Person-Centred Care – Why? Why not?

Now. Get serious. This is a thing – no longer a joke.

Scrub hands thoroughly, sterile gloves, prepare the skin; spritz of iodine and we are off; scalpel, blood vessels and threat; anatomy, physiology and biology – one giant balanced on top of another. Skill. Perfection. Precision, dexterity and commitment. No go o’er.

Admiring looks, aura. Passion. Dedication. Commitment.

In the world of medicine there are two sides to every intervention – the technical; the years of preparation and training, textbooks and articles, lectures, seminars and courses. The work.

And, on the flip-side, the non-technical, human factors. What distinguishes our performance from that of a robot or machine? The ability to sense the concern of another, to empathise, perceive and listen, to combine the talents of a team into an output that is greater than the ability of one.

To and fro, there is a pendulum swinging in every treatment, interaction or therapy. This is why doctor Google can only go so far, why for all the brilliance of computers at interpreting data, analysing patterns and signals, the humans still have a role.

And nowhere more than during a clinical encounter.

When doctor or nurse meets patient; when support is sought, an answer, and the other, healer; doyen of experience and knowledge assumes the burden of care.

There is a sense, in some circles, that all you need is the technical; without dexterity the procedure will fail, the anastomosis disjoin or the graft dissemble. And, sure, the incision must be exact, the aliquots just right to provide an accurate intervention, diagnosis or treatment.

Medicine is not a game. It is the most serious profession. Life and death.

And, yet.

And, yet, there is so much more than the technical, so much to understand that creates a meaningful experience for doctor and patient. It is not enough to hear the symptoms – they must also be interpreted, for content as well as context and emotion, the signs must be understood from the perspective of an individual’s world.

Without this, life-saving can be life-taking.

Without autonomy, the ability to control our lives, we become lesser, inferior – subjects who are processed by a medical machine, that doesn’t spit-out sausages, but might just as well.

An operation that is not wanted but perfect in commission is a failure; a drug that prolongs life and does not extend happiness or meaning – if the hours of our life are spent at the beck and call of a colostomy that horrifies or an amputation that diminishes the person physically and spiritually, we haven’t achieved our goal.

The technical is finite, the person, their wishes, hopes and ideas are infinite. The team, the dream collective is limitless.

The lessons begin in medical and nursing school; bright, young things are told to look-out for the signs and symptoms that will reveal disease, the rash, the limp or pattern of behaviour. Willingly, they are led on a dance macabre, imagining themselves Sherlocks in a world of diagnostic mystery and intrigue.

The battle is fought on uneven ground. The technology – dashboard, numerical indices of good and bad, molecular biology and evidence-based medicine are entangled in a mesmerising blend of future possibilities – a pill for this, a procedure for that.

The attraction of the physical tends to lure some into a notion that so long as mastery is achieved, whether though 10,000 hours of repetition or Xx digital algorithms whirring away, we can find the answer to everything.

Not realising that when you have infinities, that is, the people who are our patients, there can never be any solution, chemical or process that is intelligent enough to overcome all feeling or emotion.

It all returns to the person.

Medicine is heavily dependent on engineering, technology and analysis to achieve the breakthroughs that have been a theme of modern medicine; the life prolongation and disease modification which to some are still impenetrable.

We must embrace the blend.

Too much of one, without the other, results in imbalance.

We need the person. We need to consider the people and simultaneously juggle the technology. One informs the other.

So, don’t tell me you know what you are doing and you don’t need to listen to the ideas of others, to consider the emotions or feelings of your team, pretending it is OK to adopt a position of all-knowing when, all-knowing is a conceit, a deception & really today, that is now, the only way to solve problems, to treat, care or support, is through collaboration, through support, through respect and commonality. Not, going alone, but together, realising that humility is more powerful than arrogance or mockery, and, joking aside, this stuff is serious, not appropriate for an off-hand comment or jibe. This is beyond life and death, this is forever, this is endless and you and I are merely blips in the procession, let us never get too high or above our pedestal, let us not make-believe that yin and yang interpretations are adequate to carry us through. We need more, and more can only be got through listening, hand-holding, eye-contact, smiling, humour – not mockery, empathy, not condescension; allowing ourselves to be vulnerable and having adequate faith in those around us to know that they won’t take advantage the moment our back is turned, knowing that towering over all competition or greed or avarice is togetherness.

Person-Centred Care.

You care for the person. The person comes first. Not the investigation, diagnosis or treatment. We serve. We obey. We follow.

Together.

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3 thoughts on “Person-Centred Care – Why? Why not?

  1. Spot on Rod. Your last couple of blogs have really struck a chord. 91 year old father several weeks into a hospital stay after an unresponsive episode at home. Once you are on that diagnostic pathway it’s so hard to get off. They are a long way off from being ready to embrace “What matters to you” so instead we keep asking “what are we trying to achieve?”

    Liked by 1 person

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