“Who shall say what prospect life offers to another? Could a greater miracle take place than for us to look through each other’s eyes for an instant?” – Henry David Thoreau
Most often when a patient enters the room, we immediately ask them about their illness and suggest the line of treatment. And ring the bell for the next patient. All this would hardly take a few minutes (unless it is some serious condition). Our conversations are always hurried and professional to the core.
Have we ever paused and asked ourselves – Is it just a “case” who walks into the room or is it a “person” with a medical condition who requires holistic care?
Illness and recovery, pain and suffering, living and dying – these are integral part of our shared human condition. Every one of us must go through it. It is important to understand this universal truth and the human connectedness; and to remind ourselves that it is the fear of a disease and even death that has made our fellow human being to knock at our door.
As healthcare professionals, we have equipped ourselves with the technical knowledge and the scientific methodology to help our fellow human beings in sickness, disease and death. Indeed, we are the lucky ones who have the unique opportunity to take care of another human being. And to a large extent, we do impart our duty to the best possible extent.
It is also a fact that our “professional” training blinds us of this connectedness. So, when we see a patient, we only recognise the disease, we get lost in the methodology of diagnosis, to choose the right investigations, decide the priority of treatment and the various other management protocols.
I am not for a second denying that these are important and vital, but I want to ask: Do we really understand or acknowledge the patient’s emotions as they walk into our clinic or when we are doing our rounds? Are we aware of their emotions -Their anxiety, fear, anger, frustration, confusion and most importantly a sense of powerlessness.
Do we care about the patients as much as we care for them?
Unfortunately, our educational methods do not train us on humanness. However, humaneness is what reminds us that we are all human beings, living in a world that is interconnected.
As a surgeon, I have performed multiple surgeries. But, I had a role reversal once when I had undergone a surgery myself. I still remember the sense of powerlessness while I was lying on the stretcher, the bright flashing lights falling on my face in the operating theatre and the fact that I will no longer be conscious of what I will be going through was very unsettling.
So, how can we be more humane? I am enumerating 10 steps or that are more of pointers that might help us in our journey to become more humane in our healthcare practice.
First, we should acknowledge the patient’s feelings and emotions. It is easy to say to the patient, “You have to undergo a surgery. The nurse will explain about the formalities”. And you leave the room. But it takes time and effort to acknowledge their feelings and emotions. Only by exhibiting care and concern will we be able to provide the much needed emotional support – which is exactly what the patient needs and what we mostly fail to deliver.
The second step is to show empathy.Empathy is an often-used term, like compassion and kindness. We most often use it without really understanding what this word means.
Empathy is the ability to understand and share the feelings of another person. When we show empathy, we use our intellect to understand the feelings that a fellow human being is going through. However, understanding alone is not empathy. We also use our emotional intelligence to experience within ourselves what the other person is feeling. To do this we need to build a connect with the other person. It is easy to establish a connect with our near and dear ones, but it is difficult to bring ourselves to feel empathy with all our patients.
After all we all are trained to practice detached attachment.
So, how exactly can we empathise with our patient, but don’t allow our emotions to come in the way of our clinical judgment?
This brings me to the third step of humane approach to patient care – compassion.
When we use the word compassion, whom do we think about first? Mother Teresa, right? The lady with the lamp, Florence Nightingale, is another person in our profession whom we can relate to.
So, what exactly is compassion? It is the ability of not only looking at a person’s suffering in terms of their disease or medical condition, but also to be able to appreciate the emotional and psychological needs of the person. We need to be compassionate for a selfish reason too, as it gives us a meaning to our profession, a calling – to heal patients. Being compassionate has also been shown to reduce stress and burnout.
The fourth step is to consider ourselves as a healer and harbinger of hope.
We often criticise traditional healers saying that they are cheating the patients; they are being untruthful. But have you thought why so many patients, especially the ones whom we have given up as “terminal” illness go to these traditional healers? Is it because they offer hope? Even when they know that it is impossible to cure. Are we so much steeped in the scientific method that we are blunt and refuse to entertain any form of hope? I’m not saying that we need not be truthful, but can we try to bring hope even in the midst of extreme suffering and during the end-of-life care?
The fifth step is clear, distraction free and effective communication with all patients. We all know that the best form of communication is active listening. In recent times, technology and the busyness of life has taken away our ability to listen.
So , when we are with a patient, we should get rid of other distractions and with 100% focus, just listen.
The sixth step is to provide holistic care. “Holistic” is another term which is used so often that it loses its meaning. As a surgeon, when I think about holistic care, first I think about pain relief. When I have injured a patient with my incision, it is my responsibility to make sure that I take care of the pain that that the injury has caused. The next is taking care of their food and nutrition and then their emotional and social needs. Nurses, of course are trained more than doctors in holistic care. Holistic nursing is a way of treating and taking care the patient as a whole body which involves physical, social environment, psychological, cultural and religious beliefs.
The seventh step is another medical jargon “patient-centred care”. Yes, it means putting the patient first and in the centre of what we do in the hospital, day in and day out. But do we actually do it? How many times our ego overtakes this principle and we want everything the way we want it to be? Each hospital owner or administrator, unit chief or head wants to put in systems that suit their convenience. In this world of corporate medicine, it is putting the money first and the patient behind. I would like to suggest, it is the art of feeling the pulse of the patient first, not the purse of the patient!
The eight step is being sensitive to the culture, customs and values of the patient and involving the patient’s family in the disease management and decision making. I clearly remember a patient when I was a training, who was of a Christian sect called Jehovah’s witness. He was a young 18-year-old who was involved in a road traffic accident and he was bleeding to death. His family, because of the belief that they will not receive blood transfusion were adamant. I was so angry and upset by this. But then was surprised to find the approach of my consultant, who was so compassionate and took the family through this unfortunate event. Just imagine the feelings of his parents of knowing that their son is going to die but at the same time they are compelled to keep their faith intact.
The ninth step is to guarantee high quality of care, patient safety and continuity of care. To err is human. And in spite of us being cautious, errors happen and patients suffer. It has been estimated at least 300 patients die every day due to various medical errors. Most often these errors are due system faults that allow human mistakes. We should establish quality systems and patient safety protocols. And report errors so that we can learn from these mistakes and try our best to prevent these errors.
We cannot be with our patients 24 hours a day or 7 days a week. So, it is our responsibility to hand over the care of our patients to another healthcare professional and make sure that certain aspects of care do not fall in between the cracks of shift change or when they are transferred from one area to another or from one health care facility to another.
Being selfish is the final step humane approach to patient care. This step is absolutely necessary, if we need to be of maximum use to our patients and to use the humane approach. First, we need to take care of ourselves. Devote enough time to personal health, physical fitness, plan our time to spend enough time with our family and friends and to ensure a healthy work-life balance. We must make time for our professional development to keep our knowledge and skills current so that we are able to give the best possible care to all patients.
On a signing note, I would encourage you to watch this beautiful video made by Cleveland Clinic.