Good Practice Reading tasks 1 Photocopiable Cambridge University Press 2008

Dignity and the Essence of Medicine: the

A, B, C, and D of Dignity Conserving Care
1 a Look at the title of the text above and think about the meaning of Dignity
Conserving Care. How do you think this is best achieved?
b Brainstorm possible meanings for each letter of the mnemonic ABCD.
c Scan the text and check.
2 a Read Part I of the text and answer the questions.
1 What does the author mean by suggesting that healthcare workers could act
as a mirror for the patient?
2 Small acts of kindness can have a bearing on the rest of a patients care.
How might this be the case?
Part I
Introduction
Perceptions of dignity are most strongly associated with feeling a burden to others
and a sense of being treated with respect. As such, the more that healthcare
providers are able to afrm the patients value that is, seeing the person as they
are or were, rather than just the illness they have the more likely that the patients
sense of dignity will be upheld. The intimate connection between care providers
afrmation and patients self perception, underscores the basis of dignity conserving
care. The notion of dignity conserving care, while emerging primarily from palliative
care, applies across the broad spectrum of medicine. Whether patients are young
or old, and whatever their health problems, the core values of kindness, respect,
and dignity are indispensable. The simple mnemonic A, B, C, and D of dignity
conserving care may remind practitioners about the importance of caring for, as well
as caring about, their patients.
A
Healthcare providers rst and foremost need to examine A their attitudes and
assumptions towards patients. However the perceptions on which attitudes are based
may or may not reect the patients reality. For instance, is a health worker more
likely to assume intoxication in a confused, homeless patient, before considering
whether they have a metabolic disorder? Patients look at healthcare providers as
they would a mirror, seeking a positive image of themselves and their continued
sense of worth. A case in point: inordinately high suicide rates among Scandinavian
patients with advanced cancer, who were ofered no further treatment or contact
with the healthcare system. While the rationale for this may have been based on
considerations of resource allocation or medical futility, the psychological and
spiritual fallout is clear: people who are treated like they no longer matter will act
and feel like they no longer matter. In turn, healthcare providers need to be aware
that their attitudes and assumptions will shape those all-important reections.
Good Practice Reading tasks 2 Photocopiable Cambridge University Press 2008
B
A change, or at the very least an awareness, of ones attitudes can set the stage for
modied behaviour the B of dignity conserving care. Healthcare providers
behaviour towards patients must always be predicated on kindness and respect.
Small acts of kindness can personalise care and often take little time to perform.
Getting the patient a glass of water, acknowledging owers on a bedside table these
behaviours convey a powerful message, indicating that the person is worthy of such
attention. Such behaviour is particularly important when caring for patients with
advanced disease both because of the physical threats of dying and because of the
challenge to our sense of self worth and self coherence. Certain intimacies of care
require special mention taking the time to ask patients their permission to perform
an examination will make them feel less like a specimen and more like a person
whose privacy is theirs to relinquish under mutually agreed conditions. This quality
of professionalism and connectedness also increases the likelihood that patients will
be forthright in disclosing personal information, which so often has a bearing on
their ongoing care.
b With a partner, devise a set of questions for self reection to ensure that when
meeting a new patient your attitudes and subsequent behaviour doesnt inuence
the care you give.
Example: How would I be feeling in this patients situation?
c Compare your ideas with the rest of the group.
3 Take a minute to reect on an instance in your professional or personal life where
your behaviour made a difference. What was the situation and what was the eventual
outcome?
4 Read Part II of the text and answer the questions.
1 To what extent is compassion intuitive?
2 According to the author, how can you go about improving your level of
compassion?
3 What kind of information might you miss if you didnt communicate adequately
enough with your patient? Give your own (or a possible) example of this.
Part II
C
Like empathy (identication with and understanding of anothers situation, feelings,
and motives), compassion is something that is felt, beyond simply intellectual
appreciation. It refers to a deep awareness of the sufering of another coupled with the
wish to relieve it. For some healthcare providers, compassion may be part of a natural
disposition that intuitively informs patient care. For others, compassion slowly emerges
with life experience, clinical practice, and the realisation that, like patients, each of us is
vulnerable in the face of ageing and lifes many uncertainties. Compassion may develop
over time, and it may also be cultivated by exposure to the elds of humanities, social
sciences, and the arts: reading stories and novels and observing lms, theatre and art
that portray the pathos of the human condition, or discussions of narratives, paintings,
and inuential, efective role models. Each of these will not speak to every healthcare
provider, but they can ofer insight into the human condition and the pathos and
ambiguity that accompany illness. Although the process of arriving at compassion
can be difcult or complex, showing compassion often ows naturally and can be as
quick and as easy as a gentle look or a reassuring touch. In fact, compassion can be
conveyed by any form of communication spoken or unspoken that shows some
recognition of the human stories that accompany illness.
Dignity and the Essence of Medicine
Good Practice Reading tasks 3 Photocopiable Cambridge University Press 2008
D
The D of dignity conserving care, may be the mostand the leastimportant
component of this framework. At its most basic, dialogue must acknowledge
personhood beyond the illness itself and recognise the emotional impact that
accompanies illness. Dialogue should routinely be used to acquaint the healthcare
provider with aspects of the patients life that must be known to provide the best
care possible. Treating a patients severe arthritis and not knowing their core identity
as a musician; attempting to support a dying patient and not knowing he or she is
devoutly religiouseach of these scenarios is equivalent to attempting to operate
in the dark. Obtaining this essential context should be a standard and indispensable
element of dignity conserving care. It will also foster a sense of trust, honesty,
and openness, wherein personal information and medical facts are woven into a
continuous and rich dialogue informing care.
Conclusions
Easy to remember and empirically based, the A, B, C, D framework may be readily
applied to teaching, clinical practice within the healthcare profession; relocating
humanity and kindness to their proper place in the culture of patient care. For anyone
privileged to look after patients, at whatever stage of the human life cycle, the duty
to uphold, protect, and restore the dignity of those who seek our care embraces the
very essence of medicine.
Harvey Max Chochinov, Professor, Department of Psychiatry, University of Manitoba, Canada
Adapted from BMJ 2007; 335:184-187 (28 July)
5 The author talks about acknowledging the person and knowing the patient. Brainstorm
the following:
1 Statements that indicate you acknowledge the person.
Example: I can only imagine what you must be going through.
2 Questions that show you want to know the patient.
Example: What should I know about you [as a person] to help me take the best care of you
[that I can]?
Dignity and the Essence of Medicine