Like many of the rapid responses already posted, I was moved by
the wonderful article by Chochinov on dignity and the essence of medicine
[1]. As the rapid response letter by Tait points out , the ABCD framework
of dignity conserving care proposed by Chochinov applies not only to
doctors working in terminal care, but to all doctors, and indeed all who
work in the caring professions. Given the current focus on biomedical and
technical approaches to illness rather than the core values of kindness,
humanity and respect, Chochinov's analysis is a timely reminder of the
key importance of what Hart and Dieppe described as caring effects in
medicine in their essay in the Lancet in 1996 [2].
Even in the growing field of patient engagement, the emphasis
often appears to be on technical fixes or information sharing [3]
rather than the fundamental problem of the separation of humanity and
compassion from health care delivery [1]. Wilson's rapid response
reminds us that revalidation of doctors bring both challenges and
opportunities and raises the issue of measurement of the human aspects of
care. Similarly, for doctors in training in the UK, sensitive and reliable
ways of measuring and improving caring effects are now required for
workplace-based assessment.
Over recent years, myself and colleagues have developed and validated
a patient feedback measure called the Consultation and Relational Empathy
(CARE ) Measure, based on a theoretical framework of empathy in the
clinical setting and heavily informed by the views of patients from across
the socio-economic spectrum [4,5]. The validity and reliability of the
measure is high in primary care [6] and we have now similarly robust and
soon to be published findings in general practice registrars, and doctors
in a range of secondary care settings including anaesthetics, medicine,
and surgery. The ability of the measure to reliably discriminate between
doctors (using G-Theory) in all these settings is high, with a feasible
number of patients required per doctor (typically 20-30 patients to
achieve an inter-rater reliability of 0.7 and 40-50 to achieve a
reliability of 0.8). Further research is underway to assess the best way
of feeding back scores and giving support to doctors in order to help
enhance communication and empathy skills. Used wisely, the CARE Measure
may be a useful way for doctors to self-monitor caring effects and to
evaluate the effectiveness of activities aimed at restoring and/or
improving the human aspects of care.
[1] Chochinov H. Dignity and the essence of medicine: the A,B,C, and
D of dignity conserving care. BMJ 2007, 335: 184-187
[2] Hart JT and Dieppe P. Caring effects. The Lancet 1996, 347: 1606-
1608
[3] Coulter A and Ellins J. Effectiveness of strategies for
informing, educating, and involving patients. BMJ 2007, 335: 24-27
[4] Mercer SW, Reynolds WJ. Empathy and quality of care. Br J Gen
Pract 2002; 52: S9-13
[5] Mercer SW, Maxwell M, Heaney D, Watt GC. The consultation and
relational empathy (CARE) measure: development and preliminary validation
and reliability of an empathy-based consultation process Measure. Fam Prac
2004; 21: 1-6
[6] Mercer SW, McConnachie A, Maxwell M, Heaney D, Watt GC. Relevance
and practical use of the Consultation and Relational Empathy (CARE)
Measure in general practice. Fam Prac 2005; 22: 328-334
Stewart Mercer
Senior Clinical Research Fellow
Section of General Practice and Primary Care,
University of Glasgow,
Glasgow G12 9LX
Scotland, UK
Current address:
Visiting Professor in Primary Care Research,
School of Public Health,
Chinese University of Hong Kong
Rapid Response:
Measuring the human aspects of care in medicine
Like many of the rapid responses already posted, I was moved by
the wonderful article by Chochinov on dignity and the essence of medicine
[1]. As the rapid response letter by Tait points out , the ABCD framework
of dignity conserving care proposed by Chochinov applies not only to
doctors working in terminal care, but to all doctors, and indeed all who
work in the caring professions. Given the current focus on biomedical and
technical approaches to illness rather than the core values of kindness,
humanity and respect, Chochinov's analysis is a timely reminder of the
key importance of what Hart and Dieppe described as caring effects in
medicine in their essay in the Lancet in 1996 [2].
Even in the growing field of patient engagement, the emphasis
often appears to be on technical fixes or information sharing [3]
rather than the fundamental problem of the separation of humanity and
compassion from health care delivery [1]. Wilson's rapid response
reminds us that revalidation of doctors bring both challenges and
opportunities and raises the issue of measurement of the human aspects of
care. Similarly, for doctors in training in the UK, sensitive and reliable
ways of measuring and improving caring effects are now required for
workplace-based assessment.
Over recent years, myself and colleagues have developed and validated
a patient feedback measure called the Consultation and Relational Empathy
(CARE ) Measure, based on a theoretical framework of empathy in the
clinical setting and heavily informed by the views of patients from across
the socio-economic spectrum [4,5]. The validity and reliability of the
measure is high in primary care [6] and we have now similarly robust and
soon to be published findings in general practice registrars, and doctors
in a range of secondary care settings including anaesthetics, medicine,
and surgery. The ability of the measure to reliably discriminate between
doctors (using G-Theory) in all these settings is high, with a feasible
number of patients required per doctor (typically 20-30 patients to
achieve an inter-rater reliability of 0.7 and 40-50 to achieve a
reliability of 0.8). Further research is underway to assess the best way
of feeding back scores and giving support to doctors in order to help
enhance communication and empathy skills. Used wisely, the CARE Measure
may be a useful way for doctors to self-monitor caring effects and to
evaluate the effectiveness of activities aimed at restoring and/or
improving the human aspects of care.
[1] Chochinov H. Dignity and the essence of medicine: the A,B,C, and
D of dignity conserving care. BMJ 2007, 335: 184-187
[2] Hart JT and Dieppe P. Caring effects. The Lancet 1996, 347: 1606-
1608
[3] Coulter A and Ellins J. Effectiveness of strategies for
informing, educating, and involving patients. BMJ 2007, 335: 24-27
[4] Mercer SW, Reynolds WJ. Empathy and quality of care. Br J Gen
Pract 2002; 52: S9-13
[5] Mercer SW, Maxwell M, Heaney D, Watt GC. The consultation and
relational empathy (CARE) measure: development and preliminary validation
and reliability of an empathy-based consultation process Measure. Fam Prac
2004; 21: 1-6
[6] Mercer SW, McConnachie A, Maxwell M, Heaney D, Watt GC. Relevance
and practical use of the Consultation and Relational Empathy (CARE)
Measure in general practice. Fam Prac 2005; 22: 328-334
Stewart Mercer
Senior Clinical Research Fellow
Section of General Practice and Primary Care,
University of Glasgow,
Glasgow G12 9LX
Scotland, UK
Current address:
Visiting Professor in Primary Care Research,
School of Public Health,
Chinese University of Hong Kong
Email stewmercer@cuhk.edu.hk
Competing interests:
None declared
Competing interests: No competing interests