The best time to practice compassionate, attentive care is today

The ICU nurse positioned the mirror in front of my face.

“You look more like yourself now, Dr. Berk,” she said.

She was right! The nurse, whose name was Meghan, had just shampooed, dried and brushed my hair. Clean and coiffed for the first time in over a week, I appeared normal — except, that is, for the tubes sticking out of my left nostril and my mouth.

It was 2009, and my eighth day in the intensive care unit. I’d had a serious bicycle accident that resulted in a spinal cord injury at C3-4, initially paralyzing me from the neck down. (Before I was transferred to a step-down unit, I would spend ten days in that ICU and 21 days on a ventilator.) During the entire 129 days that I spent in the hospital, I had many wonderful providers but the one interaction that stands out most clearly nine years later involved the day that Meghan — using a “no-rinse shower cap” — washed my hair as I sat in my bed.

Over my 30-year career as a cardiologist, I have tried to deliver compassionate, high-quality, evidenced-based care to my patients. But thanks to that experience in the ICU, I now realize that as much as we physicians debate, intellectualize and wring our hands over how much we really can help our patients — and how the current health care system often makes that so challenging — we may have overcomplicated the issue. It’s very often the small things, the simple acts of kindness, that can make the biggest difference.

Almost every medical school applicant states at least once in their interview that an important reason they want to be a doctor is “to help people.” Because they know so little about the diseases that afflict people, and the barriers and complexities of the health care system, their desire is genuine and laudable: They want to make people feel better.

Don’t we all wish that we could easily do that now? Well, as Meghan and others showed me when I was a patient, we can.

Here’s how: I have found three essential qualities that can enable us to interact with our patients so that we can make them feel better. They are compassion and attentiveness delivered with good communication skills.

  • Compassion: We need to show we care.
  • Attentiveness: We need to pay attention to show we care.
  • Communication: We need to communicate to our patients about things that matter to them. By doing that we convey and demonstrate to them our compassion and attentiveness.

These three qualities are frequently introduced and implemented in health care organizations through programs called “patient- and family-centered care.” In 2010, we initiated such a program called the Strong Commitment at the University of Rochester Medical Center (named for Strong Memorial Hospital, our major inpatient facility) that focused on these three qualities. Over the last seven years, we have observed significant positive changes in both patient and staff satisfaction, accompanied by a 20 percent improvement in the overall hospital rating compared to national benchmarks.

Several studies seem to support our experience in Rochester: a review by Desai concluded that providing patients and families with an individualized discharge plan (transferring physician’s contact information, a detailed list of follow-up appointments, and a 24/7 telephone contact number for problems) was associated with improved outcomes. Goldfarb and colleagues showed that patient- and family-centered care–focused interventions in the ICU shortened length of stay, although there was no increase in survival.

In addition to compassion and attentiveness, another essential quality for patients in medical settings is safety. It is only when you feel safe that you can trust your providers and their care plans. Back in 2009, I was very fortunate because almost every night I had an LPN who wrapped me up in a blanket and made me feel safe. I had to roll over every two to three hours in bed to not develop a bedsore. Like many people with spinal cord injury, I was very sensitive to cold — especially my arms. However, one LPN named Bess had this special technique of wrapping me up as if I were in a cocoon. I felt warm, safe and protected — and I slept better as a result. Advanced technology enables us to make new, more accurate diagnoses and better, more personalized treatments; but human touch, compassion, and attentiveness remain essential human qualities on the road to recovery.

The best time for you as a health provider to begin to practice compassionate, attentive care is today. Start by smiling when you enter the patient exam room. End by giving them a hug; or at least put your hand around their shoulders. In between listen to them, and look them in the eye as you do. Show them you care.

As I look back on my experiences since my accident, I am reminded of the Maya Angelou quote: “I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” It is very easy after a devastating blow to your health to become depressed and apathetic; there is no time when compassion and attentiveness are more important than those first weeks and months after a severe illness, because the memories we are left with are how we felt. Nothing is more important for recovery than feeling hope, support, and love.

Thanks, Meghan, for reminding of these essential caregiving truths.

Bradford C. Berk is director, University of Rochester Neurorestoration Institute, University of Rochester Medical Center, Rochester, NY.

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