Peter Fielding Shares This Letter on Kindness in Medicine from David Jeffrey

A note from resident Peter Fielding about kindness in health care, sharing part of a letter published in the Journal of the Royal Society of Medicine by David Jeffrey:

Dear All,

A recent paper in the JRSM struck a chord. All our connections, social, administrative, medical, can benefit by taking the essence of this paper to heart, and into everyday practice. Easy to say, more difficult to do.

Hope you enjoy it.

Peter Fielding

Excerpts: A DUTY OF KINDNESS

Journal Royal Society of Medicine 2016, Vol 109(7) 261-263

From David Jeffrey, University of Edinburgh, Medical School;

Kindness has now been relegated to an attribute of losers rather than being an integral part of a doctor’s duty to a patient. Because our medical culture does not consistently support the practice of kindness, doctors may view kindness as “nice” but not an essential part of their practice. The Francis Report contained Harrowing examples of unkindness to patients and failings in basic patient care.1 Medicine’s positivist view, prioritising technical progress, evidence- based medicine and targets, risks viewing a patient solely as an object of intellectual interest.2 Respecting a patient’s dignity now involves pathways, guidelines and risk assessments. The technical and scientific elements of medicine outweigh psycho-social care which is sometimes thought of as a part of outdated ‘nostalgic professionalism.’3

Unkindness to patients is often subtle; by using distancing tactics such as appearing busy, concentrating on scans and results of tests, and ignoring patient’s anxieties, doctors can leave patients feeling isolated. In a management culture which measures success in numbers, league tables and throughput, time spent with a patient addressing their concerns is not valued, so it is not seen as an essential part of a doctor’s duty.

It is paradoxical that we have developed the most sophisticated methods of communication but at a personal level these seem to have isolated us from others. We find it difficult to find another human being to speak to face-to-face, to touch, to listen, to share our thoughts, to connect. Independence and self-reliance are now our ethical aspirations. We have come to deny our dependency on others. Rather than embracing dependence and vulnerability, we scorn them as though they are incompatible with autonomy. Kindness inevitably exposes our vulnerability and acknowledges our dependence on others. Kindness can have negative associations with patronising behaviour, pity and paternalism. It may also be regarded with suspicion as either a self-serving behaviour or a form of weakness.

Kindness may be expressed by giving time and sharing our humanity. Appropriate hurmour, self-disclosure, and empathy may be ways in which we share our human predicament and may be perceived by the patient as kindness.

The challenge we face in the West is how do we institutionalise kindness as a duty, extend our kindness to family and friends and spread it to meet the needs of strangers?9 Kindness is an integral part of what makes us fully human. We depend on each other not just for survival, but for human flourishing, a fulfilling of our potential, described by Aristotle as eudaimonia.

We need to now establish kindness as one of the doctor’s duties to the patient.

 

References:

  1. Francis R. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry: Executive Summary. London: The Stationary Office, 2013
  2. Shapiro J. The paradox of teaching empathy in medical students. In: Decety J (ed.) In Empathy: From Bench to Bedside, New York: MIT Press, 2012
  3. Erde EL. Professionalism’s facets: ambiguity, ambivalence and nostalgia. J Med Philos 2008; 33: 6-26.
  4. Philips A and Taylor B. On Kindness, London: Hamish Hamilton, 2009.

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