I don’t remember much of what happened during that fateful visit to the Emergency Department. I remember the on-call cardiologist saying something to me about my “significant heart disease”. After hearing those words, I felt so stunned that – although I could see his lips moving and could hear sounds coming out of his mouth – he may as well have been speaking Swahili. (Doctors, please remember this in the future when delivering life-altering diagnoses to your patients!)
What I do vividly remember, however, is a small but profound act of kindness later that day when I was brought to my bed in the CCU (the cardiac intensive care unit). The nurse who came to greet me as my gurney was pushed off the elevator placed one gentle hand on my shoulder (and more importantly kept it right there as she walked alongside down the long corridor). As we moved, she bent lower over my head to speak slowly and softly into one ear, introducing herself and assuring me that I was “in the right place” – and that her whole team would do their best to take very good care of me while I was with them.
Kindness is a kissing cousin to courtesy and respect. I’ve written about modern medicine’s distressing lack of each, specifically when we encounter, for example, E.R. staff posting on Facebook about that day’s trauma patients, health care professionals talking over their patients as if they were invisible pieces of meat on a slab, or hospital staff not bothering to introduce themselves.
The concepts of courtesy and kindness from our health care providers is, in fact, far more important than many professionals realize. In Dr. Iona Heath’s British Medical Journal review of the book called Intelligent Kindness, she wrote:
“Anyone who has been seriously ill knows that it is the individual acts of kindness, thoughtfulness, and sensitivity on the part of healthcare staff that make it possible to cope with the panic and indignity of a failing body.
“Kindness helps healing.”
U.K. physician and writer Dr. Jonathon Tomlinson certainly knows this, too. He believes that kindness is strongly linked to holistic or ‘whole person’ care – as he wrote in his powerful blog post Do Doctors Need To Be Kind?
“We care more when we are involved with the care of a person, not just an organ. The increasing industrialisation and specialisation of care is undermining both continuity and holism, as one specialist attends to the heart, one to the lungs, one to the kidneys and so on.
“In nursing, different grades come and go: one for washing, one for feeding, another for dressings and another for drugs, and yet another to explain what is going on. When the patient breaks down in tears, the on-call psychiatrist (or psychiatric nurse) is called.”
He also cites psychotherapist Michael Balint, author of the classic 1957 text about the doctor-patient relationship, The Doctor, His Patient And The Illness:
“This is what he referred to as the ‘collusion of anonymity’ in which ultimately no one takes responsibility for the person because each professional is only responsible for their organ of specialist interest.”
I once wrote about similar research findings that found (surprise!) that medical care actually improves when physicians consider the whole person. For example:
“When doctors treat their patients like whole persons who have a full and complex life outside of the hospital or the doctors’ waiting room, things get better.
“When doctors actually listen to what their patients are telling them – and ask questions about what they aren’t – things get better.
“When doctors take the time to find out more about what Dr. Victor Montori and his Mayo Clinic-based team describe as the “burden of treatment” that’s particularly common in those patients living with one or more chronic diagnoses, things get better.”
Dr. Montori (author of the amazing little book called Why We Revolt) works on an innovative perspective toward what he calls “careful and kind care” in medicine called Minimally Disruptive Medicine. It’s like kindness in action. This perspective encourages health care professionals to remember that a number of factors are actually at play for many patients who might appear at first blush to be simply non-compliant (arrrgh! that word again!) As he explains in this essay on careful and kind care:
“Kind care requires us to the see the patient in their rich context, including their history, their aspirations, and their strengths and limitations in light of their struggles. In particular, it requires us to respect the scarce resources they must mobilize to access and use care and to enact self-care we recommend for them. We need to develop a deeper understanding of the work associated with being a patient, of the capacity available to shoulder that work, and how life affects both.
“Signs of kindness would be to not waste people’s time or effort and to stop describing them as being non-adherent or non-compliant.”
Managing this burden of treatment can feel like overwhelmingly hard work. Dr. Montori believes that caring about what’s really going on for such patients can have a profound overall effect:
“A patient’s education level, literacy, state of depression, pain, fatigue, social connectivity and supports, financial status – all of these affect a patient’s capacity to do the work.
“The workload can simply exceed capacity to cope.”
A 2008 New York study reported in The Annals of Family Medicine found that physician qualities like kindness were so important to the Latina women being studied that the absence of such qualities affected what medical information these women were even willing to share with their doctors.(1)
Much of this interaction, however, depends largely on health care professionals’ ability to empathize – to imagine what it’s like to walk in the hospital booties of their patients.
So it’s shocking for many people to learn that, even among naturally kind and empathetic medical students, studies suggest that empathy for others begins to wane by the third year of med school as students progress. This is particularly true, apparently, for future doctors entering technology-oriented specialties – like cardiology.(2)
Some people prefer the concept of responsiveness rather than empathy. As psychiatrist, Harvard professor and author Dr. Robert Berezin describes this concept, responsiveness is a process of emotional receptivity in which “one is directly tuned into and involved with the other person with no reference to oneself at all.”
That sounds like kindness to me.
Dr. Tomlinson adds that this response has little to do with being competent in providing expert physical care to patients. But it’s also dangerous to believe it’s somehow acceptable for a graduating med student to have one trait (competence) without the other (kindness). As he says:
“A consequence of competence without kindness is that we take physical symptoms at face value without exploring their meaning or psychological impact.”
But it may not have always been like this in the practice of medicine, as cited in a must-read essay by pioneering cardiologist Dr. Bernard Lown who describes how he treated his own heart patients during his remarkable career:
“We encouraged optimism. We addressed social and family problems. We discussed significant psychosocial stresses. We minimized shuttling patients to other specialists. Foremost, doctors spent much time listening, thereby fostering trust and adherence to prescribed lifestyle changes.
“We did much FOR the patient and as little as possible TO the patient.”
So in the end, what can be done to increase awareness of the importance of basic kindness in our health care?
Dr. Tomlinson argues that kindness grows with familiarity, and that we intuitively care more about people who are close to us. It’s why continuity of care needs to be valued and built into healthcare systems. This matters, he explains, especially for patients with longterm medical conditions, in that when they must keep coming back for appointments, they know the professional they are meeting. He advises his medical colleagues:
“We need to start talking about kindness. We need to talk about the value of kindness in healthcare and agree that it has been neglected and that we need to take action.
“Everyone involved in health leadership and policy should read Intelligent Kindness. In summing up her BMJ review, Dr. Iona Heath wrote: ‘If I ruled the world, I would arrange for everyone who wields any power to be locked in a room until they had read it.’
“Once we have agreed that it is important, we need to do something to institutionalise kindness. We must focus on patients by improving continuity and a holistic approach to care.
“And in order to be kind to patients, we must cultivate kindness between and towards ourselves.”
(1) Kell Julliard et al. What Latina Patients Don’t Tell Their Doctors: A Qualitative Study. Ann Fam Med. 2008 November; 6(6): 543–549.
(2) Chen DC, Kirshenbaum DS, Yan J, Kirshenbaum E, Aseltine RH. “Characterizing changes in student empathy throughout medical school.” Medical Teacher. 2012; 34(4):305-11.
Q: Can you recall a particular kindness that affected your own health care?
NOTE FROM CAROLYN: I wrote much more about common courtesy in health care in Chapter 1 of my book, “A Woman’s Guide to Living with Heart Disease”. You can ask for it at your local bookshop (my preference!) or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from my publisher, Johns Hopkins University Press (use their code HTWN to save 20% off the list price).