Five nights into a hospital stay after surgery for a congenital heart condition, Beatrice Liddell was uncomfortable, unable to sleep and, she recalls, “really miserable”. Unsure what else to do, she pressed her bedside buzzer.
“It was the middle of the night. I had on a body brace, which I hated. I was just fed up,” recalls the 28-year-old from Kent. A nurse appeared. “She knew there was nothing specifically wrong with me, but she let me explain. She rubbed my back and chatted to me.”
Finally, Liddell, then aged 22, fell asleep. “I was in the same situation, but I felt so much better. I believe it helped me recover.”
It is the kind of anecdote that delights Dr Rana Awdish, an American intensive care doctor whose book, In Shock, published this week, makes the case for healthcare which is as compassionate as it is clinically cutting-edge.
“We have so much to offer now in terms of medical care,” she says. “But if we don’t really know who we are doing it with, are we treating people or just treating disease?”
Compassion and communication – bedside manner, in common parlance – are buzzwords in healthcare. One of the five Care Quality Commission’s inspection criteria, the extent to which services are caring, is the one most often rated good or outstanding in their most recent annual report.
In those instances where it goes awry, though, the impact is clear. A YouGov survey last year found that poor attitude accounted for more complaints about GPs (32 per cent) than misdiagnosis (20 per cent).
During one hospital stay, Liddell recalls that she saw a fellow patient given very bad news, quickly and publicly. “The doctor didn’t even close the curtains,” she says.
Rachel Power, chief executive of the Patients Association, hears many accounts of insensitive communication. “Sometimes, it is simply crass and distressing, but at other times it means patients get an inaccurate impression of their medical issue – or even that they don’t get essential information,” she says.
Evidence of communication’s impact not only the emotional response of patients but also on their health outcomes – for instance in the British Medical Journal in 2015 – continues to grow.
“We are at a spinning point,” says Awdish. “The existing system is not sustainable and we are transparent about that. When you distil medicine down to basic elements you get to relationships. I do believe that affects outcome,” she says. Medical care at its best, she believes is “a focussed, scientific form of empathy”.
Awdish runs communication training for colleagues at the Henry Ford Hospital in Detroit and across many other American hospitals and medical schools. This month she was invited to speak to British doctors by the charity Point of Care Foundation whose conference, in March, is entitled, Making Healthcare More Human.
The realisation that such interventions were urgently needed came to Awdish in the most shocking of circumstances: As she herself lay in an intensive care bed while doctors – her own colleagues– discussed how to save her life.
In 2008, Awdish, then seven months pregnant with her first child, had been having dinner when a vague, not- quite-right feeling suddenly transformed into “a breathtaking wave of pain”. Within hours she was in emergency surgery, a huge haemorrhage – from a then undiscovered tumour on her liver – having killed her unborn baby and triggered a series of organ failures.
“I heard the team in the corridor saying that I had ‘been trying to die on them’,” she says. Earlier, in the drama of theatre, another doctor had described her as “circling the drain”.
She was not merely angered by the insensitivity and jocularity of the words. “I was scared what it meant for my life,” says Awdish. “It felt like they’d put me on an opposing team. Were they giving up on me? That was a terrifying feeling.”
The impact of the way things are said by medical professionals was, Awdish says, something she had not truly considered before. “I thought surviving critical illness was all that mattered. Yet months after I did just that, I was haunted by those doctors’ words. I was having nightmares about drowning.
“I was astonished at how vulnerable I felt as a critically ill patient,” she continues. “The senses are awakened in those moments, you are adrenalised and the memories are powerful.
“I was completely dependent, my identity and control gone. How as doctors could we possibly believe we don’t need to build trust?”
The time pressure on doctors is – she knows from the inside – inescapable. Failing to communicate appropriately is a false economy, though. “If you spend 15 minutes talking and no one hears anything, you have not advanced the patient’s care at all.”
When Awdish did feel that her fears were understood, the relief was enormous. “I didn’t have to be the holder of my anxiety. I could focus on getting better.”
Bedside manner, then, is not a woolly, laudable idea, Awdish says – it’s a clinical necessity. “A doctor should not simply be the voice of medicine. We need an authentic partnership between physician and patient.”
In 2013, Chris Pointon and his wife Dr Kate Granger founded the “Hello My Name Is…” campaign. Granger, an NHS consultant in geriatrics, was receiving in-patient treatment for cancer.
“We realised one day that hospital staff weren’t always introducing themselves, and it had a huge impact on us,” says Pointon. “Being given that most personal thing – a name – seemed a simple first step to better relationships and more compassionate care,” says Pointon.
When they announced the badge scheme, the response on social media was immediate. “It was sad that we got so many replies, really.”
Since Granger – “an amazing doctor, even more so after her experiences as a patient” – died in 2016, Pointon has been invited to hospitals around the country and beyond to share the campaign’s values: effective, personally tailored communication; attention to the little things (“being at eye level with a patient, for instance”); seeing patients as individuals and putting them at the centre of every decision.
“Kate and I talked often about making a difference to others. She wanted her legacy to be in better communication,” says Pointon. The hashtag #hellomynameis has since been shared nearly 2 billion times.
“When Kate was first told the cancer had spread, the consultant was holding her hand. He asked if she wanted anyone else there. Then they both sat in silence for a few moments.” In the bleakest of situations, says Pointon, “it made such a difference”.
For Beatrice Liddell, whose heart condition has necessitated multiple surgeries and on-going regular medical tests, moments of real understanding and kindness such as this are vital. “They stay with you forever.”