I was speaking with a friend today who is scheduled to have surgery next week. She is a medical professional who has been a home care nurse for much of her career. Over the years, she has tended to patients who are in vulnerable states, due to surgery, illness and advanced age. With compassion and skills developed over decades, she has provided hands- on care and education for them and their families.
In a pre-surgical consult, she was telling the Physician Assistant that she was frightened and wanted assurance that they would take good care of her. Tearful, she told the PA that she has seen the profession fail her patients and sometimes even herself. The woman seemed ill at ease with her show of emotion, even as my friend explained that it wasn’t something taught in her own medical training way back when; the idea that patients are more than a conglomeration of body parts that require treatment. They are vulnerable human beings with needs, expecations and trepidation about the outcome of procedures. The PA attempted an empathetic response, but she seemed at a loss. When the doc came in, she asked for a hug from him. Not sure if he gave her one, but I imagine it would have helped if he did.
In the 1980’s I worked for Hahnemann Hospital in Philadelphia in a program called GTA (Gynecologic Teaching Associates). A well trained group of women’s health educators were on our team. Our role was to be practice patients for second year medical students and to teach them communication skills to put to use with actual patients once they graduated. Part of the curriculum was informing the person on the table what was going to happen beforehand and discussing the outcome of the exam once she was fully clothed and in a chair, rather than exposed, with her legs in stirrups. Another was not assuming that the patient was heterosexual and had only male partners. They were called on to be better versed about sexuality and all it implies. I don’t recall back then, the topic of transgender patients being raised. Today, that would certainly be a subject to be aware of.
One conversation stood out for me. A female student who was likely in her early 20’s told us that she had never seen a gynecologist, since she was too uncomfortable and embarressed to have an exam. What we were doing was an antidote to that for future patients, she assured us.
One of my favorite movies is called The Doctor, based on Dr. Edward Rosenbaum‘s 1988 book, A Taste Of My Own Medicine. With a stellar ensemble cast, it includes William Hurt, Mandy Patinkin, Christine Lahti, Adam Arkin and Elizabeth Perkins. Hurt, in the title role, plays an erstwhile successful surgeon whose personal life is in need of serious rescusitation. It is when his world is turned upside down by a diagnosis of throat cancer that he gets a first hand experience of being on the other side of the operating table. By the end of the film, he becomes a patient advocate who educates his medical students about complete body, mind and spirit care.
A few years ago, I recall a Naturopathic doctor friend telling me about what is called The Mother Standard of Care; a phrase that was coined by Richard Stephenson who founded Cancer Treatment Centers of America. The idea is that all patients be treated the way they would want their own mama treated. I added, tongue in cheek, “That is, if you like your mother.”
The same concept holds true for the psychotherapeutic profession. When I counsel clients, I imagine how I would want to be treated or would want a family member cared for. Empathy was part and parcel of my social work training, with the idea of ‘start where they are,’ and focus on strengths and not just vulnerabilities of the client.
How Do Patients Benefit From Compassionate Care?
In a study conducted by Stephen G. Post PhD, called “Compassionate care enhancement: benefits and outcomes,” the consensus was, “compassionate care benefits patients with regard to elected treatment adherence, wound healing, satisfaction and well-being; it benefits physicians with regard to lowered depression rates, elevated meaning, lower burnout, and more diligent technical care; it benefits healthcare systems that establish reputational gains at no greater use of time or resources; it benefits medical students with regard to their diminished complaints of abusive clinical environments and maladaptive team interactions. There is no doubt that compassionate care has many dimensions of beneficial impact.”
From first hand experience as a cardiac patient, I can say definitively that when my total wellbeing was taken into consideration, my recovery time was hastened. As a clinician, I was able to advocate for myself and knew what questions to ask. For those who may not have that opportunity, it would be beneficial to make a list of questions about tests, procedures, prognosis and outcomes. When you are sitting in the professional office, have someone by your side to take notes, if possible or record them yourself, if that isn’t feasible. Although it can be intimidating to ask, remember that you have hired the professional to oversee your needs and have every right to anticipate high quality care. Eye contact, respect, direct answers to your concerns, follow up, caring and compassionate bedside manner, are all important aspects of your treatment.
I was introduced to the pioneering work of Bernie Siegel, MD in the 1980’s via his book called Love, Medicine and Miracles in which he espouses the idea of teamwork between medical professional and patient. Outcomes are greatly improved and quality of life enhanced when patients feel empowered to speak up and take on a partnership role with their care team. His work has stood the test of time as he encourages those who seek medical guidance to be self expressed.
Patient Centered Care is Crucial
The IOM (Institute of Medicine) defines patient-centered care as: “Providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions.”
Although the traditional protocol set the stage for a barrier between patient and treatment professional, the walls are coming down and patients are encouraged to express their needs. What many patients desire is a compassionate and caring relationship, that they are understood and that their doctor is willing to listen with an open mind and open heart.
I would venture a guess that my nurse friend wants that too. It will ease the way between now and her surgery next week and speed up her recovery time as well.
Photo by matrianklw