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Posted by on Jul 3, 2012 in Bioethics | 0 comments

Kindness is underrated (03.07.2012)

Kindness is underrated (03.07.2012)

Nowhere is basic human kindness more underrated than in healthcare. I don’t mean that only in terms of kindness towards patients and caregivers, but also towards those for whom healthcare is their calling, their career, their job, or their volunteer work.

I’m certain that others will have different views, will think of other realms in which kindness could make an enormous impact, but I doubt that anyone would view kindness in healthcare as something we should discourage or discount.

As you read on, bear in mind that I’m not saying that those of us in healthcare roles shouldn’t show kindness to patients and caregivers. What I want to highlight here are two different and distinct issues; I view underlying kindness to, and respect of, patients as a foundation of what I write about.

Something I’ve noticed is that there sometimes seems to be a distinct lack of it among – and between – different groups of healthcare professionals. By ‘it’, of course, I mean kindness. And its lack is also glaringly absent in the many ways in which some (hopefully very few) patients and caregivers interact with individuals working in healthcare roles.

My background’s in bioethics, and I’ve worked over the years in several very different types of health-related environments; (group) health insurance consulting, pharmaceutical company administration, university-hospital research centres (for a group of 3 publicly-funded hospitals, in cancer epidemiology and biostatistics), and currently in clinical or medical research ethics (at a research ethics board; called a REB in Canada and an IRB, or independent review board, in the US).

I was also an officer in the Canadian Air Force (Reserve), many years ago, where the emphasis was on teamwork; the attitude there was that each team member brought to the team – as an advantage – their unique experience, perspective, skill set, and training.

When working within the research centre of a group of university hospitals, I saw some of what I called belittling behavior – actions that I’d now call out as bullying. It didn’t happen every day, but often enough that I noticed it as being more frequent than anywhere else I’d worked.

I never saw this within my team of researchers, but rather in clinical care areas. This has hopefully improved; over the past few years I’ve seen a proliferation of articles and opinion pieces stating that – despite past practices or ‘historical traditions’ – it’s simply not acceptable to bully medical students, residents, and others working within the sphere of healthcare.

And earlier this year I read a brilliant book review in the BMJ by Iona Heath, President of the UK’s Royal College of General Practitioners. She discussed a book entitled Intelligent Kindness: Reforming the Culture of Healthcare(1), which I’m planning to acquire when it becomes available in Canada*.

The premise of the book seems to be that the manner in which publicly-funded healthcare systems (the hospitals, health boards, and all the other governmental bodies that administer and oversee the delivery of healthcare) are set up is systemically unkind; that these systems foster unkindness.

Dr. Heath noted that:
“What is really needed, they argue, is a culture of kindness throughout the organisation, against which proposals for change would be evaluated and within which the real difficulties faced by front line staff would be acknowledged rather than denied. The priority of everyone involved would be to “help front line staff to help patients.”

“Such a culture of kindness would play out in encouragement, support, and the celebration of achievements rather than the current obsession with condemnation and rooting out poor practice. Staff should be given the space and stature to take pride in their work, not forever feeling the dead hand of inspection and regulation.”(2)

What I haven’t seen are similar articles or opinion pieces about the unkindness shown to (or downright bullying of) healthcare professionals – by patients. What I have seen, even at the group family medicine practice of my very kind physician, are patients who demonstrate abusive and bullying behaviour towards both administrative staff and healthcare professionals.

There may be an attitude of “Oh dear, that patient must be having a very bad day”, because I’ve never seen such behaviour being called out. Of course, it’s possible that comments are made to the patient in the privacy of a consultation room, but I’m unsure how often the patient’s own physician is even made aware of this kind of behaviour or outburst within a fast-paced clinic environment.

On several occasions I’ve intervened, and tried to calm a patient (for example by saying quietly: “My mom’s waiting here for a follow-up appointment after a heart attack, and she’s supposed to stay calm. The yelling is upsetting her. Can you please lower your voice?”).

The folks working at the front desk invariably thank me, seeming surprised and genuinely appreciative that someone had stood up for them. But there are times, especially in larger clinics and hospitals, when I don’t feel comfortable intervening when this type of situation occurs.

I was recently at a small, but very busy, suburban specialist clinic in an office-type building. I’d brought my mother in for an appointment with one of her multiple physicians, and there seemed to be 6 or 7 other specialist clinicians seeing patients there that day.

As we were sitting in the waiting room, I heard a middle-aged patient begin to yell – with some profanity – at a nurse who’d come out from the clinic area to speak with the receptionist at the front desk. Really yell. I don’t mean a raised voice; I mean they could probably hear him on the next floor. His complaint seemed to be that his appointment was at 1115, it was now 1135 and he was still waiting, and he had to be at a restaurant down the street – for a lunch – at noon.

What happened? Did someone from inside the clinic proper come out, and tell this patient that his behaviour wasn’t acceptable? Did they politely ask him to leave? No. The nurse – who seemed to be a decade older than this patient – stood there for what seemed to be a minute or two, being yelled at by this irate patient, before turning to walk back through the door leading to the consultation rooms down the hall.

My mother found out a few weeks later that the nurse had tendered her retirement letter right after that incident. She’d lost her husband suddenly several months earlier, and had just returned to work after treatment for a depression. She wanted to keep working, and viewed nursing as her calling, but felt that she could no longer deal with this type of aggressive, demanding, and unkind encounters – with patients.

Think about that for a minute. It’s okay, I’ll wait. Perhaps you could reread that last paragraph, imagining yourself as the nurse. Then consider that a recent study found that nurses are 50% more likely – two times as likely – to suffer from depression than… everyone else.(3) The same would likely be true of physicians, although I’ve been unable to locate research on that point.

The next time you’re a patient or a caregiver, spare a thought for the person who’s trying to help you; try to muster up a smile, a kind word, even just a thank you. You never know how much of a positive impact a small display of kindness might have on them, and I think we can safely assume that they don’t see nearly enough of it.

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The image is a quotation from Étienne de Grelet, known also as Stephen Grelet, who lived in the 1700s & early 1800s. There are numerous variations of the statement, but the sentiment is as valid now as it was then. It’s what I adopted as my personal motto a number of years ago, in my teens, which I strive to live up to each day:

Etienne de Grelet (Stephen Grellet); 1773-1855

 

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(1) Ballatt, John & Campling, Penelope. Intelligent Kindness: Reforming the Culture of Healthcare. RCPsych Publications; Jun 2011.
http://www.rcpsych.ac.uk/usefulresources/publications/books/rcpp/9781908020048.aspx

(2) Heath, Iona. Kindness in healthcare: what goes around. BMJ 2012; 344: e1171 22 Feb 2012.
http://www.bmj.com/content/bmj/344/bmj.e1171.full.pdf
http://www.bmj.com/content/344/bmj.e1171

(3) Robert Wood Johnson Foundation. INQRI Study: Nurses Experience Depression at Twice the Rate of General Public. Web page; 25 Jul 2012.
http://www.rwjf.org/en/library/articles-and-news/2012/07/inqri-study–nurses-experience-depression-at-twice-the-rate-of-g.html

*September 2017 update; I finally found & ordered the book on-line!

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