PATIENCE WITH HER PATIENTS

Dr Himali McInnes has learned to challenge her biases and judgements about patients and to better understand innate inequalities, leading to a more holistic model of care.

If there’s one thing that Dr Himali McInnes has learned throughout her career as a doctor, it’s that kindness and compassion can be just as important as knowledge and skill. This holistic view of medicine is at the centre of her book, The Unexpected Patient, where she recounts “Kiwi stories of life, death and unforgettable clinical cases” from different health professionals and their patients. There’s a story of an old man in hospital who was labelled a ‘grump’ by the nurses, but as it turns out, was harbouring a deep worry about the young grandson under his care.

Another tale about the complexities of the prison system is told by a trauma therapist who has their own story of trauma. One moving story tells of a Christchurch mosque attack victim’s enduring resilience in the face of life-changing injury, and the impact he had on his rehabilitation specialist.

These stories, McInnes explains, demonstrate the unseen factors that feed into our health. “We’re not just a body that needs fixing. It’s all those things – how we feel, our relationships, our whānau – all of that. We don’t just exist in isolation,” says the Auckland-based doctor. “It seems so obvious, but we don’t think about it sometimes, especially in hospital medicine. I remember how we would just compartmentalise everybody.”

Those unseen factors can apply to doctors as well, something McInnes explores in her own essay about a Māori patient struggling with addiction, whom she later learned had suffered sexual trauma as a child. The experience led her to learn more about the lasting impacts of colonisation and confront her own privilege. “Before that interaction, I had a very superficial understanding of human nature. I’d think, ‘Why are people addicted to stuff’? ‘Why can’t they change?’”

Born in Sri Lanka, McInnes’ parents moved their family to Malaysia when she was one, due to the unstable political situation that was edging towards a civil war. Malaysia was seeing a growing economy, and McInnes’ parents – her father an accountant, her mother a doctor – found a good life for their family, later sending McInnes and her brother to university in New Zealand.

“With my upbringing of quite a lot of privilege and safety, it seemed easy to change. But actually, change is not easy. And especially when you’ve had trauma, addiction becomes a difficult thing to shake.”

In the book, she ponders her own biases that developed early in her career as a doctor. “There was a vivid perception among many of us that Māori patients were ‘difficult’ ... Were those patients actually hostile or were they simply unwell? Were they acting defensively because of previous poor medical treatment? Were there in fact many Māori patients who were perfectly lovely to deal with, but I only noticed those who fitted my preconceived bias?”

After working in South Auckland and reading up on the history of colonisation in New Zealand, McInnes had her eyes opened to the systemic inequalities that feed into people’s health. She saw firsthand how during the 2016 housing crisis a lot of her patients had to sleep in their cars and were presenting with chest and breathing problems, what she describes as “physical repercussions of economic deprivation”. She says: “Now, when I encounter someone who’s ‘difficult’, I always say, there’s a reason why they’re being difficult. They’re doing it because they hurt. You realise there are other reasons – they may have a sick child at home, or their business is not doing well – those behaviours don’t exist in isolation.”

Another eye-opening experience has been her work as a doctor in prisons. “I started about three years ago. Initially I was quite nervous,” she says. “But actually what I found in prison is that the people are really nice. Some of them can be difficult, but then again, when someone is being difficult and you ask them about their past history, they’ve almost always experienced sexual abuse, domestic violence or parents with mental health issues.”

In fact, a 2015 Department of Corrections study of 1200 New Zealand prisoners found that 91 per cent of prisoners surveyed had a lifetime diagnosis of a mental health or a substance abuse disorder. “When you look into the science of it, you realise that people’s brains are changed by these [traumatic] events when they’re children. If you’ve had a stable, safe upbringing, you’re likely to have a healthy brain. If you haven’t, you can have a brain that’s shrunken in certain parts, dysfunctional in other parts. Then that plays out in the way we behave.”

These interactions with prisoners have taught McInnes the value of a holistic and open-minded approach to healthcare. “It’s not hard to be kind. And it really does open up the interaction. I often think, ‘They’re not bad people. They’re people who are hurting. I know it is a balance between having some sort of deterrent towards crime and having restoration, but I would love a lot more restoration to be happening, as well as prevention ... preventing children falling through the cracks because their parents have had a hard time.”

Dr Himali McInnes will be speaking at the 2022 Aotearoa New Zealand Festival of the Arts in Wellington on 26 February. Visit festival.nz

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“WE’RE NOT JUST A BODY THAT NEEDS FIXING.”

At a time when people are suffering from the effects of fear and hate, we talk to experts on the virtues of kindness. mindfood.com/kindness-experts