Is 'caring' the real problem?
The publication of the Francis report last week has definitely put 'caring' in the spotlight. Clinicians from many different spheres are calling for a greater emphasis on this aspect of clinical behaviour. RCGP chair Clare Gerada said in her weekly newsletter that "reinstating care and kindness back at the heart of patient care is the key to restoring confidence in the NHS and trust in those who work in it." Des Spence in the BMJ also said "the practice of medicine was never about cleverness nor mere learning, but duty, accountability, vocation and caring, words that need to return to the everyday lexicon of medicine."
In my first clinical attachment on a general surgical firm as a student, I remember the attitude of my SHO early on in the attachment. We had just delivered some devastating news to an older lady and she was visibly distressed with no family to support her. My instinct was to reach out and touch her hand. She took my hand in hers and squeezed it firmly. Later he said with some disdain, "Oh God, you're a hand-holder. You'd better be a GP." With the nature of primary care and an ongoing relationship, perhaps we do have more opportunities to show kindness than some specialties who 'hit and run'. During my training in obstetrics and gynaecology I remember the large folder I carried around with my record of training inside. There were many boxes to be ticked; cases to manage, procedures to be mastered. However, I remember nothing requiring me to demonstrate care, or show kindness.
But do we really want to turn this into another 'key performance indicator'? Something to be measured and defined. I have been in clinical medicine for 20 years and have come across many hundreds of medical students and doctors, of all grades. Not all were great, but of barely a handful would I have said "they just don't care", even if they were uncomfortable showing that. I struggle to accept this is the real issue. But what happens when a caring doctor has concerns? Even if they raise their issues appropriately, we work within an enormous organisation which provides free medical treatment to a high standard for thousands of people. The organisation is complex and there are many political and financial pressures at play. Are we, like the banks, deemed too big to fail? Some problems are so complex, it feels they can never truly be solved. Successive administrations have chopped and changed our working environment, but the day-to day-work of clinicians carries on - because it has to.
To assist you in your day-to-day work, this month we have updated our professional reference articles and patient information leaflets on ectopic pregnancy and miscarriage, following NICE guidance issued in December 2012. We have also updated our pages on diabetic retinopathy in accordance with the Royal College of Ophthalmologists guidelines, also published in December 2012.
Our newly updated pages for February 2013 can be found at: http://patient.info/content-updates