The Place of Dignity and Compassion in the Medical Care of People

The British Government has launched a ‘dignity and care’ campaign with 4,500 NHS health care staff; the plans are to provide training courses on compassion for these employees. It would not surprise me if the HSE takes up on the NHS’s initiative. Surveys within the NHS have shown that many health care personnel view their medical duties as a series of mechanical tasks rather than a series of human interactions. This lack of compassionate responding to and the dignifying of individuals who are ill and distressed are viewed as having a counter-therapeutic effect. Indeed, the research findings suggest that dignity and compassion may have an even greater therapeutic effect than the actual medical therapies or surgeries being carried out. This claim is not new – bedside manner has always been seen as critical to the medical care of a person.

Whilst treating symptoms is necessary, thoughtfulness and care are also needed to help someone truly feel better. Indeed, Professor Hugh McKenna of Ulster University last year asserted that within the complex maze of health services what is needed are staff members who are prepared to enter into relationship with their clients and to foster hope rather than hopelessness. The British NHS in its constitution has listed compassion as one of its core values and it pledges that staff ‘find the time to listen and talk when it is needed, make the effort to understand, and get on and do the small things that mean so much – not because we are asked to but because we care.’ The NHS are determined to find ways of measuring compassionate caring. In my view, the qualities of compassionate care are:

The French philosopher, Jean-Jacques Rousseau, sums up compassion very well when he says ‘there is no greater wisdom than human kindness.’

However, the emphasis on there being ‘a pill for every ill’, on routines and systems and the pressures on the health services have eroded the place of heart in the medical care of individuals. However, what the NHS in Britain do not seem to be addressing is one, that health care personnel are very much at risk themselves when they are not compassionate in the carrying out of their duties and two, that many health care employees do not experience compassion from their managers in their interactions with them. For example, stress related illness and absenteeism are high among the major body of health care personnel – nurses – and yet there does not appear to be the presence of any effort on the part of managers to compassionately respond to this worrying phenomenon. For example, a nurse was telling me recently of her having missed work due to a stress-related illness. On her return to work she was called to the nurse manager’s office and told that her absenteeism was not acceptable. When she protested about the levels of stress she and other nurses were under, she was told she needed to go the Employment Assistance Officer to learn ‘better coping skills.’ It appears to me that it is the manager who needs to learn more effective and compassionate managerial skills. These managers might defend themselves by saying that they, too, are under pressure from higher up the ladder of power to have staff on wards and in specialist units. However, nurses could engage the same defence by asserting that they are under pressure within what appears to be a highly mismanaged national health service.

When staff or managers are under pressure, then resolution of these pressures is required. It is a bit too much to now ask health care staff to go on courses on how to be compassionate in their profession. Don’t take me up wrongly here. I believe the proposed training is vital for an effective health service but if ‘charity starts at home’, so does compassion. When health care personnel are not compassionate in the carrying out of their duties, it is important to see that this deficit puts not only their clients at risk, but also themselves. I believe it is in our nature to love and when that is repressed or suppressed in daily work practices then the health care person is now ‘psychologically’ distressed and may well have accompanying embodiments of that inner turmoil.

I do hope – because it was not directly expressed – that the training in compassionate caring will be offered to all health care professionals, in particular, managers and medical consultants, who sadly, are notoriously known for their lack of compassionate responding. Incidentally, compassionate responding is not just a responsibility for those of us who work in the area of health care; it is also a responsibility for individuals working in all professions – education, finance, industry, politics, etc.

Dr. Tony Humphreys practices as a clinical psychologist and is author of several books including Whose Life Are You Living?