“Complicating relationships”—the water that doctors breathe
BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h4185 (Published 03 August 2015) Cite this as: BMJ 2015;351:h4185
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Thank you once again to Dr Loxterkamp for another excellent Letter from New England. I always come away from reading his articles inspired and reminded why my role as Advanced Nurse Practitioner in general practice is both a privilege and a joy. It sounds so simple, we should care about , not just for, our patients . And yet we are bombarded daily by personal and professional examples of a lack of care and compassion by those who are charged with this responsibility. In the neighbouring article on compassion by Chadwick we are told that compassion is given freely to a patient and cannot be mandated. I dispute this. Those of us who teach future generations of doctors and nurses must inspire them to deliver excellence in care and this means that the onus is on us to shape their attitudes. How we care for our patients is every bit as important as what we do to them. To quote the airline industry "if you don't have the attitude you don't have the altitude". Let us teach our junior colleagues to fly.
Competing interests: I am Advanced Nurse Practitioner in General Practice and clinical supervisor to F2 grade doctors.
This article by David Loxrterkamp discusses the world of human relationships and in particular that of the doctor-patient. (I didn't think there were patients any more? Are they not "clients", and are doctors not "health providers"?) If you could graph the categories of such relationships in general over the decades, I think you would find a very definite trend toward the adversarial end of the graph, as opposed to the trusting mutual respecting end.
This is unfortunate and possibly mirrors human relationships in general over the past several decades. People aren't as friendly in the Western World as before, they don't say "Hello" they don't care. The crime figures are worse, the poverty figures are appalling (over 3 million children in poverty in UK), the media and book stands are full of depressing and terrible news and stories. Why wouldn't the "client - health provider" relationship slip to cold adversarial categories like every other relationship?
Despite all the negativity, people still do care, and good doctors do go the extra mile for the sick people they serve. It is no longer the paternalistic role of years gone by, but most doctors do see the suffering person behind the insurance forms and the litigation threats and the risk managers. What medical insurers find when they trawl through their stats is that it is the very smile on the doctors face, and the kind word, and the apology, and the humanity of the doctor that saves the day. The adverse event occurrred alright but the client morphed into a patient on seeing the genuine caring of the doctor "and didn't have the heart to sue him/her."
Doctors that don't get sued (provided they are competent) are kind, good listeners, often have a sense of humour, and acknowledge the "person" in front of them - see reports of medical councils or medical insurers to see who does get complained about and sued. This tallies with Dr Loxterkamp's observations. However, you don't need to be wearing rose tinted glasses, which will only blind you to the risks involved in professional relationships, but you do have to wear kid gloves to detect the suffering of another human being, and to serve them as best you can.
Competing interests: Author of book series "The Human Mind and Belief" which touches on the topic of what it means to be human.
Re: “Complicating relationships”—the water that doctors breathe
My thanks to Dr. Loxterkamp for expressing these ideas.
I do not think the role of doctor can be complete unless you are immersed in the community you serve. You can still do excellent work and contribute much but community is everything. I have treated colleagues, neighbours, friends and acquaintances with no adverse outcomes of which I am aware - either clinical or social. The ripples in the community pool you pick up with your antennae and these can transform otherwise intractable situations.
A management trussed automaton who lives apart from the community is materially disadvantaged.
Having observed the decline of primary care over recent decades into another proletarianised clinical silo I am struck by the lack of change in the populations served. The needs are similar to decades ago and the responses that used to work when doctors were closer to their patients can still work.
This cycle of change is taking a long time to turn but it will. It will.
Steve Ford
Competing interests: No competing interests