Do doctors need to be told to be kind?BMJ 2023; 382 doi: https://doi.org/10.1136/bmj.p1976 (Published 25 August 2023) Cite this as: BMJ 2023;382:p1976
On 22 August 2023, the General Medical Council (GMC) published the latest version of Good Medical Practice, its guidance for doctors.1 The guidance will come into effect on 30 January 2024, but it has already been widely debated by doctors on social media. The target of the discussion is the introduction of a requirement to treat patients and colleagues with “kindness, courtesy, and respect.”
Critics of the guidance say “kindness” is too subjective. They say it is patronising. They say it will prevent doctors from speaking out, or sharing unpleasant news. They say it will result in frivolous complaints and referrals to the GMC, with a disproportionate impact on women and doctors trained abroad.
The GMC, at paragraph 23 of its guidance, elaborates on the meaning of “kindness, courtesy, and respect.” It means that doctors should communicate “sensitively and considerately, particularly when sharing potentially distressing issues about the patient’s prognosis and care.” Similarly, doctors should be “willing to explain the reasons for the options they offer (and the options they don’t) and any recommendations they make.” The explanation dispels the worry that kindness is incompatible with breaking bad news, refusing patient requests, or making recommendations. Rather, it informs how these actions, and others, should be performed. This is in line with what philosopher Robert Audi called “duties of manner.”2 These duties relate to how we do things, since it is possible to do the right thing, like disclosing a grim prognosis to a patient, in the wrong way (e.g., insensitively or callously).
What kindness requires differs from culture to culture. Yet, the same is true of other qualities mentioned in the guidance, such as courtesy, respect, openness, fairness, trust, honesty, and professionalism. There is no need, in my view, to seek a technical definition of kindness. It is a word whose ordinary meaning most of us understand without much difficulty.
However, when determining whether a doctor has been kind or unkind, decision makers must be sensitive to context and culture.
William Osler remarked that a doctor “needs a clear head and a kind heart.”3 In an unpublished draft of an address to medical students, he wrote “the kindly word, the cheerful greeting, the sympathetic look, trivial though they may seem, help to brighten the paths of the poor sufferers and are often as ‘oil and wine’ to the bruised spirits entrusted to our care…remember that every patient …will examine you critically and form an estimate of you by the way in which you conduct yourself at the bedside.”4 The Latin root of “beneficence” (doing good for your patients), one of the four principles of medical ethics along with non-maleficence (respect for autonomy and justice) is beneficentia: active kindness. It is surely right that most doctors strive to be kind but, on a bad day, at the end of a busy shift, or when confronted with unsympathetic patients or relatives, it is easy to forget this noble intention.
The GMC says little about the specific requirements of kindness with respect to colleagues, defined in the guidance as including “anyone you work with, whether or not they are a medical professional.” However, just as kindness does not preclude difficult conversations or unpopular advice to patients, it does not prohibit doctors from raising concerns with, or about, colleagues. Rather, it dictates the way in which these acts are done.
The fear that the kindness requirements will open floodgates of complaints is misplaced. The heavens will not fall. The current guidance already contains instructions that doctors should treat patients politely, maintain good relationships with colleagues, and treat them with respect. The reference to kindness in the updated guidance serves to remind doctors to apply their skill and knowledge in a manner that respects the dignity, vulnerability, and humanity of their sick patients, while treating colleagues with due consideration. In these times of high stress and low morale among healthcare staff, such a reminder is no bad thing.
Daniel Sokol is a medical ethicist and barrister. He provides ethics training to doctors undergoing GMC proceedings.