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The little things matter
Dr Kate Granger, a Specialist Registrar in Geriatric Medicine currently working at Leeds Teaching Hospitals Trust, is terminally ill with cancer. Here, in another intensely personal blog, she explains why trust in the people caring for you is so vital:
I am blessed to be looked after by some of the kindest, most dedicated doctors the NHS has to offer.
But what makes these people – my Oncologist, my Palliative Care Consultant, my Urologist and my GP – kind and dedicated? Why do I trust them implicitly with the management of my cancer and related health problems? Why do I feel able to share with them sometimes very personal and distressing thoughts? What makes these people different from other doctors I have encountered on this journey and struggled to build a rapport with?
I believe much of my trust in these professionals has been built upon behaviours they all exhibit which I refer to as ‘the little things’.
In my mind ‘the little things’ aren’t little at all, they are indeed huge and of central importance in any practice of healthcare. When I say ‘little things’ I mean someone sitting down next to you rather than standing over you; someone holding your hand when you’re upset or distressed; someone taking that extra moment to really listen and allow you to express your fears; someone recognising you are in pain and being gentle when they examine you.
I have just been through a cycle of palliative chemotherapy for a recent progression in my cancer. Consenting to further chemotherapy was a hugely difficult decision to make, knowing that without treatment my life expectancy was going to be measured in weeks, but also being fully aware of how much suffering I was about to expose myself to given my previous experiences.
The support I received to make this decision was however, superb. My Oncologist spent a great deal of time gently exploring all the options at my level and my Palliative Care Consultant let me use her as a sounding board with her fantastic listening skills.
In both interactions I felt truly at the centre of what was happening. I was not being told what to do and there was definitely a partnership in decision making that respected my own views, ideas and concerns. This support helped me to accept treatment as the right way forward at that particular time. Because of their skills and ‘the little things’ it felt as though I had consented to treatment on my own terms.
When the first cycle of chemotherapy was complicated by febrile neutropaenia and I ended up hospitalised, feeling physically very unwell and psychologically consumed by second thoughts regarding my decision to pursue chemotherapy, both my Oncologist and Palliative Care Consultant were there for me. They intuitively understood. They sat down. They listened. The ‘little things’ were on full display helping me to feel supported and allowing me to express my distress openly.
Compassion is the buzz word in the NHS at present. We, as healthcare professionals, are all constantly being told to be more compassionate. We hear stories of compassion failure every day in the media. I believe giving proper consideration to ‘the little things’ however, goes a long way to increasing the compassion we display to our patients, helping them to feel supported, respected and cared for during illness, at what is often the most vulnerable time of their life.
I recently took a family member for his chemo to a Bury St Edmunds hospital. Because the chemo was delayed by well over 2 hours, in the time he was there he saw 4 nurses, only one of whom paid attention to the ‘little things’. She was a model of quiet, thoughtful, courteous, care & treated him as a human, rather than as a problem to be solved. She was the one who introduced herself properly, smiled, asked him a couple of questions about his family & home, kept him informed about the resolution of the problem that had led to the chemo being delayed, & who revealed something of her personality without imposing it on him. She was kind & ordinary in the best way. Unlike her colleagues she didn’t appear to simply be going through the motions in a bored way, & was also the only one who acknowledged my existence (one plonked a chair on my foot without apology). A good experience in which the patient does not feel alienated can hang on apparently very trivial things, what someone once described as ‘the small ceremonies of belittlement’. Thank you for your blog, Kate, & I send you my very best wishes.
I really admired what Kate said and the way she said it on radio 4 this week. So sensible and sincere.
Hi, this is the type of attitude i breach over and over again, it is pleasing to hear others are of the same opinion. Just knowing someones name can be so so reasurring and make a pt feel so much more at ease, along with the name add a smile,(a smile is extremely contatious and one will follow another) those 2 things that take no extra time or effert have, from the onset told a pt you are caring, approachable, ready to listen, don’t feel they are wasting your time. We all need to remember, that for some, it may be their first experience of hospital life.
i must also add how important it is for staff to acknowledge a pt with an hello and smile when they are transfered from one department to another, continuity. please continue your good work, take care xx
I so totally agree with you. These ” little things” are priceless and especially in a clinical setting. Kindness is worth it’s weight in medicine. Unfortunately some people although very clever maybe, are not always kind. I wish you peace of mind