Time to care
When I retired from clinical practice, the thank you letters and messages I received from my patients all talked of care – the aspect of my work that mattered most to them was deeply human and extraordinarily untechnical.
I had been working as a GP for about a year when I was asked to see Joe. Joe was a farm labourer, living in a village on the edge of my practice area. In his eighties, and still working on the farm, he was badly bothered by how exhausted he felt. Trying to examine him on the rickety bed in his tiny cottage was far from easy, but it was all that I needed to show me just how grim the situation was. The bowel cancer surgeon rapidly agreed. Joe’s tumour was inoperable, and TLC was recommended. I vowed to myself to do the best that I possibly could for him. After all, this was all a new experience for me – my first patient requiring palliative care, as I don’t think we called it in those days, but a vital and central part of general practice.
A month or so after Joe died, his daughter came to see me about her high blood pressure. As she got up to leave, she turned and, with a tear in her eye, she said, “I just wanted you to know that Dad always said that you were definitely the best doctor he had ever seen in his life.” And internally I know that I preened. All that hard work, all those exams, had paid off. My skill had been truly recognised. But his daughter hadn’t finished. “And you know why? Of all the doctors who ever came to visit him, you were the only one who ever sat down.” And with that she left the room.
An eye opener
Over the last four decades it’s a conversation that I’ve often thought about. The one aspect of care that really mattered to this critically ill man was that I sat down. I will never know for certain, but my hunch is that Joe interpreted this simple act as meaning that I had time for him. I don’t think I had even given it a second thought – but it was so important to Joe, and to his family. Any diagnostic, therapeutic, and other relevant skills seemed to be of secondary importance at this critical time in his life.
And an entire career-span later, when I finally retired from clinical practice, the thank you letters and messages I received from my patients all talked of similar aspects of care – people seemed particularly appreciative of what they saw as my calmness. Heavens – if they had only realised the panic just below the surface. But, just as with Joe, the aspect of my work that mattered most to them was deeply human, and extraordinarily untechnical. Not a single letter, or message, or card mentioned any technical, diagnostic, therapeutic, pharmacological, or referral skills. There could have been a good reason for that, but it was quite an eye opener, discovering that most mattered to people was something I was barely aware of.
Making human connections online
The world moves on. I have long been a great fan of technology, and the extraordinary rapidity with which healthcare – and particularly general practice – has taken up digital consulting has been an immensely worthwhile side-effect of the Covid-19 pandemic. The potential for digital has been apparent for years with benefits on so many fronts – time saving for patients and clinicians, efficient, environmentally beneficial, and a great aid to so many aspects of patient empowerment. It’s been absolutely necessary too. At the height of the pandemic it was almost the only safe way that much of the NHS could continue.
Will a face-to-face consultation in the same room as another human being become a rarity, saved for special occasions?
So, will digital become the default for the future? Will a face-to-face consultation in the same room as another human being become a rarity, saved for special occasions? There’s no doubt that digital will find a vital role – particularly in replacing many of those absurd out-patient reviews – “How are you getting on?”, “Fine thanks”, “Excellent. I’ll see you in six months”. I exaggerate – but not a lot.
But somewhere in enhancing our efficiency we have to ensure that we retain those aspects of care such as kindness, and calmness, and empathy, and whatever it was that Joe was so grateful for. This doesn’t mean abandoning digital. It doesn’t mean we have to revert to how things were in the past. We just have to we ensure that the “care” aspect of “healthcare” is build it into how we use the systems, not left as an optional extra. And that certainly won’t happen by accident.
New challenges require new ways of working and at Kaleidoscope we are thinking a lot about how build connection and kindness into digital interactions. People come to technology with different skills and experiences and for many it is still a barrier. Perhaps before we rush ahead to delivering digital consultations at scale we need to do the digital equivalent of sitting down. We have to take the time to acknowledge the experiences people at the other end of that Zoom call are bringing with them. We just have to be human.