Monday, 2 January 2017

#HappyNewYear: rehumanising MSology

Can we stop the dehumanisation of healthcare? #HappyNewYear #RehumanisingMS #MSBlog

Do we need New Year's resolutions? If yes, then my vote goes to 'rehumanising MSology'. Every year the BMJ produces a special Christmas Edition; one of my essential reads over the Christmas break. This year one of Editorials on 'Humanising Healthcare' sums up everything that is wrong with the evolving modern practice of medicine. As the trends leading to the 'industrialisation of healthcare' are likely to continue we the 'healthcare professionals' need to say enough is enough and do something about it. We have to save our professions, for our own sanity, but also for our patients and their families. If we don't we will all burn-out and lose the sparkle that makes our professions so vital, so special, so privileged, ....



Robin Youngson & Mitzi Blennerhassett. Humanising healthcare. BMJ 2016;355:i6262

We have to start by building a more compassionate society

When we are sick, injured, or facing an existential life crisis, our greatest human need is loving kindness and compassion in response to our vulnerability and suffering. One of us (MB) has previously described her first hand experience of the difference such care can make:

In shock, I am admitted to a cancer hospital. Treatment must necessarily be aggressive. I am terrified. Will I die? I am so alone, but trying to be brave. A doctor in a white coat sits down and asks why I am there. When I tell him he encloses my hand with both of his. Instantly, I am encased in warmth, comfort, compassion.

Unconvincingly I say, “I’m not nervous.”

“That’s all right,” he replies, “I’m enjoying it!”

We both laugh. And I leave my hand there. The encounter stays with me; I revisit it whenever I need the healing touch of a human hand.

Years later I am overjoyed to tell him what his kindness meant to me. But he can never really know how much, or the depth of my gratitude.

Too often, what patients actually receive is rushed, clinical, and emotionally detached care. Physicians have many evidence based guidelines for disease management but little evidence based medicine for care of the whole person.

Sometimes, the inhumanity is failure of the wider system. RY’s daughter spent three months in spinal traction with a broken neck. Many days she went hungry. She could not see a television or read a book. But the hospital prioritised clinical care, not her needs as a human being.

The system is also dehumanising to those who work within it; witness the emotional exhaustion, depersonalisation, and cynicism now so widespread among health professionals.

Multiple wins

Randomised controlled trials have provided good evidence that compassionate care also improves clinical outcomes. Empathetic and supportive preoperative consultation improves wound healing and surgical outcomes, halves opiate requirements, and reduces length of stay. Patients in emergency departments are 30% less likely to return if treated with compassion. Early access to palliative care reduces costly interventions, improves quality of life, and prolongs survival in cancer patients. Meta-analysis suggests that having a caring doctor reduces five year mortality in men more than does stopping smoking.

Compassionate caring also gives meaning, joy, and satisfaction to health professionals, aligns with their ideals, and protects against burnout.

Human centred care is therefore good for patients, professionals, and funders. Why isn’t it spreading like wildfire?

After decades of campaigning for a more humane health system, we conclude that the underlying values of the healthcare system are incompatible with compassion, caring, and healing.

Societal failings

Although health professionals care deeply about their patients, the values of the wider system are competition, rationalism, materialistic science, productivity, efficiency, and profit. There is no room for healing. We call this the “industrialisation of healthcare.”

As campaigners, our mistake was to assume that these values were somehow intrinsic to healthcare and that the system could be fixed. However, these values are adopted from society; if we want to re-humanise healthcare we have to build a more compassionate society.

Heroic models of leadership—always campaigning and battling to “win the war” against cancer or drugs—sabotage our efforts. We need our leaders to be healers more than heroes; it begins with self compassion and self care.

We call for a new breed of physician leader-activist; people who are “internal activists” in the workplace, role modelling the best of human centred care, and also social activists in wider society, leading the movement for compassionate communities. The compassionate cities programme (charterforcompassion.org) is a good starting place.

In the 1980s the International Physicians for the Prevention of Nuclear War rose up to address the global threat of nuclear war. It is now time for physicians to stand together and address the societal values that are driving us to social breakdown, epidemics of chronic disease, and ecological collapse.

Our work in humanising healthcare became much more successful when we gave up battling the system and changed our leadership style:

• Being non-judgmental and compassionate—rather than moral crusading
• Showing humility and vulnerability—rather than persuading and evangelistic
• Seeking the wisdom of individuals and communities we serve—rather than casting ourselves as the experts
• Giving away our materials, offering our time for free, and asking for donations—rather than seeking transactional business relationships
• Using appreciative inquiry to seek stories of what works best—rather than a focus on problems

These same ways of being are also a powerful foundation for patient centred medical practice and fulfil the promise in the Declaration of Geneva: “I solemnly pledge to consecrate my life to the service of humanity.”

We are encouraged by seeing new organisations joining our Hearts in Healthcare campaign (heartsinhealthcare.com), including the Journal of Compassionate Healthcare and the International Charter for Human Values in Healthcare.

Compassion is the golden rule of every religion. This festive season, will you reflect on how your compassionate care of patients might be extended to our communities and the broader healthcare system?

You may find the TEDx by Robin Youngson of interest. The messages in his talk are very insightful; they have taught me a lot. 


6 comments:

  1. Thanks for posting on this. It is very relevant to the way people with MS are managed. Happy New Year, I hope 2017 brings you great success.

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  2. Yes interesting post. I watched the TED talk and wondered if it would of been of help to the patient (in this case his daughter) to project onto the ceiling of the hospital above the patient photographs of the faces of the care team. Also to project a HCP such as an OT or psychologist speaking to the patient about mindfulness for example and having a discussion. A bit like Skype. With technology today I am sure this is possible.

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  3. I can't thank you enough for writing this as your first entry in the new year.

    My word, the one I'm focusing on in 2017, is kindness. And you wrote about it from the point of view of the medical industry. Ahh.

    After living with MS for 30 years I've seen the disjointed,uncaring side of the medical profession that does not help the patient - and this patient - in acquiring better health. The WHOLE person is what needs to always be considered. Kindness and compassion go a long way toward better medicine.

    I will long remember your post. I thank you from the bottom of my growing cynical heart. There are still good people in the world.

    Cathy

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  4. I've thought about this in the context of 'breaking the bad news'. Whether it's a diagnosis of cancer or MS, I think your mind goes into shock when you hear the words and you can't really take in what is being said, no matter how caring the doctor is. Perhaps a better option would be to have someone kind and compassionate break the bad news, and then say the doctor will see you later today or tomorrow to answer your questions and explain your options. That would give you time to get your head around the enormity of what you've been told, to talk to friends and family, and to think of what you would like to ask the doctor.

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  5. Its a admirable thing to strive to do and had measurable patient benefits, but it going to put more pressure of the time of the HCPs which is pretty acute with the NHS as it is.

    It's like the TV show 'House', bedside manner and clinical effectiveness are not always linked.

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