"Why did you leave him there for five hours? Admitted straight from diabetic clinic to A&E, unwell. Why not straight to a ward instead of hours waiting 'to be clerked'? The tea lady was nice, simple but caring. Her BMI was no example of 'health'. She looked cuddly though, in her ill fitting uniform. She remained oblivious to time-scales and targets. She dutifully, but kindly, offered us tea every hour or so. No one else acknowledged us.
He is diabetic y'know. He took his insulin at 5pm and was not given any food - hypo ahead. He cannot hold his neck up in this seated position for much longer, he has cervical spondylosis too. You have made him sit on the A&E trolley for 5 hours.
I can see you are busy. He is in too much pain. I can't watch this.
We weighed up the situation. We decided that being at home is better than this, despite his eGFR (kidney function) being in his boots. We walked out of the department. No one noticed....except for the tea lady. You could see the anguish in her face. She felt powerless to do anything, she tried to tell someone...everyone was too busy.
She was not powerless...her compassion had power."
This incident broke my heart. It was a defining evening in October 2012. I am blessed that my father is still alive, but the realisation that doctors and nurses are too busy to care drove me to want to be part of a solution...not part of the problem. I work for the NHS, I have to take some responsibility for this event.
"The only thing necessary for the triumph [of evil] is for good men to do nothing." (E Burke)
I realise I have made a big generalisation, apologies to those who strive to hold on to the values that compelled them to work in the "caring" profession.
Earlier this year we were shocked and saddened by the stories of neglect and poor care described in the Francis report. What is happening? Compassion fatigue?
Compassion costs nothing
On the 25th April I attended an RCGP Midland conference called " Compassion in Healthcare". I heard Prof David Haslam speak of a deterioration due to 'task based care' versus 'person centred care'. He spoke of the barriers to compassionate care e.g. busy-ness, lack of continuity, lack of a sense of personal responsibility. He went on to suggest what we could do about it:
- Value compassion
- Review criteria for medical school recruitment
- Value the role of the Generalist
- Appreciate each other - the way we treat each other matters
Everything he was saying made absolute sense. Interestingly, in a workshop, one doctor said that he has not got time for compassion in the ten minute consultation. I can see where he was coming from as I think he was alluding the the time pressure and being 'busy', but I was not in agreement. Earlier in the week I had an interesting conversation with Kevin Ilsley about the impact one can make in ten minutes. Clinicians are often not aware that in ten minutes you could change someone's life...by inspiring them, by empowering them, by being kind to them, by offering a solution. On the flip side it takes less than ten minutes to break someone's trust and lose them for life.
Jill Fraser gave a very sincere, high speed talk on the charity Kissing it better. She entertained us with the ridiculous levels of bureaucracy standing in the way of 'greater good'. Admirable and Simple interventions.
The short narrative at the top of this post was written as part of a workshop by Katherine King and Kevin Ilsley. I had never written down the incident before. We were asked to narrate an incidence where compassion was lacking. In writing it down it made me think about how to use words to convey feelings and context. Most of us don't really get the chance to do this kind of thing.
"For the professionals, storytelling and hearing has some particularly important roles to play in helping us to understand our clients and in helping us to explore our own practice. These stories that we tell and hear, but which, at the same time we are also part of. And we learn early in professional practice, if not early in our life, that there is always more than one version of a story. This, of course can be turned to positive use in trying to understand something through a story. And one of those things that we can learn to understand better is the art of storytelling itself"
Fish.D 1998 Appreciating Practice in the Caring Professions p154
Stories can be entertaining, shocking, untrue and there is often much to disentangle. De Cossart and Fish - Developing the wise doctor (2011) state that doctors have to make sense of individual accounts of patients or colleagues, in a world of complexity, paradox and ambiguity, above all else, stories:
- Exist in the particular ( they are about individuals)
- Highlight the importance of moral enquiry (they show the importance of seeking in the given case what the most opportune action might be)
- Promote the pursuit of practical reasoning - 'the ability to determine the best action to take in particular circumstances that cannot be distilled into universally applicable solutions'.
I find the latter point most interesting. De Cossart and Fish cite Montgomery (2006) for the quote. This, to me sounds like Aristotle's concept of Phronesis - Practical Wisdom.....a subject I am sure to mention again, as it forms the basis of my PhD.
Storytelling need not be in the form we traditionally associate it with. Dr Anne Marie Cunningham (who writes a good blog and is very much engaged in technologies and Medical Education) brought my attention to the potential of digital storytelling and it's ability to help students to reflect. I have to admit that I love watching the RSA Animate videos on YouTube. I had not thought of it as digital storytelling!
Storytelling need not be in the form we traditionally associate it with. Dr Anne Marie Cunningham (who writes a good blog and is very much engaged in technologies and Medical Education) brought my attention to the potential of digital storytelling and it's ability to help students to reflect. I have to admit that I love watching the RSA Animate videos on YouTube. I had not thought of it as digital storytelling!
One final thing I wanted to mention is Storytelling in Leadership. I am coming across an increasing amount of information referring to the power of the art of storytelling in leadership. There are even courses at top universities e.g "Winning Hearts and Minds - Storytelling for professional managers" - Cranfield Business School. The hyper-links are from Forbes magazine and Harvard Business School, respectively.
I certainly think there is room, for those of us who were pummelled with years of bio-medical and clinical education, to revisit the art of telling, and interpreting tales.
Tell me a fact and I'll learn. Tell me a truth and I'll believe. But tell me a story and it will live in my heart forever. ~ Indian proverb
