(This gorgeous canvas was gifted to my gentle daughter, who is going into nursing school this fall).
Six years ago, near the beginning of my career in the world of patient and family centred care, I was at a Family Centred Care Conference hosted by a pediatric hospital. I was in a session that was facilitated by the wonderful Peter Rosenbaum. He broke us into small groups, and asked the question: Family Centred care is…. Each group had to fill in the blank.
One nurse stood up and said, rather angrily, I don’t have time for family centred care. I was sitting at a group of family representatives. We all audibly gasped. No time to introduce yourself? No time to smile? No time to make eye contact? Family centred care is all those small gestures that mean a lot to patients and families. It is these small demonstrations by health professionals that show us that you care.
One element of family centred care that does takes time is listening. Making space for people. Listening with your whole self. Minimizing distractions. Not rushing or appearing rushed. And yes, sometimes you can effectively listen to what patients need in thirty seconds. But many times listening means slowing down, pulling up a chair and sitting down for a while.
Alas, our health system does not compensate for this types of kindness or compassion. Our Canadian system is either based on fee-for-service (see as many patients as possible) or it is driven by the need for efficiencies. I’ve always been wary of philosophies in health care that are modelled after processes in car factories. For human beings are not cars. An interaction with another human being includes taking the time to get to know each other. This is the only way to create a relationship that is built on mutual trust.
Dhruv Khullar wrote a poignant essay in the New York Times earlier this month called The Importance of Sitting with Patients. In it, he laments a system that is so focused on the ‘altar of efficiency’ that it forgets the importance of sitting with patients. Should hospitals really be run like businesses? Does the race for efficiency sacrifice empathy? I concur with Dr. Khullar and say yes, in its current form, it does.
But here’s what I think. Visionary health leaders can add measures for compassion in performance reviews, hire based on both heart and brains, share patient stories at committee meetings (or even better, invite patient reps to committee meetings), and celebrate acts of kindness in their hospitals. If they can somehow figure out a way to compensate for listening, well then empathy can indeed function alongside efficiencies.
I read an unattributed quote on Twitter, and I think it is brilliant: health care should be less about the care, and more about caring for people. Less about services, more about serving people. And caring and serving does take time. Having worked in health settings for the past six years, I now feel for that nurse who stood up at that conference and said she didn’t have enough time to practice family centred care. Because the health system has slowly but surely stamped out her passion for caring for people.
As Dr. Khullar says, there is tremendous value in having more time to spend with patients. Let’s continue to build our own altar of empathy. Six years later, I believe now, more than ever, that love always wins. I know that it is the gentle people, like my own daughter Ella, who are going to change the world.