There has been a lot in the news recently about the lack of compassion in doctors and nurses, and in hospitals in the UK. Even our heir to the British throne Prince Charles said, “…are we doing enough to ensure there is sufficient empathy and compassion instilled throughout training at medical schools and for the duration of hospital training? And should we not be doing more to enhance the amount of contact time and continuity of relationships between professionals and patients?”
“I have been saying for what seems a very long time that until we develop truly integrated systems – not simply treating the symptoms of disease, but actively creating health, putting the patient at the heart of the process by incorporating our core human elements of mind, body and spirit – we shall always struggle, in my view, with an over-emphasis on mechanistic, technological approaches.” Quotes from a speech at the Royal College of Medicine, London, UK May 4th 2012.
I want to tell you about two examples that I saw on the same day that left me, as a primary care doctor, deeply affected.
The first situation was the death of one of my patients who had had breast cancer on and off since 1979, had finally developed bony secondaries three years ago and had been at home for a month waiting to die. She did die the day after New Year’s Day, surrounded by her son and daughter and their partners, her loving husband and soon after the death by the arrival of two carers, cancer nurses, myself and the district nurse. Some neighbours saw me arriving and waved as if to say “we know it’s happened”. The house is a very ordinary house, small and tucked in between other houses on a housing estate, but inside it is an environment that demonstrates compassion at every turn. Compassion towards Hazel, who had just died and towards all who visit this home. In the bedroom where Hazel had spent her last month was a beautiful Christmas grotto, warmly decorated and lit with red fairy lights, many Christmas cards and music on in the background. The room smelt lovely and was clearly set so that people could squeeze in to be with Hazel and sit and talk to her or just be there.
I certified the death and gave her husband a hug of condolence as I had looked after his wife for many years. She was finally gone and I asked him how he felt. After some tears he expressed such gratitude to all the nurses, carers, neighbours, friends and family who had supported and helped him. He was a humble man who had given his all to give and invite compassion towards his dying wife. He had succeeded marvellously, and will continue to be loved by these people who have helped him. He felt overwhelmed by the care and attention to detail that the nurses and carers had shown towards his wife.
This is how end of life should be and how it is for many of my patients who are loved and who love others. Compassion is the love and the action, the attitude to care for the patient in a way that really is the best for them, not in the sense of money, drugs or equipment, but in the sense of knowing what their needs are and in setting up the environment both physically, emotionally, spiritually and relationally in such a way that love is realised for that person.
I went straight from this house to another where I was drawn into a rather combative conversation by a neighbour of the patient who lived in the house with her daughter. This patient is a smoker with lung cancer who sat alone in rather grubby, smoky room with dull lighting coughing with a chest infection and not even a cup of tea or drink of water next to her. Her medication had not been collected from the chemist that I had organised and she looked thin drawn and depressed. This lady was not so near death but was living in a home without compassion.
What the neighbour wanted to discuss was the news of a suggestion there be a cost of £0.50p for telephoning an ambulance in an emergency. This is thought to be a way of discouraging people calling emergency ambulances unnecessarily or inappropriately. My patient’s neighbour disagreed with the idea and wished everything to be free at the point of contact for health. She doubted that if she met a person collapsed on the road that she or others would wish to pay a small fee to call an ambulance for them on their mobile phone. She went on to suggest that there should be extra payments for people who chose to smoke and get the smoking-related disease that ensues, that people who are overweight should pay extra fees to use the health service so that things were more fair. I asked her how she would feel if it was her who had collapsed and challenged her that surely she couldn’t mean that her neighbour, who was dying of the smoking-related disease in the next room, would also have to pay. There was no answer to this.
I left this house feeling very confused. It appeared to me that in the first situation, a deep love led to compassion which became contagious to all who came near or into contact with this love in action. I felt that the selfless love and service of the husband towards the wife had extracted love out of the hearts of all those around. In the second situation it seemed that a lack of compassion is also catching. Our society has become a society of individualism within which there is a lot of selfishness and negligible amounts of altruism. The possibility of altruism was completely absent to the patient’s neighbour above and hardhearted, judgemental individualism seem to have won in her heart. Worse than that, the daughter of my patient with cancer was being influenced by this neighbour and others around her and did not know how to love her mother.
When I was a new mother of three small children and babies, my mother-in-law taught me how to love and care for the children, and my friends showed me how to nurture the small minds and personalities into responsible adults. This did not happen by instinct, it happened by role-modelling, showing, discussing and much trial and error. However, what did come very naturally, and does to many homemakers who have grown up in a loving home, is the ability to create the atmosphere for love in the home, to create the physical environment that allows and facilitates compassionate acts and to recognise and praise love when it is shown by the children towards others. I believe these factors apply equally well to caring for patients in healthcare situations, whether it is a primary care clinic, a hospital ward, or the patient’s home.
Even though there is much in society that demonstrates hardhearted, selfish attitudes without compassion, we must work with public health to look at how this contagious disease of compassion can be spread from healthcare workers through to patients and hence through to their families.
This is one public health situation where vaccination would definitely be the wrong thing, and that mass epidemic on a global scale would be the right thing.
What would the world be like if a majority caught the compassion infection?…
Dr Ros Simpson
PRIME senior tutor