A wish list for ideal care

Of course it had to happen when I was least prepared for it—that is, my need to seek urgent care. As a card-carrying member of the system that provides that care, I confess that I had a degree of wariness about how I would be treated, and feared the worst. To my great pleasure, that proved to be far from the truth. I received kind, timely, and considerate care, and consequently was proud both of my profession and of the colleagues who work alongside us.

But I was a privileged patient, and I did from time to time see interactions with other patients that made me pause. Virtually all of these centred on a lack of kindness, which regrettably is one of the first features of care to be skipped in a pressure-filled environment. Words and attitudes matter: it takes no more time to say “I can see you’re in pain—we will get to you as soon as we possibly can” than “Take a seat, and we’ll call you when we have a bed,” but the difference for the patient is profound. Patients who overhear themselves described as “the knee” or “the migraine” are bound to feel diminished. Unfortunately, kindness can’t be mandated in providing care. The best we can do is to demonstrate it as often and as clearly as we can in our own actions, and hope that all our colleagues reflect what we do.

So if I develop a serious condition that requires the best possible care, what—in addition to kindness —will I want? Having given this a lot of thought over the years, I have a pretty daunting list of requirements for my medical attendants, but I surely won’t have a hope of receiving most of the items on my list. This is because they are so patient-centred that even I think I’m being unreasonable—to a degree.

First, I would want the physician who is providing my care to see me as an individual, not as a case with characteristics vaguely like those of patients with similar complaints. I would want someone who listens and tries to understand what I am feeling and what I am most concerned about. I wouldn’t want simply to be crammed into the nearest category of management. I would want a physician who is honest and open, but who will know when it is important to soften the tough information. Oh, and I would expect my physician to be comfortable working collegially with others, or as part of a team. I would not want to have treatment provided by a lone wolf or a maverick.

My goodness, this does sound self-centred. But remember, this is not a realistic list, because next I would expect that whatever investigation or treatment is necessary would be provided immediately, and with no cost to me. The treatment I need to have would be evidence-based, but would also take into account (as far as possible) the subtle things that make me different from other people of my age. I will want to know everything, good and bad, that I might expect from this treatment. What will it feel like? I would probably (but not definitely) want to have my care provided as part of a clinical trial, because patients enrolled in such trials tend to have better outcomes that those having, one-off treatment.

Okay, enough. Physicians reading this may think “in your dreams.” But real patients? Perhaps not. Committees developing guidelines for management of complex health issues tend now to include patient representatives, because the things that a patient will be most concerned about are often simply not seen as being important by physicians. Physicians, reasonably, focus on outcomes, but patients will also focus on the path to getting better. I’m aware that only in a publicly funded, comprehensive health care system would my wish for free care be possible, and I’m in no position to criticize policymakers for not doing their best with the resources they are given. But my recent experience as a consumer of care, rather than a provider, has given me a perspective that I hadn’t expected, and henceforth I hope to keep this list in the back of my head. So what kind of care would you want?

Timothy C. Rowe, MBBS, FRCSC, FRCOG. A wish list for ideal care. BCMJ, Vol. 58, No. 6, July, August, 2016, Page(s) 301 - Editorials.

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