COMPASSIONATE CARE
Relationships between medical staff and patients affect outcome: doctor
Five nights into a hospital stay after surgery for a congenital heart condition, Beatrice Liddell was uncomfortable, unable to sleep and, she recalls, “really miserable.”
“It was the middle of the night. I had on a body brace, which I hated. I was just fed up,” says the 28-yearold. A nurse appeared. “She knew there was nothing specifically wrong with me, but she let me explain. She rubbed my back and chatted to me.”
Finally, Liddell, then aged 22, fell asleep. “I was in the same situation, but I felt so much better. I believe it helped me recover.”
It is the kind of anecdote that delights Rana Awdish, an American intensive care doctor whose new book, In Shock: My Journey from Death to Recovery and the Redemptive Power of Hope (St. Martin’s Press, 2017), makes the case for health-care that is as compassionate as it is clinically cutting-edge.
“We have so much to offer now in terms of medical care,” she says. “But if we don’t really know who we are doing it with, are we treating people or just treating disease?”
Compassion and communication — bedside manner, in common parlance — are buzzwords in health care.
During one hospital stay, Liddell recalls that she saw a fellow patient given very bad news, quickly and publicly. “The doctor didn’t even close the curtains,” she says.
“We are at a tipping point,” says Awdish. “The existing system is not sustainable and we are transparent about that. When you distil medicine down to basic elements, you get to relationships. I do believe that affects outcome,” she says. Medical care at its best, she believes, is “a focused, scientific form of empathy.”
The realization that such interventions were needed came to Awdish in the most shocking of circumstances: as she herself lay in an intensive care bed, while doctors — her own colleagues — discussed how to save her life.
In 2008, Awdish, then seven months pregnant with her first child, had been having dinner when a vague, not-quite-right feeling suddenly transformed into “a breathtaking wave of pain.” Within hours she was in emergency surgery, a huge hemorrhage — from a then undiscovered tumour on her liver — having killed her unborn baby and triggered a series of organ failures.
“I heard the team in the corridor saying that I had ‘been trying to die on them,’” she says. Earlier, in the drama of theatre, another doctor had described her as “circling the drain.”
The impact of the way things are said by medical professionals was, Awdish says, something she had not truly considered before. “I thought surviving critical illness was all that mattered. Yet months after I did just that, I was haunted by those doctors’ words. I was having nightmares about drowning.
“I was astonished at how vulnerable I felt as a critically ill patient,” she says. “The senses are awakened in those moments, you are adrenalized and the memories are powerful.
“I was completely dependent, my identity and control gone. How as doctors could we possibly believe we don’t need to build trust?”
Bedside manner, then, is not a woolly, laudable idea, Awdish says — it’s a clinical necessity. “A doctor should not simply be the voice of medicine. We need an authentic partnership between physician and patient.”
In 2013, Chris Pointon and his wife Dr. Kate Granger founded the “Hello My Name Is...” campaign. Granger, a National Health Service consultant in geriatrics in the U.K., was receiving treatment for cancer. “We realized one day that hospital staff weren’t always introducing themselves, and it had a huge impact on us,” says Pointon. “Being given that most personal thing — a name — seemed a simple first step to better relationships and more compassionate care,” says Pointon.
Since Granger died in 2016, Pointon has been invited to hospitals around the country and beyond to share the campaign’s values: effective, personally tailored communication; attention to the little things (“being at eye level with a patient”); seeing patients as individuals and putting them at the centre of every decision.
“Kate and I talked often about making a difference to others. She wanted her legacy to be in better communication,” says Pointon.
The Twitter hashtag #hellomynameis has since been shared nearly two billion times.
“When Kate was first told the cancer had spread, the consultant was holding her hand. He asked if she wanted anyone else there. Then they both sat in silence for a few moments.” In the bleakest of situations, adds Pointon, “it made such a difference”.
For Beatrice Liddell, whose heart condition has necessitated multiple surgeries and ongoing regular medical tests, moments of real understanding and kindness such as this are vital. “They stay with you forever,” she says.