It’s now been 6 weeks since I stopped work. The difficulties are still going, but I am still going on too. It’s hard to know if things are getting better. My body is still very slow, my mind works ok as long as it has no questions asked of it.

It feels strange writing here about myself. Generally when I write it is with thoughts on the world around me rather than my own world. I don’t even know if I want to publish these musings about my own life. Maybe that’s because I don’t want to make myself vulnerable, maybe it’s because I don’t see that people would have much to learn from me just focusing on myself. Maybe I don’t want to get too introspective.

A big question for me is if everyone is valuable, do I value myself as a human being? This week I feel like I have achieved something if I have walked up my road. However I do have a sense of being valuable that goes beyond my achievements. It is time now for me to remind myself of this whilst avoiding self obsession.

I write this about 2 weeks into a time that in some ways is like no other time I have ever experienced in my life. It is one of those ‘difficult times’. I have experienced a number of difficult times in the past, for a variety of reasons but somehow the experience this time is different.

For a starter it has affected me to the degree that I need to be off work both for my own good and for the good of my patients. It has brought home the importance of the wellbeing of healthcare workers.

The thing that is really strange is that it doesn’t always feel painful. At times there can be unrelenting overwhelming pain but it can also just feel numb. My mind seems to generally work ok but then when I try to articulate my thoughts they come out slow and monotone. It would be so good if I could be like those IT problems where I could be turned off and on again and somehow I would be rebooted back to my factory settings.

What I am so grateful for is that underneath it all I still believe that I am valuable. My value is not defined by my ability to work or to speak normally. My value is defined by much more significant things.

So having looked at the reasons why valuing people needs to be at the heart of healthcare, it’s time to learn about how to communicate to people that they are valuable. The starting point is always to recognise the value of the person in front of you simply because they are human, whether patient or colleague.

Time is always limited but it doesn’t need to limit how we perceive the person in front of us. There will be many different ways in which we communicate to people that they are valuable. Some of these will be things that we would all aim for such as thinking through the problems that come to us well, using the best of our knowledge and the knowledge of others. Some of these will be things we have learnt as an individual be it empathy for a particular situation or wisdom we have learnt in work and in our lives.

One thing I have learnt from colleagues is to use patients names as they talk with them. It’s not something I do naturally but it’s something I’d like to learn to do if possible. The person in front of me is not ‘just another person on my appointment list’ but a valuable human being. I have changed the way I write my notes at work and try to use people’s names rather than ‘the patient’. I have noticed since I have started to do this it has helped me to see the person in front of me as a person not ‘just a patient ‘.

The other change I am currently working on is to try to find out something about a patient that doesn’t relate directly to the problem they are coming with, which can be interesting for me but I can see helps patients see that I value them as people.

The big challenge is that a huge way of communicating to people that they are valuable is to give them time but our time is limited and so we need to find brief ways to do this. Several times I have told people directly that although I can see what they are going through is really difficult this doesn’t change their value as humans because it doesn’t stop them from being human.

I suspect there is actually a broad variety of ways I can make small adjustments to my time with patients that show them that I see them as valuable. I am still learning and will continue to learn, both from patients and from colleagues. Whatever these things are, if they help patients to see that I regard them as valuable, they have the potential to have a significant impact on the care and health of patients.

It’s so key in healthcare to recognise that everyone is valuable.

Everyone is valuable because people are valuable. People can be patients, can suffer long term sickness, terrible tragedy, or can suddenly experience life threatening disease.

A person is always a person whether in the role of a patient or not. A person is always valuable whether they are a patient or not. Illness and disease can rob us of many things but it can never rob us of our humanity. We are valuable because we are human.

Healthcare of course doesn’t just involve patients. It involves healthcare workers of all kinds. It involves paid and unpaid workers. It involves carers and friends and neighbours.

If we say ‘everyone is valuable’ that includes everyone.

Not just patients but everyone involved in healthcare provision, medical and non medical, paid and voluntary. It involves people with various degrees of training and skills. It involves people who have direct contact with patients and people who do not but they are all involved in care.

All of these people are valuable because they are human. None of them are perfect but they are valuable human beings. They all have roles and responsibilities and at times we need to be held to account for how we carry out our roles. Everyone who is involved in healthcare work will also be patients themselves. They have their own health needs and at times these can be significant, just like anyone else.

Let’s value all involved in healthcare work, not just because of what they do or because they can get sick at times too but because they are human.

There is a great photography project which highlights the humanity of doctors. The photos are taken in way to highlight that doctors are human as well as healthcare workers. It does a great job of reminding us that doctors are humans, and of course as humans we are valuable. Please see the photos using the link below.

https://www.amitandnaroop.com/doctors-with-soul/

We need to remember as healthcare staff that if we recognise that everyone is valuable then we are valuable ourselves. We are not going to be able to value others much as we care for them if we do not see ourselves as valuable. If valuing others is the core value for healthcare, then how can we genuinely care for the health of others if we genuinely do not see ourselves as valuable simply because we are human?

There’s a great charity called ‘Heart of the Health Service which recognises how important it is to show people in healthcare that they are valuable. This isn’t just a ‘good thing to do’ but this is a key to improving healthcare for patients as well as helping the healthcare workers themselves.

You can read more about them at http://www.heartofthehealthservice.co.uk

The charity’s founder Beth Hutton writes below:

There are few people in the world who don’t like cake I think most do?!  As a charity we run a weekly ‘Cakeathon’ simply to say Thank you to NHS staff members. Someone bakes and then nominates who they would like the cake to go to. I will never forget the team of porters at Lincoln County Hospital that we delivered cakes too around Easter time 2017. I rang to say that we were coming to bring cakes and that they had been nominated to receive the cakes. I was welcomed into a crammed full room of guys who had been gathered to receive these cakes. They were cakes not a £1000 but this meant so much to them as they had been thought of. As I read out why they had been nominated I saw a few of these burly guys get teary, and heard one of them say “See…finally we’ve been recognised for what we do”. For me, this is the exact reason why we do what we do. A simple thank you goes such a long way – never underestimate the power of it.

Let’s keep valuing people, and let’s keep remembering that includes not just patients but all healthcare workers as well.

There is one particular type of anxiety that affects many of us. I call it ‘happiness anxiety’.

In the UK we live in a culture where seeking comfort isn’t just a value but a pressure. Clearly seeking comfort, happiness and health is a good thing, but could it generate a problem when there is an intense pressure to seek these things? We want to be happy, but are we going to be happy if we pursue it so hard that we become anxious that we are not happy enough?

We are influenced by the deeply rooted US value of the ‘pursuit of happiness’, defined as a right in the US Declaration of Independence. This is a good thing, the freedom to do this, but if it becomes a pressure we can develop this ‘happiness anxiety’.

To help with this we can remind patients that however difficult or easy their life is they are still valuable as humans. We do not need our lives to be perfect for us to be valuable. We do not need to be happy or healthy to be valuable. We want to be healthy and happy, of course we do, but life will always have its difficulties.

Patients’ beliefs about health are affected by their doctors. The WHO definition of health is ‘A state of complete physical, social, mental well-being, and not merely the absence of disease or infirmity’. If we require complete well-being in all these things to define a person as healthy, it could be argued that to be healthy is an extremely hard thing to achieve. It is not too different to the pressure to become happier. We all want to be healthy but I don’t think I have ever been healthy if this is what health is.

Would not a better definition would be ‘A degree of physical, social and mental well-being that does not lead to unmanageable distress’? This is not as black and white as the current definition; but health usually exists in shades of grey. Let’s pursue health and happiness but not to the point it consumes us with anxiety.

Happiness anxiety just leads us round and round in circles. We want to be happy, we try so hard to be happy, this makes us unhappy, and so we want to be happy. Let’s remember we are valuable simply because we are human.

Anxiety is a huge issue. It doesn’t just affect the many people who experience Generalised Anxiety Disorder and other formal diagnoses containing components of anxiety, it affects all of us.

Sometimes life contains more anxiety than at other times, but there will usually  be some form of anxiety linked in to a visit to a doctor.

All kinds of anxieties can abound when visiting a doctor.

Will the doctor be running on time? When I see them will I be able to properly explain what it is I am seeing them about? Will I forget to say or ask something in the pressure of the moment? Will they take me seriously? Will they help with what I think I need or will they ignore what I want? Will they be able to find out what the problem is? Will they be able to make me better?

The list goes on and on…..

It’s well recognised that its important to consider a patient’s anxieties when they come to see a doctor. Repeatedly we were reminded as GP trainees to ask about Ideas, Concerns and Expextations (ICE).

Even if we are fantastic at eliciting these things, as we talk to our patients the even bigger challenge presents itself of how we help patients with these things. Expressing anxiety helps to some degree but how do we respond to these anxieties?

Disease and illness is a scary thing – it would be strange not to find it scary!

Anxiety is about the realm of the unknown, of what could change in the future. However, human value is unchanging. In helping our patients see their value is unchanging it will help deal with the anxiety relating to the uncertainties of their illness and disease.

If we have our patients’ trust because they can see we value then we will be in a much better position to help talk through their anxieties. We need to earn the trust of our patients as well as recognising the trust they heave already put in us by coming to see us.

We earn trust by showing we value patients, by giving well thought out clinical advice and by communicating to them we think they are valuable by the way we communicate with them. We can even tell our patients directly that we see them as valuable.

In the case in my first post, when I was listening to my patient his anxieties were expressed. However, I responded through becoming anxious myself and I wasn’t able to help him work through his own anxiety. When I looked to start again by making his value my focus, I was much more able to help him with the anxieties around his health.

Not just for some

This is not anything new and many doctors already approach patients in this way. However should this just be something for those who have a particular interest in mental health or those who are highly compassionate?

This is about good quality care, and maybe we could aim to work at this in the same way as we work to provide more measurable aspects of care? It is a huge challenge and we are already working hard. When we think about working at valuing patients, we often see the way to do this well is to give patients more time – which is certainly an excellent way of doing this. We need to keep looking at ways of finding more time. However our time is limited. We need to learn to communicate value not just with time but with how we approach our patients, having valuing patients at the core of how we approach each patient.

Background

Above the desk, in my room, I have a poster stating ‘Everyone is valuable’. I put it up there because I think that if we value our patients and we value one another simply as people, we can have a big impact on our effectiveness in our work as health professionals. We know it is good to respect our colleagues and patients, but I think we underestimate just how much difference it can make to our patients’ lives to have human value as our starting point for care.

In our practice, we have another saying; ‘Traditional Values, Modern Medicine’. My concern is that we see traditional values or respect for patients as something that is good ethically, which it clearly is, but we are losing sight of the fact that these things have a significant impact on patient care. I think we need to remember again that there is therapeutic benefit in valuing people.

Case Presentation

Once I was seeing a patient and struggling to make progress. He had been suffering for many years. He seemed to be overwhelmed by his history of suffering and his symptoms on that day. He also seemed frustrated by the lack of progress from help by the medical profession. I did not seem to be able to find the right words – everything I said seemed to make things worse. Then I caught sight of the words above my desk. At that point I chose to make my patient’s value my starting place rather than attempting to persuade him of how the medical profession could help him. I told him that even though he may have lost hope that I would hope for him on his behalf and that I believed he was valuable and significant whether he had pain or no pain. He started to cry, shook my hand and left.

Discussion

We know we have a responsibility to respect patients, but may it also be the case that valuing all our patients and communicating this to them in various ways will actually have a significant therapeutic effect?

Usually, the effect may not be as dramatic as in the story above, but if we were to consistently do this, would it not still have a significant effect on patient health?

Every patient we see comes to us because they are experiencing some kind of pain, whether physical, emotional or both. The surgeon Paul Brand wrote about five different challenges that can have a clear impact on how we process pain. (Brand P, Yancey P. Pain. London: Marshall Pickering, 1994.) He was writing about physical pain, but it would seem reasonable to apply them not just to physical pain but to all suffering. They are loneliness, helplessness, anger, guilt and fear. He gives a good overview of studies and anecdotes on how these things have real impact on patient care.

When a patient sees that we value them, and when we work to recognise a patient’s value, it has the potential to address all of these challenges. This case demonstrates a couple of ways we can communicate to patients that they are valuable, namely empathy and hope, but there will be many other ways of doing this.

In conclusion, valuing our patients needs to be at the core of what we do. We cannot just perceive it as ‘icing on the cake’ on top of our practice but rather as the starting point for excellent patient care. If we consult in a way that communicates to our patients that they are valuable on a regular basis, we are providing a service and creating a culture where doctors and patients are better equipped to manage the distress of illness.

Taken from BMJ Case Reports – for original article please follow the link below

Everyone is valuable – BMJ Case Reports