Care and compassion within the NHS

I read In the Midst of Life quite a few years ago; it’s by Jennifer Worth who wrote the Call the Midwife series before they were adapted for the BBC.  The book itself is beautifully philosophical and opens up a much needed debate about how we treat those who are dying.

Surgery in the 1800s

One of the stories that stayed with me (and I’ll have to paraphrase) is of a man who was taken into hospital.  He couldn’t speak English and throughout his stay he was distraught.  He tried his best to resist any treatment, was scared of the nurses, scared of the doctors and maintained a high state of anxiety at all times.  The nurses treated him as best they good, but he remained inconsolable, becoming more agitated as the days continued.

It was only when a relative came who could translate for him that the nurses found out why he had been so terrified during his stay.  Previously the man had been in a prisoner of war camp and while there he had been tortured.  Because no one had been able to explain to him where he was or what had happened to him he had become convinced that he had been captured again.  He had interpreted his treatment as torture.

Context matters hugely in the medical profession.  Surgeons are allowed to commit actual bodily harm on a patient because they know in the long term it will save their life or improve their quality of life.  Doctors prescribe medicines that cause a host of awful side effects because those side effects are considered better than the disease itself.  In another context, without the knowledge that things will improve for the patient, what the medical profession does could be considered cruel or abusive.  It is only within the context of medicine that their actions are flipped to be considered as virtually saintly.

But does the change in context remove the distress for the patient?  Does the knowledge that the treatment is in their best interest compensate to the extent that the patient is able to psychological process their treatment has positive and helpful?

I would say that the knowledge is only enough when it is combined with a sense that those who are hurting you care about you. 

If someone is administrating painful treatment and they console them during the procedure this teaches the patient a few things:

• Firstly, the patient learns that they are worthy of care and compassion.  For someone with a chronic illness this is vitally important.  If you are consistently being treated by doctors who are aloof and act as if your pain is inconsequential, it is difficult not to internalise that to some degree and begin to think that all pain inflicted on you is inconsequential.  It is only by having professionals that treat you consistently with compassion that you learn that your pain should be extraordinary to your everyday experience.
• Secondly, the patient learns what are the acceptable limits and boundaries of pain in everyday life.  If a doctor allows you to experience a lot of pain during a procedure, they reinforce the idea that this level of pain is acceptable.  This in turn will lead to a patient believing that pain from their illness is acceptable and therefore will continue to live with a lower quality of life.  However, if the doctor provides good pain relief and takes the pain of the patient seriously then the patient learns that they are only expected to tolerate so much.

The NHS is splitting at the seams, some hospitals have compensated by becoming excessively bureaucratic in order to ensure that that they provide a streamlined, efficient service.  However, this streamlining comes at the considerable cost of compassion, empathy and time.  For those with chronic illnesses, who spend a lot of their lives in hospital, it is difficult not to internalise this treatment and make it part of your lived experience and expectation. 

If I could change one thing about the NHS, it would be to make sure each professional is trained in a way that empathy, compassion and interest in the patient is valued just as highly as their technical skill.  Unfortunately, as the government increases cuts and puts more value on competition and profit it seems as though this hope will be increasingly lost.