Day 787

The Francis report concluded that patients were routinely neglected by a trust that was preoccupied with cost cutting, targets and processes and lost sight of its fundamental responsibility to provide safe care. An estimated 400 to 1,200 people could have died unnecessarily there between 2005 and 2008. In addition, the inquiry heard that receptionists in the accident and emergency department had regularly triaged patients

The public inquiry heard common themes of call bells going unanswered, patients left lying in their own urine or excrement, or with food and drink out of reach. Patient falls were also concealed from relatives.  An inward looking organisation, with a low staff turnover, the trust suffered from a lack of new ideas and a negative culture that became entrenched. Extremely poor nursing care was at the heart of this enquiry bringing into question ‘empathy’ in health care professionals.

Studies have shown that physician empathy is significantly associated with desirable clinical outcomes for patients with diabetes mellitus and should be considered an important component of clinical competence. ( Source: http://www.forcedo.org/wp-content/uploads/2013/03/The_Relationship_Between_Physician_Empathy_and.26.pdf)

A qualitative study of empathy in 3rd year medical students showed that inhibitors of empathy may originate in the hidden curriculum creating a greater distance between patients and physicians. Cynicism as a coping strategy, primary importance of technical knowledge, emotional control, becoming and being a professional hence keeping a professional distance from patients reinforced lack of empathy. One student explained that exploring a patient’s true feelings is not permitted. She noted that she explored and discussed patients’ emotions less than before because she felt that it is not accepted within the medical educational environment.(Source: http://bmcmededuc.biomedcentral.com/articles/10.1186/1472-6920-14-165)

Good bedside manner is nothing but a practical demonstration of empathy. Can it be taught and learnt?

While at one level it is possible to ‘understand’ how another person might be feeling (cognitive empathy), not everyone is capable of feeling how the other person might be feeling (emotional empathy). Both are essential for people in caring roles.

In all my years as a practicing doctor, I have learnt that patients are not just a source of inspiration for me but a primary source of learning. Books can only teach you so much. Most valuable lessons come from patients and from observing the attitudes and behaviour of senior colleagues.

Considering the fact that GP training in the UK is the shortest amongst all European countries, patients must be treated with greater respect as sources of learning. In my specialist training of 7 years duration, I learnt a lot about Anaesthesia. GPs are expected to learn a fair amount about everything in 3 years. (http://www.rcgp.org.uk/news/2016/october/mental-health-is-key-in-the-gp-training-curriculum-says-rcgp.aspx)

Am I optimistic? Yes. The government is waking up. There is hope.

 

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