Blog: Care and Humanity
30 March 2015
On 19 March 2015 a blurred grainy photo was posted on social network reddit and spread rapidly across the internet, attracting thousands of comments, shares and tweets. For once this was not about scandal or celebrity, but an image of an unnamed emergency doctor in California momentarily overcome by emotion having just lost a 19 year old patient. The doctor had stepped outside and was crouched down against a wall, seemingly pole axed by what had just happened. Many of the comments remarked in awe on the compassion and humanity of the doctor, but why does this come as such a surprise? Surely those are exactly the qualities that we would want and expect in clinicians and those providing care and support. The story told us that moments after the picture was taken the doctor regained his composure and returned to work with his head held high. Both parts of this story are important.
People – and their loved ones – who are receiving health care, particularly in emergency or end of life situations, generally don’t want their doctors to be emotional or distressed, but they do want them to show empathy and care. A year ago my father was in his last days in hospital following an emergency admission. The young duty registrar told us late at night that Dad had little chance of surviving the night and if we wanted to be with him we shouldn’t leave the hospital. He told us gently and with care, but it was a huge shock particularly for my elderly mother. He spoke to her kindly and carefully and when she told him that they had been married for nearly 63 years, his eyes suddenly filled with tears and he was on the point of breaking down. His reaction seemed to take him by surprise as much as it did us. He had probably been on duty a long time and was tired; Mum’s situation might have touched him on a personal level – perhaps reminded him of his own parents or grandparents. But whatever the reasons, the moment was a real point of connection and we all recall his kindness and humanity in that moment. Indeed, all the people who stood out in Dad’s care were those who allowed themselves to connect with us as people, to show empathy and compassion and who were touched by our situation. There were also some we would rather not have come in contact with – people who were task-focused but who had ceased to see the person they were supposedly caring for, and who responded to requests for help grudgingly and without warmth.
Doctors, nurses and others providing care and support cannot become emotionally saturated by every case they deal with. Their professional judgement could be affected and their role would be unsustainable as they struggled to cope with the burden and overload of distress. But the other extreme of distance, professional aloofness and efficiency can appear cold, uncaring and lacking understanding. These professionals can experience life and death decisions, serious illness and trauma every day of their lives; the familiar can become prosaic and commonplace; but for the patients and families these situations are uniquely shocking and unfamiliar, and they are desperate for support, empathy and acknowledgement.
The importance of recognising these basic principles and values is reflected in the astounding profile achieved by the social media campaign #hellomynameis launched by terminally ill doctor Kate Granger. This promotes the simple idea that a friendly greeting from doctors and all those involved in caring for a patient can make an enormous difference. As she described it, it is “the first rung on the ladder to providing compassionate care by establishing a human connection and building trust with a person.”
Repeated cases of failure of care – whether in situations such as Winterbourne View or in the ‘serious failings’ of the mid-Staffordshire NHS Trust – have common features; staff at all levels of the organisation from managers to front line lose sight of the person and stop responding to patients as people. Once someone is objectified it becomes easy to ignore their needs, and as the Francis inquiry reported, an insidious negative culture develops “involving a tolerance of poor standards and a disengagement from managerial and leadership responsibilities.” The solution is by now well rehearsed and the lynchpin has to be a focus on the patient above all else. Francis spoke about the need for a fundamental culture change that would see shared values adhered to at all levels of the organisation that would make it impossible for a recurrence of the situation that failed to ensure basic standards of care, privacy and dignity and which would not permit the treatment of patients and their families with ‘callous indifference’ such as had typified the experience in Mid-Staffordshire. We’re not there yet, but hopefully we’re on the right road.
So why are we still stopped in our tracks by the emotional response of an emergency doctor? It probably says as much about us and the media as it does about the health system. We have perhaps lowered our expectations; the negative stories of recent years and the shocking incidents of failure and patient neglect have coloured our views and created a stereotype of uncaring staff that is far from accurate. Everyday acts of kindness and humanity happen throughout our care and health systems, but they are rarely news-worthy. It is the absence of these which makes the headlines and rightly shocks us when it happens, but cold indifference is not the norm.
A TV report on the story in the USA showed an astonished news anchor pronouncing the image to be ‘incredible’. It isn’t, and it shouldn’t ever be. If a doctor is unmoved by the sudden death of a young person, something is deeply wrong. Every death is a tragedy for those most closely involved; but when those engaged in trying to save those lives each day forget that, they risk losing their better self. ‘Do no harm’ is often cited as the first principle of medical practice, but at least as important should be ‘see every patient as a person.’
This was published in the Guardian healthcare network on 17 April 2015.