R-E-S-P-E-C-T

Remember the song?

From The Blues Brothers.

Aretha Franklin in the diner.

Respect is odd.

Lots of people over the years have died because of either perceived or actual

lack of respect.

Back in the day,

If you met someone of higher status

In China,

You were expected to kowtow to them.

This is literally

Get on your knees and bow, demonstrating your subservience.

There were issues at the time of the Empire

Pushing opium

Where moustachioed Victorians would not oblige

Much unhappiness ensued.

And, on the street.

Gang member to homie to whatever term is used nowadays,

Not doffing the cap

or backing down

or averting the eyes

leads to

stabbing

or gunshot.

And, yes, our patients,

How do we respect them?

How do we demonstrate our appreciation of their humanity?

Or, is the process one-way?

I am always very conscious when I speak with a patient

Whether I call them

Mr Cohen

Or Albert

Mrs Shleperstein

Or Gloria.

Usually,

Actually, always, when I use the first name, and I accidentally say, Dr Kersh, I always follow-up with, Rod Kersh, the doctor from… More often if I call them by their first name, I will purposefully, if they know me, say, ‘It’s Rod Kersh,’ If they don’t, ‘It’s Rod Kersh, doctor from…)

Anyway.

My plan is to offer respect to the patient and almost always they return it.

Nothing more and nothing less.

Occasionally I am treated with suspicion, particularly if I am cold-calling someone to talk about their raised blood pressure – it is hard to disentangle the genuine from the fraudsters and payday loan sharks.

And, respect.

I see you, you see me. Remember Avatar?

Yet, how often does this fragment, dissemble?

On Friday I gave an international lecture to nursing students.

Sounds grand, eh?

I was talking to a class at the University of the Highlands and Islands. Based in Inverness.

The discussion focused (or should or was meant to) on dementia. Yes, I did cover the relevant components although every slide or two, I returned to person-centred care (PCC).

At the start, I asked the group of a 100-odd Mhari’s, Catriona’s, Angus’s and Colins, whether they had heard of PCC. There was an impressively positive reply. (10 years ago, this would not have happened), so, yes, a move in the right direction. And yet, I kept returning to this. The focus of seeing a patient as a person. Not just a person, a person then a patient, an individual then a disease, Rod or Tom or Fred then the Asthma. Not the demented Gloria, and not even, Gloria the dementia sufferer, Gloria who has dementia.

The talk veered into Stoicism.

Greek and Roman.

The obstacle is the way and that kind of thing.

Why people living with dementia prefer this to ‘suffering.’

Funnily, 10 or so years ago, I wrote a dementia strategy for Doncaster Hospital which was lauded at the time.

In an early draft, demonstrating my ignorance, I used the ‘suffering’.

My friend Wayne Goddard aka Peter Kay, put me right.

He didn’t explain why, but it made sense.

Only more recently have I understood the deeper meaning.

Which is, that suffering is a choice.

So, says Epictetus.

We do not suffer externally. It may be cold (the water), there may be pain or discomfort; the experience is however internal, it is what we do with the experience that matters.

The same stimulus in different circumstances can yield different perceptions.

Sunlight can be great, to the same person with a migraine, hell.

The world is what you make it. Our perceptions create everything. Suffering is a choice. You can live with dementia, even when the disease eats-away at you, nibbles your personality, your good humour, your sense of self. Suffering must not and should not be imposed.

And that is the living. That is why we, the doctors, nurses, brothers and sisters are in a position to support the person with dementia or cancer or lung disease; we can enable them to live with their condition, to understand that they are themselves and most of who they are is them, the disease is a component, it may be continuously expanding its influence, but with support, they can continue to shine, to be, until the end and, even afterwards, the focus can be on the person’s 85 good years before the dementia, not the awful three or four last.

And back to respect.

There is a common phenomenon in healthcare where those living with dementia are perceived as lesser, not quite whole. Perhaps the thought by the doctor or nurse that the disease is the person, not a part of the individual and with this notion passes respect, passes the niceties of human interaction, respect, the waiting to hear what another has to say before expressing your opinion, the decision to act without sharing, the notion, ‘They have dementia, they have broken their hip, demented (people/zombies/others) don’t feel pain they say, and yes, they have not said they are in pain, here, give them a couple of Annadin’ (You or I would be screaming for morphine).

Older people frequently, even without the label of a life-limiting disease, are offered less respect than others, than the young, the working-age. Because of their immobility, hearing, or visual impairment they are considered lesser and the shared decision making that should be core to every clinical (and human) interaction is removed; Let’s move Ralph (dementia, 89) to ward A, then, B, then C (he won’t know/complain, then, let’s send him to care home D. Don’t worry, you don’t need to tell or ask him, he has dementia, he wouldn’t understand or know the difference.

He is, not quite human is what is being expressed.

A rephrasing of human all too human.

Not quite human.

And back to respect.

Without respect we have little.

We are molecules random in Brownian motion.

We are scattergun.

The purpose and meaning of our actions are diminished.

Today we should not have to sing about r-e-s-p-e-c-t, it should be a given. We know and understand enough about what works and what does not. We know that disempowering a person is harmful to their ego, is damaging to their sense of self, has adverse outcomes, makes a person depressed and anxious, reduces their white cell count – forces them into themselves and away from recovery.

Respect.

It’s all about respect.

Without respect we are lost.

With respect we can aspire to greater things.

With a notion of equality, we don’t have men inflicting violence on women and consequently other men (the former almost aways comes first).

In a health or social care system that views people as equals, regardless of their protected characteristics or those which aren’t protected (he’s just got wax in his ears, he is not hearing impaired; we don’t need to adapt to accommodate) we have some hope, without we will fail.