How did it get lost? Is this due to attitudes and abuse during medical training – too much emphasis on technology – overwork and under-staffing – oversight…other/a combination of things?
The need for more compassion in healthcare is something I experienced and a truth borne out by successive reports into standards of care (Age Concern, The Audit Commission, The Kings Fund etc) – and I intend to give it more space on this blog.
As usual, I am time- and energy-limited but will start the ball rolling with this article in the New England Journal of Medicine:
n engl j med 365;24 nejm.org 2252 december 15, 2011
Dealing with Uncertainty in a Time of Plenty
Ranjana Srivastava, F.R.A.C.P.
– an intriguing article about misunderstandings between patients and doctors on what patient-centred care should mean when patients want answers, yet the answers are unclear:
‘How do we educate our patients well about what we know, but avoid displaying hopelessness when we don’t know? First, we must acknowledge our own feelings. If we’re uncertain about a complex diagnosis, decision, or therapy, we’re probably not alone. But it’s easier to disguise our realization that we don’t have all the answers than to accept it and feel like fledgling physicians again.’
I have experienced withheld information, tailored information, lying by default and outright lies.This all resulted in having nothing to rely on and destroyed trust in my doctors at a time when I most needed it. You cannot have partial truth. I felt desolate. Paternalism may have worked in the Dark Ages, but it’s past its sell-by date.
To my mind, it all comes down to good communications skills and these can be taught and learned (especially by those who think they do not need them!) eg via the National Cancer Action Team’s ‘Connected’ Advanced Communication Skills Programme.
Armed with such skills, doctors and others do not have to stand well back for self protection, but can enable patients to discuss uncomfortable issues, and deal with patients’ emotions, without getting involved but by supporting them – while also being able to acknowledge and deal with their own emotions. Good communications skills training can enable doctors to acknowledge that their treatments cause harm and so meet the needs of patients. While distancing oneself is a barrier to compassion (and can result in neglect and physical and psychological harms) learned communications skills facilitate compassion. And compassion is needed for patient-centred care. Both are very necessary if doctors (and others involved in patient care) are to ‘first do no harm’.
This insightful discussion also includes, ‘But we must also learn to feel compassion for ourselves, especially when the stakes are high and the answers not straightforward.’
We must be aware of the needs of clinicians as well as those of patients when we talk of compassion in healthcare and try to implement patient-centred care.