I have to confess that my best answer is: 'No. We cannot guarantee compassionate care. But we can and should do more to make it more likely.'
Some of the things that get in the way of delivering compassionate care – care that involves 'a deep awareness of the suffering of another coupled with the wish to relieve it' – are highlighted in a powerful video interview with Dr Kieran Sweeney, recorded shortly before his death from the asbestos-related cancer mesothelioma in December 2009.
I first had the privilege and pleasure of working with Kieran – a GP and fine medical scholar – at the Commission for Health Improvement ten years ago. Over the years, we became friends as well as colleagues; he was one of our first advisers on the Point of Care programme.
Kieran knew from the moment of diagnosis that he was, in his words, 'a man devoid of hope'. But while there was time, he wanted to communicate widely his reflections on compassionate care, as a health professional committed to compassion-based medicine and as a patient.
In his interview on the E-learning for healthcare website, he talks about something I think of as almost an 'existential' problem dividing health professionals and patients.
'The health care professional,' he says, 'does a job, and for many people this job is pretty mundane. They're doing the same kind of thing to the same kind of people pretty well every day. So for them that activity becomes completely routine. And some days rather dull. For the individual patient it's anything but that. Every individual that comes through a hospital is apprehensive. It's a strange place, you lie in a strange bed, you have strange sheets, you have odd tea in a plastic cup. The whole thing is vibrantly different.'
(I love the detail about sensations – the strange sheets and odd tea. It is so accurate and immediate.)
The existential challenge to 'see the person in the patient' is profound. Nowadays there is a host of imaginative ways to remind staff about what it is like for patients: interviews, films, creative writing, work with actors etc. On the whole, these methods probably work, but for how long?
Somehow, we take it for granted that people who work in health, care about patients. But, frankly, it is likely that health workers are as diverse in their motivations as any other group, and in any case, is it right, or reasonable, given the nature of hospital medicine and the number of patients professionals encounter, to expect them to be sensitive to each and every one? Staff are, after all, 'only human'.
It is precisely because they are 'only human' that I think we need to work harder to understand how to develop, sustain and renew compassionate responses and find systemic solutions.
The Point of Care is piloting Schwartz Rounds® in the UK, which we believe are part of the answer. The Rounds are a monthly multidisciplinary forum for care-givers to discuss the emotional and psychological issues arising from care-giving. They aim to strengthen relationships between patients and caregivers by offering staff an opportunity to reflect together, in a non-judgemental forum, on the nature of their work with patients.
But Schwartz Rounds® alone will not deliver reliable care or guarantee respect and kindness to patients, no matter who is looking after them. The solution to reliability lies with teams and with team working. Teams create compassionate care in the same way that teams create patient safety.
I believe that some of Kieran's painful experiences might not have occurred had all the staff caring for him been encouraged to share their aspirations for patient communication and patient care, and to discuss openly and honestly what they would do – in terms of feedback and mutual support – if, as would inevitably happen, the conduct of a team member fell short of the agreed standard.
I urge you to watch the interview. It is unforgettable, deeply affecting and rewards more than one viewing. If you have more time, you can read the educational resources that accompany it on compassionate care, team working and leadership. It is a good resource, it is free, and it helps to refine our understanding of what gets in the way of compassionate care.
- Read Kieran Sweeney's BMJ article: A patient's journey: Mesothelioma
- More information on our Point of Care programme