Editorial 5th January 2009: Love in a cold climate
Hello, and welcome back to Health Policy Insight in 2009.
It would seem that the gift of prophecy has not yet deserted me (www.healthpolicyinsight.com/?q=node/234), and the sundry winter bugs did not make the NHS fall over in any meaningful way. That said, most workplaces only go back today and schools tomorrow, so be warned, chaps: this weekend could be quite lively.
Congratulations to our regular contributor and friend Professor Alan Maynard on his being invested with the Order of the British Empire. It will henceforth be mandatory to genuflect when addressing him, or even referring to His Excellence. Can a ‘K’ be far away? Only branding and copyright issues with a certain Tottenham Hotspur-supporting BBC2 star-cum-market trader, formerly in the computing game, may delay things until the recession is over …
Anyway, to celebrate his ascent into the pantheon, Professor Maynard OBE has penned a suitably uncontroversial piece about the need for NICE to get nasty. The latest instalment of The Maynard Doctrine can be found here - www.healthpolicyinsight.com/?q=node/235
During the Yuletide break, one story that caught my eye was the Kings Fund’s piece with the BBC highlighting compassion in NHS healthcare – or more accurately, the perception that there is a widespread lack of it (www.news.bbc.co.uk/1/hi/health/7797868.stm). To address the situation, the Kings Fund has been supporting and piloting an idea called ‘Schwartz rounds’ in several NHS hospitals.
Schwartz rounds are a US import – read more about them here (www.theschwartzcenter.org/programs/rounds.html). Their founder, who died of an aggressive cancer, created the institute “dedicated to strengthening the relationships between patients and caregivers”.
The Schwartz round process involves a monthly multidisciplinary meeting of staff, to discuss aspects of care that they have found difficult.
Instinctively, this sounds like a good idea. I am moved to wonder whether the performance of parts of oprganisations who undertake Schwartz rounds wil be compared against others who do not. Perhaps this would be unethical?
The story reminded me of a good paper written for the NHS Confederation in May 2008 by Robin Youngson – ‘Compassion in healthcare – the missing dimension of healthcare reform?’ (www.debatepapers.org.uk/pdf/Futures-Debate-2.pdf).
Youngson is a UK-trained anaesthetist and clinical leader working in New Zealand. His thoughtful document starts by describing the experience of his daughter, hospitalized for months in traction with a broken neck.
Youngson defines compassion as “the humane quality of understanding suffering in
others and wanting to do something about it”, and ascribes its lack more to gaps in the system than to individual callousness.
His eight-point action plan also looks largely sensible, although I may not be the only one who feels twitchy about declaring compassion as a ‘core value’ – it’s a dangerously short step from core values to mission statements and similarly meaningless management jargon.
The real question about compassion
The instinctively attractive idea may not always be the good one, as any fund manager or investment banker would probably tell you. Now it is going to take some neck to argue against compassion in healthcare. It depends crucially on a workable and generally agreed definition.
Let’s consider difficult circumstances. If I reach a point in my life where illness or simple old age has incapacitated me beyond a point where I consider that I still have quality of life, I would want somebody – not necessarily a doctor – to show the compassion needed to help me to end my life with a minimum of suffering. (Knowing my views on this, my mum’s terrified of me, by the way. She won’t let me near her if she’s even got a cold - thinks I’ll reach straight for the pillow …)
But there are people who consider that it is always compassionate to extend human life, even if it is pretty clear that the person being so extended does not want it.
It would be nice for human dignity to be given higher importance in healthcare. Darzi chunters on about this in New Labourspeak – a “dignity agenda”. (At New Labour policy forums, do they have an “agenda agenda”?)
Equally, it might be possible sometimes to settle for politeness, competence and adequate handwashing. Here is a shamelessly un-evidence-based personal anecdote – when I was offline for a month with flu, chest infection and the Black Death last November, I cracked when my temperature was 39.5 degrees and went to bother a GP about it. The GP didn’t show me much compassion. But he was courteous, professional, quick, communicated very clearly and prescribed antibiotics and anti-emetics once he was clear I had a chest infection.
It’s not every situation, and you have to judge the situation and patient in front of you. I wouldn’t have scored that GP highly for compassion; but I wasn’t looking for it. I would have scored him very highly for competence and clarity. It’s fatuous to suggest that these qualities would always be enough on their own: in fact, competence and clarity are the basics. Perhaps it is in no small part a reflection on my expectations that I was so pleased to find them.