Ouch! When the "care" is missing from healthcare

This year I've been focussing on communication and empathy in health care.  Working with undergraduate students in a range of health care professions, I was heartened and optimistic about their views towards patients/clients and thrilled that they seemed to want to work with patients and their families in an empathetic way.  It was hard to reconcile their attitudes with the studies done by Monash University that show empathy declines during the course of study and falls off a cliff in the first year of work in most health professions.

This week, I've been face to face with the health system in New South Wales and I am completely disheartened and appalled.

My Dad required emergency treatment for a potentially life threatening condition.  He lives in rural NSW near a large regional city and another smaller country town.  He was admitted to hospital in the large regional city, but required a surgical procedure which could only be done at the nearest "tertiary hospital" which is the John Hunter Hospital in Newcastle.  After four days he was transported by air ambulance to Newcastle.  He was treated yesterday and seems to be on the road to recovery.

He's also on the road to nowhere.

We needed to get him back home after his treatment, about four hours or so away by road.  All family members who live nearby are unable to drive and the rest of us live in different states at opposite ends of the country.  We would need assistance to get him home, but were being told by the Doctor he could not travel by bus or train and then by a very cranky nurse that the Doctor didn't know what she was talking about and that of course he'd be fine to travel on the train.  Who should I listen to - the cardiologist or the nurse?

I swung into action, calling my contacts in ambulance and health to find out how to solve this problem.  All the advice I was receiving was that he should be transported home in the non-emergency patient transport provided by the ambulance service.  As a paid up member of the ambulance there would be no cost to him and there would be no cost to the hospital, but a Doctor needed to authorise the booking.

Hospitals are impenetrable.  They are lumbering institutions that require insider knowledge to get what you need and find who you need.  I took a deep breath and called the one number listed on the website.  I was put through to information.  Information put me through to a lovely Doctor who was in the intensive care unit and had not met Dad and knew nothing about his case.  Dad wasn't in the ICU.  I explained the situation to the Doctor and he agreed that suitable transport should be arranged.

No one called me back, so I called again and was put through to the Registered Nurse on Dad's ward. This nurse had the tone and attitude of someone who has forgotten what their job is all about.  She spoke to me like a naughty child, talked over the top of me, was impatient when I asked her to listen to me and dismissive of my concerns for my father.  She said she would talk to the social worker and hung up the phone while I was in the middle of explaining the family situation, including the fact that Dad had no clothes with him, only his pyjamas.

After 20 minutes, I called again.  I asked her why she had hung up on me.  Her response was that she told me she was going to speak to the social worker and she already knew what I was going to say.  Again, her tone was horrible.  I told her that I wanted to have a conversation with someone about my father's situation to get a better resolution than putting him on the train to a town he doesn't live in.  She then argued the point with me about where my father's home is, interrupting me again to confirm with my father where he lives.  As if I don't know where my father resides! I asked her to change her tone and speak to me with some respect and empathy for the situation and she told me that wasn't possible.  Apparently I had offended her when I said she was wrong about where Dad lives.  I asked to speak to someone who was interested in helping us, she said that wasn't possible either.

She then proceeded to shrilly tell me that I shouldn't be concerned.  He'd had his procedure and lots of people have the same procedure and he's fine! What's the big deal?  She said - in the most condescending tone possible - that Dad was sick when he came in and that's why he needed an ambulance.  The hospital had made him better, so he wasn't sick anymore and now he just had to go home.

Here was a blinding lack of empathy for me to confront.  I heard myself echoing something I said in the empathy workshops I facilitated during the year:  "This might be routine for you, but this is the most serious health concern my father has ever had.  It's the first time we've dealt with something like this and it is not routine for us.  I'm a long way away and trying to be supportive and organise everything on the phone from Melbourne, I need your help!"

She then advised me that normally the family would collect a patient.  Just what I needed - judgement.  I'd had no impact at all.  She had become institutionalised and part of a system that obviously sees the people who are meant to be served as an annoying inconvenience.

I asked to speak to the social worker.  "That's not possible," came the reply.

"Why not?"

"She's gone home for the day."

"What's the social worker's name?"

"I can't tell you."

"Why not?"

"I don't know her name."

"How many social workers are there?"

"One."

"And you don't know her name."

"No."

"Not even her first name?"

"No."

If this nurse had been empathetic to our situation she would have just told me that the social worker had gone home for the day and that she wasn't sure of her name but would leave a message for her to call me in the morning.  It didn't need to be that hard.

Even when I explicitly said I wasn't looking for a fight, she expressed frustration that she had become the meat in the sandwich.

"Why? What's the sandwich? Aren't we all working for the same thing?"

"What do you mean?"

"To look after my Dad and make sure he travels home safely."

She had no answer.  She was clearly viewing us as a battle to be fought and won.

It appears that the clinical care has been great.  Hopefully the procedure will make a big difference to Dad's health and well being.  Clinical care is not the whole picture though and I'm surprised at just how lacking the broader care has been.  In regional Australia, in this hospital, it must be common for people to be admitted to a hospital far from home and need to get back to where they came from after they've been treated.  I hate to think of all the other people facing the same dilemmas.  To be a patient subject to the a nurse who is a bully is a significant power imbalance - all at the time when you're trying to recover from surgery.  How can you advocate for yourself in this situation?

I've been researching about the hospital.  Like most big organisations these days they have a statement of rights and responsibilities for patients, including values.  Sadly, there is a big gap between the big statements of values and the lived reality for one patient and his family.

I really hope the awareness of the need for an empathetic approach to care will make a difference in the future.

Now, I'm off to research the complaints process.

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You might like to read this earlier post about empathy.

Emergency services call - communication failure.

My local ABC radio station just played the audio of a call to "000" emergency services.  The call was from a young woman called Penny Pratt and she was murdered soon after she made this call.  You can listen to the call here.

I've been working with medical students all day today, providing feedback on their communication skills, so perhaps I'm particularly attuned to communication flaws at this moment if hearing the call.

I don't know any more about the case and I certainly have never worked in the emergency services environment.  I imagine that it must be a fairly challenging communication environment, but I have never experienced it myself.  That said, I have worked in a call centre (debt collection for a bank) I teach communication and work with people to resolve conflict.  I understand what it's all about.

It sounds like the worker who took the call had lost sight of the needs and situation of a person calling emergency services and was putting her own needs first.  Empathy was absent.  Here we have a woman hiding in the bush from two men who have put her in fear of her life.  An empathetic person would recognise why the woman calling is whispering and a bit erratic in her communication.  She's in full "fight or flight" mode...she's HIDING IN THE BUSH!  She's not sitting at a desk or standing on the street making a call.  Two men are going to kill her!

The response from the worker who took the call reacts to the whispering as if the woman calling is speaking quietly to make her life difficult rather than imagining what it would be like to be in fear of your life.

The call quickly escalates into a power play where the operator is complaining that the caller is making it hard for her to do her job.  If it gets too hard, help will be withdrawn.  Details about the street name and suburb had been clearly stated by Penny Pratt, yet the operator asked for them to be repeated and then asked a question, citing a different suburb.  Instead of diffusing the emotion, the operator's tone, as well as her words, create conflict.  Suddenly Penny Pratt is facing conflict on two fronts - one she is running from and one from the person she has turned to for help.

This poor woman called "000" twice, asking for police assistance.  Neither of the calls were referred onto the police.  She was found dead soon afterwards.

I understand that there would be certain key pieces of information which need to be gained by the emergency services operator so that the call can be passed onto the relevant service.  However, in this situation, a person who is really listening to the words as well as the context would be able to hear that the police needed to get there very quickly.

This is all obvious, basic communication skills.  I am wondering what emotional support is given to the staff so that they have enough resilience to ensure they focus on the needs of the caller rather than their own needs.

I've called "000" on a few occasions, but never when my life is under threat.  I've usually been a bystander reporting violence to police or calling an ambulance for an ill commuter travelling on the same train as me.  Regardless of the fact that my life hasn't been under threat, I have an expectation that calling "000" will help me, efficiently and without fuss - not put me through the process wringer.

It must be awful for the call centre operator to know what happened to Penny Pratt not long after this conversation took place.

I hope that her employer focusses on improving training and support to staff rather than punishment or performance management.  I'd love to talk to the call centre operator and find out what was going on for her...what was the last call she'd taken?  What had happened to her that day? That week?  What else had she heard that day? Had her supervisor chipped her about something? Had she had some bad news? We're all human and carry our human responses into everything.

Mistakes, however tragic, all provide a learning opportunity.  I hope it's taken up.

When being one of the "best people" is dangerous.

"The best people possess a feeling for beauty, the courage to take risks, the discipline to tell the truth, the capacity for sacrifice."  

As I read this sentence from Ernest Hemingway I identified with his ideas.  These ideas align with my own aspirations.  

Then I read the next sentence:  "Ironically their virtues make them vulnerable, they are often wounded, sometimes destroyed."

I felt vulnerable just reading that and then I wrestled with my feelings.  Initially I wanted to argue with Hemingway, the writer I think of when I think of "masculine".  Then I started to think and remember.

Before I was a freelancer, I worked for a trade union in a variety of capacities.  I was an elected official for many years.  I was a campaign leader, a director, a negotiator, an industrial officer.  While I was doing it, I loved it.  It was challenging and dynamic.  Some of the battles were impossible, but it felt like they really mattered.  I took my role as an advocate and representative very seriously.  I had some wonderful colleagues and delegates to work with - some of these people remain important in my life.  There were others who I didn't enjoy being around, but recognised that we all shared the same values.  

What I didn't appreciate at the time was that "battle mode" was my default setting.  Sometimes the foe was recognisable because they were in the traditional role of employer or the conservative government.  Sometimes the enemy was less recognisable - they were the person sharing a table in the lunch room or reporting to me.  Being in battle mode meant putting armour on every day and being battle ready.  In terms of Hemingway's quote, I took risks regularly and it took courage; truth often looked different depending on who the audience was; I made enormous personal sacrifices in order to put the interest of members and working people before my own.  I still had a "feeling for beauty" but didn't have a lot of time to devote to it.  

I now know that this changed me.  I became quite hard.  Tough.  "Intimidating" was a word that was often used to describe me.  I hated that.  I didn't want to be known as that, even if it did mean I succeeded in meeting my responsibilities.  

At a music retreat about nine years ago, I had a life changing experience.  Before the celebration party, there was a ritual.  We were asked to think about what we wanted to let go of.  Then we were asked to find a natural object to represent that thing and bring it to the ritual.  I decided I wanted to give up my "hardness" and I found a stone to represent that.  

As we arrived at the door we were greeted.  The greeters held eye contact and physically "blessed" us (it wasn't a religious ceremony, more a spiritual one).   As I was being greeted, I felt a lump just under my sternum.  It moved up through my torso as I moved to the next stage of the ritual where I had my feet washed and dried.   As I was sitting there the lump was replaced by tears.  I started to weep, uncontrollably.  I held the stone and felt that I was indeed letting go of my hardness.  I placed the stone in a basket and all those objects were released into the ocean.

I was inconsolable for the next hour.  Raw emotion that had been bottled up for many years of being tough was now released.  Nobody thought I was weird, they seemed to know what was happening and I remember having my hand held by people I'd known for a mere four days, but who seemed to understand.

I felt different, refreshed.  The world looked different.  As the time to leave the retreat came, I became aware of my new found vulnerability.  I wondered how long I'd be able to stay "soft".  Would I be able to be like this and continue my work?   I was conscientious about this, but also aware of the need to protect myself.  That was not sustainable.  Spending time appreciating beauty and creating beauty helped but sometimes it was a struggle to fit it in.  Accidental opportunities did not often arise.

I'm pleased to say that I now spend a lot of time appreciating and creating beauty.  It has required a complete change in my life.  At the time, the change was traumatic and frightening, but now I know that it was the best thing.  It facilitated a way for me to live more truthfully.  

As I consider this now, I know that I am very fortunate.  I'm still drawn to work in conflict, but my mindset is completely different and my investment is different.  In a way, conflict resolution and facilitation is a way of creating beauty.  When human beings find a way to see past their differences there is beauty to be seen.

So despite the dangers, I do strive to be one of the "best people" as described by Hemingway.  Friends have told me that I'm nicer to be around too.

How about you?  Do you have balance in your life? Are you living truthfully?

Where do you stand in a conflict?

Flicking television stations last night, I caught a snippet of The Simpsons.  The Pastor and his wife were going through a rocky patch.  The Pastor asked his wife why they were always arguing lately.  She replied by saying they weren't arguing - arguing would mean they were speaking to each other.

I often find that one of The Simpsons (usually Lisa) has something to say which supports my work in various organisations.  Recently I was working with a group of leaders in one of Australia's oldest companies.  We were talking about the role of conversation in relationships with their teams and what happens when the conversation is a tough one.

The preparedness to have a difficult conversation implies an investment in the relationship.  If something at the heart of a relationship is wrong, unwillingness or avoidance to talk about it, suggests that the relationship is disposable. The Pastor's wife was almost saying that arguing would be healthier than the absence of talking at all.

One of the things I love most about my work is that I meet so many people every week.  Even though I am leading the learning, I always learn something from them.  Recently, I picked up the idea of "leaning into the conflict".  The person who told me about this said that usually when conflict arises, or there is a hard conversation to had, many people withdraw and won't engage because they don't like conflict.  As a result the conflict often goes on for longer than everyone would like.  He said he liked the idea of "leaning" into conflict because it was a gentle movement, rather than a startling, confrontational one.  How thoughtful!

On reflection, I discover some further ideas that flow from this idea: leaning also requires balance and consciousness about placement of one's body.  Leaning suggests to me a level of flexibility and the ability to shift position.  I love this idea as it provides a physical and visual queue or anchor - useful to hang onto when the adrenalin kicks in when we're in the middle of conflict.

I also have an opposite image for when I'm sitting in the role of mediator in conflict.  As someone who loves to problem solve and negotiate, I have to work consciously to let go of attachment to control of the conversation that occurs in a mediation.  One of the experienced mediators I learnt a lot from suggested I "feel the back of my chair" in those moments when I was tempted to intervene (or perhaps lean into the conflict!).  I now apply this idea when I'm facilitating a group. "Feeling the back of the chair" means leaning out, rather than in, removing oneself from the centre but still being present.

How to reconcile these two ideas? When I am a leader and have responsibility for people, or am in a relationship (any kind of relationship) where something isn't right, I need to decide whether the relationship and the people matter.  If they do, then leaning into the conflict is a helpful queue.  When I'm an outsider and working in the service of other people ( as a facilitator or mediator), then knowing when to feel the back of the chair can create ownership of the problem for the people who are having the problem.

Both of these stances are non-threatening and if done mindfully and genuinely in alignment with thoughts and feelings can have a powerful effect.

When it comes to conflict, where do you stand?