Intended for healthcare professionals

Opinion

The job of a doctor is not necessarily to be kind

BMJ 2023; 382 doi: https://doi.org/10.1136/bmj.p1995 (Published 31 August 2023) Cite this as: BMJ 2023;382:p1995
  1. Margaret McCartney,
  2. GP
  1. Glasgow

Kindness has made an appearance in the General Medical Council’s updated guidance Good Medical Practice, published last week. This is our lodestone, the thing doctors are meant to do in order to stop us from being complained about, reported, and struck off. “Treating patients with kindness, compassion, and respect can profoundly shape their experience of care,” says the GMC. It tells us to listen to patients and work in partnership with them. Indeed, not just patients: “You must treat colleagues with kindness, courtesy, and respect.” Sure, the GMC does say that this does not mean that we should agree to “every request or withhold information that may be ‘upsetting or unwelcome’”—but, seriously?

Kindness is a word that has become weaponised. It is particularly toxic when filtered through social media and aimed at women. I used to think that kindness was indeed where the NHS should focus, given the routine carelessness and disregard thrown around from the top down onto frontline staff—not everywhere, not all the time—but often enough for pressured clinical staff to feel chastised for not always showing enough kindness, while not being given the resources to demonstrate it. It’s much easier to be kind when you are not pressed for time, when your computer is not slow and doesn’t need restarting twice a day, or when you are not having to tell people that the waiting list for surgery is a year long. Kindness is subjective. Proving it is present, or not, is a fool’s game.

But essentially: the job of a doctor is not necessarily to be kind, liked, popular, or nice. It is, sometimes, to disagree, to challenge, to object, and, at times, to refuse. All of these things may be correct clinically, morally, and ethically, but risk complaint, with all the problems that brings. Certainly, we should not look for opportunity to disagree. But it will present itself often enough. We learn enough about communication skills to know that there are better, and worse, ways to give bad news—which include not prescribing inappropriate opiates, or benzodiazepines, for example. This sort of difficult consultation may be done well or badly. True “kindness” considers not just now, but the next year or 10 years, and the repercussions for decisions made now. Short sighted “kindness” thinks about the patient satisfaction scores at the end of today’s surgery. But what about child protection, reporting a colleague, using the Mental Health Act, or even managing resources in the NHS?

I used to think that “be kind” was a suitable recommendation for professional practice. I have changed my mind. I think it is dangerous, and will end up being used as a threat against doctors doing necessary things that may appear to be, or are, harsh. Naturally, I am not recommending “unkind” practice, though I do recognise that this is the environment that is normal for many of us to work in, because we are often without the resources to do our job. Rather, the GMC should not make recommendations of this type at all. We should make the care of our patient our first concern. If we feel this needs us to act in ways that could be perceived as “unkind,” then so be it.

Footnotes