Does it matter, if your doctor knows anything more about you than your date of birth, NHS number, gender and medical condition?
A 50-year-old male with lung cancer
Mike, a 50-year-old father of three, youngest of four, painter and decorator, who has lived all his life in Doncaster, likes going to the movies and ballroom dancing – has lung cancer.
The first tells you what is wrong, it is concise, to the point, doesn’t mess about, doesn’t introduce emotions, and is unbiased clinical information.
Does the second tell you anything more that is relevant – does this influence how you approach the patient, Mike?
I have, over the years both been involved in and observed conversations between, usually, nurses and doctors, where the nurse has seen the patient, has been at their bed-side, felt their pulse, spoken with their relatives, seen the cracked skin of their lips, and the other, is somewhere else in the hospital.
Usually the former is on the phone, asking for help from the latter – ‘Please come and see Mr Grey, he has terrible pain in his abdomen,’ or, ‘Charlotte P. is very short of breath, I am worried she might deteriorate.’
These conversations can go one of two ways – either the doctor will respond, ‘OK, I am on my way,’ inferring from the tone of voice, the urgency of speech that their help is needed now, or, there will be a prolonged discussion reviewing the clinical minutiae of the ‘case’ – how far they can walk, how many pills they take, their blood pressure, sodium level, number of carers, etc. (All the time the nurse or junior doctor screaming in their head,’for goodness sakes, just come and see my patient!’)
It is this conversation, the latter which is medicine as science, cold to the touch, whereas the former, is medicine that is person-centred, where there is a person and people in the room and that person and those people are what matter.
In recent years, ‘SBAR’ has come into use in hospitals, based on a system used in the military, SBAR is the accepted means of communication between staff – it stands for ‘Situation, Background, Assessment and Recommendation’ – it is meant to take the subjectivity out of communication. In my experience, it often fails, breaks-down under the pressure of person-centred experience.
How do we make sure that all patients are seen as people, with more information provided to those nurses and doctors who are providing the care? How can we change a 98 year old with pneumonia into a person, how can we sketch, add layers of detail that establish the place of this person in the clinical stratosphere? How can I convey their humanity?
We stop talking about patients and we begin talking about people, we can add layers of personality, of past and present, to the data, the numbers and medicines, we create a tapestry that seeks to reflect some of the richness of the people we are supporting; elevating people, and person-centred care to a level that is equal to that of the science, the technology, third decimal point and the double-blind studies.
Suddenly people appear and caring increases.