DEA BIRKETT ON TREATING PATIENTS WELL

Published: 17/03/2005, Volume II5, No. 5947 Page 17

It is hard to maintain your dignity in hospital. Recently, wearing the uniform of a patient - one of those wraparound gowns with the humiliating slit up the back - I immediately became a non-person, stripped of any distinguishing characteristics.

On a ward, we become nothing but an illness or chronic condition to be treated or ameliorated. I have heard a doctor shout out across the rows of beds: 'There is another hernia over here.' Survey after survey has shown that right at the top of a patient's wish list, on a par with sound medical treatment, is maintaining their dignity while they are being treated. Last month, a Healthcare Commission report found that one third of accident and emergency patients felt doctors and nurses did not listen to them.

The same month, the Citizens Advice Bureau announced that one in seven formal complaints against the NHS were about staff attitude (news, page 7, 24 February). In response to the concerns of callers to their helpline, the Patients' Association recently brought doctors' poor communication skills to the attention of the General Medical Council and Department of Health.

Patients had made reports such as, 'Medical staff talked about me amongst themselves as if I wasn't in the room'.

Being talked down to

None of these findings are surprising. Ask almost anyone what has been their worst medical experience, and they will not site a misprescribed drug or incorrect diagnosis. They probably will not even moan about how long they had to wait for treatment.

What you will hear is a tale about being talked down to; a tale of not being treated with respect. The biggest single improvement that could be made in any hospital is to get the medical staff to treat the patients well.

Sadly, this doesn't happen as often as it ought. I expect - if you were honest - many of you could slot your medical staff into one of the following categories.

First, there is the paternalist, who treats patients like children even when we are pushing 50. I have had a doctor almost half my age pat my knee in a reassurance.

Next, there is the insensitive type who seems to have no regard whatsoever for the particular nature of your complaint and how that might impact on your everyday life.

Astounding insensitivity

Doctors' insensitivity can be astounding. I remember once phoning a fertility clinic and speaking to my consultant who apologised for the racket in the background, but she had 'had to bring her kids into work today'.

I was thankful I was not booked in for an appointment; how could I possibly have talked to her about my difficulty in reproducing while her kids built mini operating tables out of Lego on the floor below us?

Then there is the demagogue who hates to be questioned on any aspect of their field. For this type, a patient gingerly asking if there is any way they could possibly be treated without an operation which would make lifting impossible for two months as they had a young baby to care for is seen as a direct challenge.

The demagogue's reaction is not a healthy, 'Let's see, and talk it over, ' but a confrontational, 'Well, if That is how you feel.' Patients may not be medical experts, but we are pretty well-versed on our own lives. Yet any notion of partnership between patient and practitioner is sadly absent.

I was debating with a senior paediatrician recently what could be done to make doctors address patients more sympathetically. 'Do you want me to cry when I break bad news?' he rebuffed. Of course I do not. But the paediatrician had identified the nub of the problem.

We would like a doctor to display understanding, but not emotion.

The last thing we would want a surgeon to do is weep into our open wounds. Cool, clinical detachment is at the heart of their ability to help us. Yet we also want them to treat us, and our feelings, with respect.

If we do not want tears, paternalism, insensitivity or unassailable authority from our medical staff, what do we want?

The Patients' Association has suggested the art of communication be put on the medical college curriculum. This aspect of care, which patients often consider paramount, is simply not seen by the profession as an essential element of good medical practice.

Collaborate to accumulate

Another way forward would be to look at ways for medical staff and patients to work together. Parents and Paediatricians Together is one such project, where paediatricians are encouraged to approach families as equals, provide appropriate and accessible information, and to make them feel empowered rather than belittled by the encounter.

It is important that medical centres heed patients' concerns and attempt to tackle them. Because, in the age of so-called choice, are patients going to select where they go for medical attention on success rates in heart by-passes and cancer cures?

Or will they pick a place where they will be treated with respect?

Current key targets determining star-rating do not seem to take the doctor-patient relationship into account. Perhaps they should.

Perhaps there should be key targets for attitudes, not just medical achievement. Then patients would really be able to tell where the best doctors are.

Dea Birkett is a writer on health and social issues. She can be contacted through www. deabirkett. com.

However, if you would like to debate the issues raised in this column on HSJ's letters page, send your comments to hsjfeedback@emap. com.

Dea's next column will appear on 21 April.

Next week's columnist: Simon Stevens, former senior policy advisor to Tony Blair and Alan Milburn and current president of UnitedHealth Europe.