Every year, the Schwartz Center for Compassionate Healthcare recognizes one Boston-area health care provider for the extraordinary care they provide and the connections they build with their patients. This year's winner is John Zawacki, a professor of medicine at the University of Massachusetts Medical School and a gastroenterologist at UMass Memorial, who specializes in treating patients with Crohn's, colitis, and inflammatory bowel disease.
Q. What does it mean to you to be compassionate?
A. I look upon compassion as a gift we all have, but it's nurtured in different ways.
Q. Where does your compassion come from?
A. My father was an assistant superintendent of a 1,600-bed psychiatric hospital, back in the '40s. Dad took care of the people [at the hospital] during the day, and at night he had a private practice, six days a week. The number of people he would see was remarkable. I can remember being told to say goodnight to the patients on my way up to bed. I grew up with this huge human being who deserved this award more than I did. He just gave and gave and gave.
Q. How did that background prepare you for your field of gastroenterology?
A. People with certain kinds of gastrointestinal disorders have pain and discomfort and irregular bowel movements aggravated by stress. That component I felt comfortable dealing with. I have an irritable bowel myself. If I'm going to give you a lecture and I haven't had a bowel movement, I'm not going to be too excited about it, because I'm going to get nervous.
Q. So there is a clear connection between the brain and the digestive system?
A. You teach medical students that you're going to meet patients who, when they get anxious, that sensation in their brain is translated through the spinal cord and probably through a serotonin network to stimulate the gut to contract more. When people are very anxious they can get diarrhea, and when people are depressed they can get constipated. Physiologically how that takes place is not well known, but it's there.
Q. These digestive problems are exacerbated by stress, but what causes them?
A. Some time in your life you get a bug. The people on a cruise ship who all come down with a stomach bug, if you follow them six months later, 5-10 percent of them have a change in their bowel habits that never quite gets better. It's either going too fast or too slow.
Q. What do you tell someone who is newly diagnosed with conditions like irritable bowel and Crohn's?
A. You have to teach people, walk with them as they start to understand how they can alter their diet, better deal with stress, how certain kinds of medicine can help, and you help them get some control back into their life. It's wonderful to watch how they adjust and many, many grow and overcome it. When you see a patient do that, you have tremendous admiration for them. I think that's one of the great lessons my father taught me: respect.
Q. You treat patients with chronic conditions that are probably never going to go away. How do you offer patients hope without being unrealistic?
A. As you listen and educate, even if you can't solve their problem, you can still do things to help modify it, to help them do things on their own — be that exercise, be that meditation, be that dietary changes. You keep coming back with other things that can be tried. It allows them to cope.
Q. Can you teach the kind of respect and compassion you have?
A. I tell [medical school] students if you want to be a great physician, it's very simple. Before you walk in the room, you have an attitude that you want the best for that patient, you want to help them in some way. You go in there and you have respect for them no matter what that situation is. You listen to the story. Don't interrupt too much until they've told their story. Most importantly, you continue to walk with them — you don't abandon them. If you do all those things, you become extraordinary.
Q. But so much of medicine today seems to fall short of this kind of compassionate care.
A. The pressures are on because of the time constraints of seeing so many people. But I always tell [students] you can create, even in minutes, a meaningful relationship just by your whole demeanor.