Patients’ stories are typically
rich in detail, complex, and open to multiple interpretations. They are
crafted for listeners: this one for a medical audience. Every story
tells a truth, but not the only truth. The doctors in the surgical team,
the specialist nurse, and the radiology attendant would all have their
own stories about this particular patient. Stories are rhetorical (told
to persuade): what is it that this storyteller wants his listeners to
understand?
The central act takes place on the morning of the biopsy, the instruction in management of the pleural catheter, and the radiograph. The story persuades us that the professionals are not able to walk in the patient’s shoes, but we do not know if it is because the patient is a doctor. Dr Toy says caring for a renowned colleague is a particular challenge, provoking a natural defensiveness and fear of mistakes that make colleagues reticent. The patient himself believes that treating a fellow doctor puts his colleagues in touch with their own vulnerability. The difficulty is that he is “too much like them”; “the horror of what lies before [him] deflects clinical carers from straying on to that territory.”
My hunch is that it is more
difficult because some people in the room know him personally and
because he is a doctor. But my expectation is that other patients would
have broadly similar experiences because everyone dealing with them has
been left to invent for themselves how to talk and how to behave towards
patients and relatives.
Cumulatively, subtly, the unexamined routines and ordinary behaviours inflict grievous emotional harm. Casually but firmly the patient learns that he is completely alone. The professionals can apply their knowledge and expertise; they are efficient and technically competent. But if they ever learnt that, “The treatment of a disease may be entirely impersonal, [while] the care of a patient must be completely personal,” they seem to have forgotten. They are unable to make eye contact and they turn a blind eye to patients being stripped of their own clothes, embarrassingly gowned, addressed in derogatory terms, and ordered around.
All of which leads me to question the nature of the multidisciplinary team caring for the patient. What is it? Who does, and does not, belong to it? What do the team members think and talk about together? Do they share the same values? Do they have a common perspective? Have they articulated what they want to achieve for their patients? If their intention is to provide completely personal care, have they worked out the arrangements and processes that could make it a reality? And who is in charge of making it happen?
Providing personal care for patients is phenomenally hard work for individuals and teams. Professor Sweeney’s ground rules will improve interactions with patients, but they do not go far enough. The intention to deliver personal care needs to be matched by investment: in practical support for care givers to help them to keep in touch with their own humanity; in training in multidisciplinary team working; and in clinical leadership.
My ground rules to prevent teams from abandoning patients when they most need human warmth and empathy start with:
Promoting a sense of shared work through a commitment to regular planned communication
Acknowledging the possibility of miscommunication, investigating how it occurs, and building the processes to prevent it
Striving to be transparent with one another and allowing members of the team to explore their own questions and vulnerabilities
Inviting members of the team who know something of the personal life of the patient to share what they know in team meetings
Reminding team members always to refer to patients by name rather than by diagnosis.
Jocelyn Cornwell, director, Point of Care Programme, The King’s Fund (www.kingsfund.org.uk) pointofcare@kingsfund.org.uk
The central act takes place on the morning of the biopsy, the instruction in management of the pleural catheter, and the radiograph. The story persuades us that the professionals are not able to walk in the patient’s shoes, but we do not know if it is because the patient is a doctor. Dr Toy says caring for a renowned colleague is a particular challenge, provoking a natural defensiveness and fear of mistakes that make colleagues reticent. The patient himself believes that treating a fellow doctor puts his colleagues in touch with their own vulnerability. The difficulty is that he is “too much like them”; “the horror of what lies before [him] deflects clinical carers from straying on to that territory.”
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| Seeing the person in the patient |
Cumulatively, subtly, the unexamined routines and ordinary behaviours inflict grievous emotional harm. Casually but firmly the patient learns that he is completely alone. The professionals can apply their knowledge and expertise; they are efficient and technically competent. But if they ever learnt that, “The treatment of a disease may be entirely impersonal, [while] the care of a patient must be completely personal,” they seem to have forgotten. They are unable to make eye contact and they turn a blind eye to patients being stripped of their own clothes, embarrassingly gowned, addressed in derogatory terms, and ordered around.
All of which leads me to question the nature of the multidisciplinary team caring for the patient. What is it? Who does, and does not, belong to it? What do the team members think and talk about together? Do they share the same values? Do they have a common perspective? Have they articulated what they want to achieve for their patients? If their intention is to provide completely personal care, have they worked out the arrangements and processes that could make it a reality? And who is in charge of making it happen?
Providing personal care for patients is phenomenally hard work for individuals and teams. Professor Sweeney’s ground rules will improve interactions with patients, but they do not go far enough. The intention to deliver personal care needs to be matched by investment: in practical support for care givers to help them to keep in touch with their own humanity; in training in multidisciplinary team working; and in clinical leadership.
My ground rules to prevent teams from abandoning patients when they most need human warmth and empathy start with:
Promoting a sense of shared work through a commitment to regular planned communication
Acknowledging the possibility of miscommunication, investigating how it occurs, and building the processes to prevent it
Striving to be transparent with one another and allowing members of the team to explore their own questions and vulnerabilities
Inviting members of the team who know something of the personal life of the patient to share what they know in team meetings
Reminding team members always to refer to patients by name rather than by diagnosis.
Jocelyn Cornwell, director, Point of Care Programme, The King’s Fund (www.kingsfund.org.uk) pointofcare@kingsfund.org.uk
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