not only clinicians can incorporate into their care, but how any of us can incorporate it into our daily life and the people we interact with. Thank you so much again for coming on today. This is all incredible to hear about.

Marcus Engel: Absolutely, it's my pleasure. Thank you for having me on.

About Marcus Engel

Marcus Engel, MS, CPXP, CSP, is a Certified Speaking Professional, Certified Patient Experience Professional, and renowned author and compassion consultant in the field of health care. He holds a Master's in Narrative Medicine from Columbia University and serves as an adjunct faculty member at the University of Notre Dame. He has written four books which are used by nursing schools, medical schools, and allied health care programs to teach strategies for incorporating compassion into patient care.

For More Information

Marcus Engel (2023). Available at: https://marcusengel.com/

Compassion & Courage: Conversations in Healthcare (2023). Available at: https://marcusengel.com/podcast/

Transcript edited for clarity. Any views expressed above are the speaker's own and do not necessarily reflect those of Oncology Data Advisor.