Have you ever wondered why the various polls for different occupations vary when measured against the parameters of honesty, ethics and caring?
The top three positions are usually fought out between nursing, pharmacy and medicine.
Nursing has consistently come in at number one, with pharmacy a close second, and usually medicine a little further back in number three position.
The positions change year on year depending on the type of publicity inflicted on the various professions, but they consistently come out on top as a collective.
In looking for a common thread I have discovered that the “caring” component of each service is prized by patients above all else, and the largest component of caring is “emotional support”.
In fact the level of emotional support given to a patient is a major factor for a patient deciding on an end of life decision – whether to die now or postpone for a bit longer.
The following is an excerpt from a patient conversation:
“I don’t remember exactly when I started feeling something was wrong. I know the symptoms included worsening headaches, bouts of dizziness, and tingling and numbness in my leg. Each appointment over the course of several weeks (and there were many) my doctor told me it was the flu, migraines, allergies or such. I never felt like she heard me.
I began journaling my symptoms to help process and to document. I shared them with my doctor and asked her for a referral to a neurologist and an MRI. Her response? ‘I’ll approve the MRI but if it comes back normal you need to let this go.’ It wasn’t just that she didn’t hear me. It was the tone of voice, the manner in which she dismissed me.”
The patient had her MRI with the support of her mother holding her foot and providing a lifeline that to date, her caregivers and the system had not.
That evening the patient received a call from a doctor she did not know. This physician shared everything a patient could possibly want to know—but only if the patient was a medical student. They were cold, calculated, data and facts.
Then he said: “You might have an aneurysm.”
He did not ensure the patient understood what he said, he did not empathize, he did not ask, “Are you okay? How can I best be of support to you? What do you need?”
Shortly thereafter the patient met with her neurosurgeon.
“He was world-renowned. He sat us down and explained the technical details of my aneurysm and the treatment options (brain surgery or coiling). He showed me the chance of it rupturing, and he informed me that if it did there was a 50 percent chance that it would kill me and another 50 percent chance if I were to survive that I’d live with some sort of disability.”
Yes, the facts are important and yet again a lost opportunity. Most of our patients are not medical students, nor are they machines. We are all complex, adaptive humans with physical, mental, emotional and spiritual sides. We get scared. We fall in love. We get anxious. We find peace. Data and data collection is important, but it does not replace the need for a shared human connection or compassion.
“He didn’t ask if I was scared. He didn’t ask if I was anxious or depressed about this news or the prospect of brain surgery to fix it. He gave me the facts. I would have appreciated it if he had realised that I was fragile and that I was about to break down.”
The patient had her surgery and by most standards it would be considered a success. Her inpatient post-surgical nursing care was phenomenal. Her nursing care team listened and they demonstrated that they heard.
They provided the human connection and support she needed.
Why wouldn’t they be voted number one in any poll comparing professions?
And yet, the system was still broken and they were not part of the discharge process.
“After five days in the hospital my wound was healing. My pain was under control. But my emotional state was a wreck. I got asked a few questions about anxiety but no one probed deeper. There wasn’t an option to see a therapist or social worker.”
As healthcare providers we talk consistently about patient-centred care and patient engagement and yet we still have not created the systems to ensure throughout the continuum of care we are ensuring we are honouring our pledge.
In this instance the patient’s needs were lost.
“What I needed was someone to really sit down and ask questions and listen to the answers. I needed discharge planning that included mental health care. I needed someone to see that even though they fixed my head. I was very broken.”
Many of us go beyond touting the need for patient centred care. We talk of the need for compassionate care.
The Schwartz Center for Compassionate Health Care states, “When asked whether ‘good communication’ and ’emotional support’ can make a difference in whether a patient lives or dies, 81 percent of patients said: Yes. But what’s really shocking, is that 71 percent of doctors also agreed. That means that the vast majority of patients and doctors believe that compassionate care, defined as an emotionally supportive provider who actually talks and listens to his or her patients, can mean the difference between life and death.”
The patient agrees.
“It’s not brain surgery, it’s the common, compassionate sense about people and their entire person emotionally and physically. It’s about listening to family and friends and it’s about hearing, actively, what’s said.”
As healthcare providers it is time to listen to our patients and actually hear them–to truly embrace and honour what they are telling us, and to care compassionately about them.
Now a lot of the “old pharts” , slowly passing out of today’s pharmacy system will tell you that was exactly how they engaged with their patients.
Of course, they did not have an irritating PBS system relentlessly driving them along a treadmill.
But in giving their time they also engaged in patient-centred care providing support for a range of non-medical services e.g. they may have paid for a taxi to take their exhausted patient home who had no other form of transport; they may have utilised one of their own staff to fulfil the shopping list from adjacent shops that their patient was incapable of completing on that day; they may have followed up later in the day with a telephone call to enquire how the patient was travelling.
All these “care” items costing the business, but building up priceless goodwill and word of mouth promotion, that would leave a market group for dead in the final effect.
This was once the heart of a pharmacy that has been forced to follow the beat of a different drum, managed by bureaucrats that had no idea of patient-centred care.
The pressure of dollars and cents has forced this component out of the system.
So, in re-inventing a new pharmacy model it is essential that it be based on the successful components of the older versions.
I believe that an opportunity exists in expanding the interface between hospital pharmacy and community pharmacy.
Certainly, there are some hospitals looking at this activity but it tends to be driven at a doctor-centric level which never seems to do the job.
Patients will visit a pharmacy more times than their doctor so there is more opportunity for continuity of care.
It makes more sense for the pharmacy department in a hospital to manage a patient’s discharge because their community counterparts will have more opportunity to create an unbroken chain of care, and at minimal cost to the patient.
Pharmacists are generally IT literate and well suited to storing and managing communications in a secure and confidential manner.
The systems for this are already in place.
The other opportunity for community pharmacy is a “pharmacy-in-the-home” service managed by a dedicated team of clinical and dispensary assistants, managed by a pharmacist – all fostering a mentoring approach to the patient.
This type of system would create the type of opportunities for the old-fashioned care noted above, plus create a range of partnering opportunities with people like community nurses and GP’s.
However, we need to skew our government agreement negotiations to budget for those expenses that are not commercially able to be passed on to patients.
A recurrent budget by government for this activity would return huge dividends for government, because it is placing a patient in a convenient setting of primary care at an everyday level that they trust, understand and fit in with.
And although there may be expanding overlaps with some GP turf, it is certainly within a direction I can see no GP heading towards.
So the sooner the turf battles are settled here, the more productive we can all become.
I’ll end this post with a quote from Patch Adams, a movie character played by the recently deceased Robin Williams:
“I’ve given love and fun and creativity and passion and hope, and these things ease suffering.”
Let’s all get on with the job of caring.