Compassion in healthcare

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:

PERSPECTIVE

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.

 

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About bmitzi

Medical writer, author, artist. Cancer campaigner. Aiming always to improve health services and bring compassion into health care.
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4 Responses to Compassion in healthcare

  1. Mitzi,
    In one small degree I disagree with the author – I never minded ‘paternalism’ when my doctors knew what they were talking about – now I object to it strongly. Why? When I caught polio as a child, my doctors told me the truth (worst was that I would never walk again), and worked tirelessly to give me the best outcome possible, As a result, it soon became obvious that by working together, I did have a chance of walking again – and I did.
    Today, when I was diagnosed with cancer, the same spirit of ‘doing what was best for the patient’ disappeared. I was told lies (I have never seen this drug side effect before – these side effects are due to your age, etc) The trust between medical staff who did their best for each patient seems to have gone, and now doctors rely heavily on drugs, without treating the patient as a whole.
    Very sad – what would Hippocrates say?

    • bmitzi says:

      Hi Verite

      Your polio doctors told you truth and that meant you could trust them and work with them.

      I don’t know how many times I have heard patients say medical staff have denied their symptoms are side effects of treatments, though they are, as they find out later. Deny everything and don’t get sued? Another common assumption is that symptoms are simply psychosomatic – easier to label the patient than take the trouble to find out what the problem really is – and easier to accept another doctors ‘diagnosis’ than do the proper investigations. I had such a colleague mis-diagnosed with psychosomatic symptoms for 5 years, but then diagnosed with ME AND MS. I’ve just heard from a friend who has had severe back pain and numbness in legs for about a year. Any connection between the two was dismissed by various doctors. She insisted on an MRI but only received a non urgent referral. So it has taken months to access, but now she is diagnosed with bulging disc needing urgent treatment. Hmmm.

      BW

      Mitzi

  2. OMASORO BIDDEMI says:

    wow am quite inspired by your write up.I am a medical student in Nigeria and please, I would like to know your view about the attitude of medical students to patients especially those with terminal ailments. you can send me a mail :omasorobidemi@yahoo.com

    • bmitzi says:

      Thanks for your interest, Omasoro. I haven’t had much personal experience with medical students, but have heard of other people’s experiences. I would imagine it could be very difficult for students to show compassion and communicate in an appropriate manner to terminally ill patients if they (the students) have not had communications skills training (and specific training in communicating with terminally ill patients because there will be very ‘difficult’ issues that need addressing). It can be heart-breaking when patients have not realised that they are soon to die and feel they have lost precious time to do an say the things they would otherwise have done had they known. It should also be a person’s right to decide where they want to die. And they may need help to arrange personal matters. But to just tell a person they are going to die, without a warnng sentence or two, is brutal. And harmful. First do no harm? If this is to be the case, doctors must have high quality communication skills training. I have suffered first hand when they did not.

      I have had experience of a doctor training in a certain technique who ignored my groans and gave no pain relief for about 45 minutes during which time it was obvious I was in real agony (radioactive wire implants in muscle repeatedly going into spasm – described in my book). I think medical students will sometimes not have the knowledge or experience that enables them to do the right thing, or give the correct medications/drugs to relieve suffering – and I’m sure they will feel bad about their mistakes, so they will need support.

      I’ve also had experience of a ‘houseman’ (I think) who pretended to know more than he did. When I asked how many lymph nodes would be removed during my impending breast cancer ooperation the next day he told me (after a hesitation) ‘All of them!’ I told him in that case I would be going home right away! When the surgeon called by (as promised) he assured me there would be far less removed and in fact he removed 11. This seemed to be a case of the young doctor not wanting to admit that he did not know. Let’s hope he has learned by now that it is much better to admit not knowing and say he will find out. Patient’s respect such honesty and feel they can trust the student/doctor. Authoritarianism and paternalism do not win trust or respect these days.

      I also think students attitudes could depend on the way they themselves have been treated by doctors and superiors – (abuse begets abuse). The hierarchal system of healthcare has to change – doctors need support and to be able to acknowledge their own feelings as well as those of patients. Dr Robin Youngson, an anaesthetist in New Zealand, has started a movement ‘Hearts in Healthcare’ which is trying to bring more compassion into healthcare – for doctors and nurses as well as for patients. I’ve mentioned it elsewhere on this blog. You may also want to read Dr Kate Granger’s book The Other Side. Dr Granger is a young doctor working in Leeds but has an incurable cancer. She has turned her diary into a book so that doctors and medical students can learn from her experiences – just as I did. It is so tragic, and I feel deeply for her and her family. One good thing is that more and more doctors are speaking out about what needs to change in healthcare.

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