What’s most important in providing good health care?
My answer – people.
Every doctor I know has personal stories of experiencing a dehumanisation of patients in health care. From the well known “liver problem in bed 3” way of referring to someone, to stories like the ones Dan Siegel tells in his “Mindsight” book of being clearly and specifically instructed not to ask about patients’ lives and feelings, but, instead to concentrate on “diseases”.
Here’s two conversations I’ve had with junior doctors in the last few months. One told me that she had been instructed by her clinical teacher “Don’t believe patients. They lie all the time. You can only trust the results” By “results”, they meant the results of investigations – blood tests, X-Rays etc. The second told me she’d been taught “If a patient takes an evidence based drug and says that it didn’t help, they’re either lying or they didn’t take the drug.”
Frankly, both these conversations shocked me. It seems like dehumanisation has been take to a new level. What kind of doctor has these attitudes and beliefs? Are these caring doctors? What, or who, do they care about? Are they scientific doctors? Is it scientific to dismiss patients’ narratives and patients’ subjective experiences? It’s not. Dr Robert Smith, in his book, “Patient-centered Interviewing. An Evidence Based Approach” describes clearly and eloquently why it’s not. Without considering all the “data” available, he says, then the assessment will be invalid. He makes the point that the “data” includes the patient’s reported subjective symptoms.
These attitudes were very evident in the recent Science and Technology Committee’s attack on homeopathy. They made it very clear that they considered irrelevant the fact that repeated research has shown 70% of patients who received homeopathic treatment on the NHS stated that it helped them.
There’s another consequence of the failure to make people the most important priority in health care – that’s they way the health carers are treated. There’s wholesale destruction of professionalism underway with nurses’ and doctors’ work being broken down into hundreds of individual tasks which can be measured and monitored. Procedures become more important than people, and the nurses and doctors feel undervalued.
It’s sad. And it’s not good.
Do we need to create a campaign to redress the balance? To insist that people are more important than statistics? To teach doctors to believe what their patients tell them and to show that there are no “evidence based drugs” which work in every person who takes them? To create the conditions for more care and more respect?
I think we do. What do you think?
Heroes Not Zombies 
I am not surprised in the least with the two examples you heard . I work in orthopaedics and am bombarded with patients experiences where they have been treated rudely, not listened to, dismissed and not given adequate time to explain their story. The root cause of this is in teaching. I firmly believe that listening and coping with the populations ill health is a difficult psychological experience, some dont enjoy or cope with this and graduate into teaching or management where their arrogance, dismissive attitude or reliance on so-called randomised controlled studies are perpetuated.
Healthcare is increasingly becoming a corporate experience and my fear is that it will become completely infiltrated by the creatures we have seen recently who almost sunk the banking industry.
Do we need to redress the balance ? Absolutely and i think it needs to begin with the patient experience.
Jim
Jim, you’re right. Yet again! How interesting that in our very different specialities we’re coming across the same basic issues.
Your remark about the people who almost sunk the banking industry is interesting and pertinent. There’s something about values here which needs to be addressed. Something about focusing attention on, as you say, patient experience.
Bob, i think the comments both these students heard absolutely shocking and infuriating, but sadly totally believable.
Over the past 18months or so,I have spent time with many health and social work professionals, trying to get them to see my mum as person, with a life and a story,that she cannot relay to them, but that is totally relevent when caring for her , i have been shocked by the lack of compassion that i’ve encountered.
Sadly, i think it is a larger problem within society, whether that be in health, banking or where i see it daily in Education.
I think it comes down to basic values, whatever area we live or work in.It’s about a bit of human respect, value for one and other, and that good old point that we have often discussed….people being heard! We need more listeners in our world, and i just feel blessed that on a day like today, it’s you who is my Doctor and i know i will be both valued and heard as always when i come through the door at the hospital.
I guess it’s hard sometimes not too run with the negativity this can bring, but just to focus on what each one of us can do where we are to try and redress this, by living respectfully and teaching our children values.
Oh, and of course maybe finding the courage to challenge that total lack of respect, unfortunately so frequently displayed.
Bet the story about your Mum is really disturbing, facing the ignomy of not being cared for by people and orginizations that were solely designed for such a task is really despicable.
My father passed away recently, he was diagnosed with cancer and taken to a large teaching hospital , for four weeks he was largely ignored other than the tests that were performed, he became disholusioned, lonely and depressed during this period. I eventually insisted that he was transferred home to the small cottage hospital on the west coast island where he lived. Unbelievably they left him in the public waiting room at the ferry terminal with his clinical notes on his lap. A confused old man who was digesting a terminal diagnosis. He was unable to get on the ferry and had to be manhandled by ferry staff, I would never be able to convey in words his embarrassment, frail and failing in his pajamas being dragged onto a boat because no one had the care ,the foresight, the job title, the time.
When he got to the hospital at home the contrast could not have been more extreme, i witnessed care and empathy from every member of staff , i spent his last two weeks with him in an atmosphere that was both understanding and caring, they shared our laughs and grief.
They knew him , his history , his personality , he was a person not a number on a wrist or a name above a bed. I hope you find someone who will have the compassion to see your Mum for everything she is and you are correct in your observation that we need to have the courage to front up to poor care .
Yes, Dr Leckridge, I do think that we need a campaign which centres on people. Every kind of people. From the jobsworth and the angel in the jobcentre, to the freelancers who give of themselves, to our law enforcement agencies who pick up the pieces, to the healthcare practitioners who constantly have to add new hoops to their skillbase, to those who serve in shops, to the vulnerable and disaffected, to those who keep trying, to our elders, to the tiny little children who inspire us and make it all worthwhile and to those who assume the mantle of high office with all the responsibility and exposure that brings.
What we need Dr Leckridge is a UK wide campaign allied to a book for the worldwide market. We won’t need much funding. So many firms and people will be keen to give of themselves freely, indeed they already have to get the work to the stage it is presently at. Let’s get the work commissioned starting from April 1 2010 with a publication deadline two years hence.
See you at the first steering group meeting, the team is already in place, as is the commitment. Won’t take us long to draw it all together. A blueprint for peace and harmony.
Ciao.
Well said Bob. I find the focus on targets completely out of step with the goal of better healthcare. Sound bite solutions to a complex health and societal issues do nothing besides make things worse!
As a long term user of the health service I totally applaud Bob’s suggestion and will do anything to make this happen.
I am now nearly 50 (omg) and have been in the health service system since birth. The first place I was ever treated like a person within the health service was The Glasgow Homeopathic Hospital.
So let’s get the campaign going
A Physiotherapy lecturer in Birmingham wrote a very interesting piece in the journal recently (the first for a very long time!) on narratives in heath care . He has just written to me describing how difficult it is to get this type of research funded.
It is important to value the ‘human’ and I am not sure machine based metaphors and the results of RCT trials do this in the ‘growing grey’ zones that primary care seems to operate in.
I think Arthur Franks’ latest book The Renewal of Generosity
is probably a very relevant work in this area and a brief review appears here http://philpapers.org/rec/FRATRO-9
I think what kills the spirit of generosity is a societal desire for certainty and protocols which seem to kill individual creativity and lead to ‘zombie like’ behaviour …..
Jim,
thankyou for your comments on the situation with my mum.I feel that there is a lot of ‘ticking boxes that goes on,dressed up as ‘care’.
I felt really vexed to read of the experiences that your dad went through.That no-one took the time to stay with him during his transfer,at such an emotional as well as physically difficult time is just beyond comprehension. Was there not a single soul who looked and saw an elderly man, a human being , in need of support and comfort? Thank goodness you insisted that he be brought home. I hope you have managed to take a lot of comfort in the fact that once he got to the cottage hospital, he was well cared for at every level, and that you too got to spend this valuable time with your dad.That is just so important Jim. I think Bob has something here, maybe a campaign to redress the balance is what society needs.
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