2019; Volume 20, No 2, February

Featured Article

IAHPC Board Member Emeritus Dr. Derek Doyle compresses a lifetime of experience into a few best practices when speaking to patients.

Let Us Review Our Practice Priorities: ‘Secret’ tips for better patient care

From the earliest days of hospice and palliative care, wherever it was taught and whatever the languages used, it was recognized that workers needed more than clinical pharmacological skills. They needed to be able to converse with obvious compassion and, above all, to be clearly understood.

Those of us who work in hospice and palliative care are — or should be — like missionaries, taking every opportunity to both tell and demonstrate to other carers some of the ‘secrets’ of what we do, and why people seem to appreciate them.

For a few minutes, let us throw away our modesty! It helps when putting into practice these ‘secrets’ that I learned to rely upon.

1. Bend to hear, and be heard

Every patient I have ever spoken to has said how they appreciate us getting down to their level, either by kneeling or sitting in a low chair by the bedside. It is important to never stand at a bedside, or from the foot of the bed, and look down on them, as some doctors and nurses do.

2. Enlist the power of a pen

Every patient has told me how they wished that they had pen and paper beside them to write down what had been explained to them. (Let me interject here to note that it is worth admitting that most doctors and nurses explain things far too quickly, and seem to forget that newly admitted patients may hardly have slept the night before.)

3. Be open to contact

By all means leave your name and title with the patient (‘Don't hesitate to tell someone you want to see me when I’m free’), but never assume that patients will know (or visibly appreciate) what a famous or wonderful person you are!

4. Were you understood?

Always — yes, always — ask if the patient has understood what you have explained or said to them. If the answer is ‘no,’ try again: use different words, or simpler sentences, or speak more slowly.

5. Expect to talk about dying

You are a palliative care nurse or doctor, so expect to be asked about dying. The person may ask when that might happen, and suggest who they want to be by their bedside as the end approaches. You can also ask who they would most like to stay with them, for instance, after daytime visitors have gone home and a long, sleepless night may be in store. Or they may wish for a special someone to be with them as they sleep.

Communication is #1

Having read many curricula and examination papers sent to me by hospice and palliative care units in the last 40 years, I am more convinced than ever that, important as they are, pain relief and symptom control are not the most important topics for intensive training, demonstration, and evaluation. That honor goes to communication: communication by doctors, nurses, and patients; closely followed with communication and support by the palliative care physician or family doctor.

My favorite demonstration

I would like to tell you a very personal anecdote. In the years immediately before my retirement from Edinburgh University’s School of Medicine, I was granted permission by the Dean to give a series of lectures, including a demonstration on ‘How best to upset patients!’ It was a tongue-in-cheek display of doctors’ actions guaranteed to provoke anxiety: the dramatic drawing-in of breath when measuring blood pressure, the chilling effect of a doctor’s exclamation "Oh, dear me!" when he or she looks at an X-ray, the agony experienced by the patient and their relatives when the doctor falls silent, and so on! Those lectures were voted as the best teaching students experienced in their six-year course.

What thrilling opportunities you all have now!

Editor’s note: If you enjoyed this column, you may appreciate Dr. Doyle’s speech, ‘The Essence of Palliative Care: A personal perspective,’ given at a conference at The Royal Society of Medicine in 2004. You can access it here.

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