‘She gloried in being a sailor's wife, but she must pay the tax of quick alarm for belonging to that profession, which is, if possible more distinguished in its domestic virtues than in its national importance’
There’s a lot of politics, power and persuasion in the book as a whole, but Jane Austen’s final words in ‘Persuasion’ would be worth us all remembering as we engage in our daily clinical work. For it is not in grand presentations, complicated policy development and the general prestige of being a ‘Doctor’ where I see our power; it is in our ‘domestic virtues’ and interaction with our patients as fellow human beings. If we promote these aspects of clinical care both where we work and to managers and politicians, we can truly call ourselves a distinguished profession.
Before you start thinking that I’m the one who needs medical attention for likening doctors to sailor’s wives, think about the last time you felt like you really made a difference. The Francis and Keogh reports remind us that the things that make us memorable as doctors are not our clinical acumen or ability to knock out a really smashing audit. Considering the former, it should be a given that we are constantly seeking to improve our clinical care, and the latter, well, how often are audits ‘really smashing’ (and how often are they a ‘tick’ in the career activity box exercise?). What makes the patient experience memorable in the right ways? It’s actually taking the time to talk to Mrs Jones about how she’s going to manage at home after her hip replacement, noticing that Mr Smith has been incontinent and needs his sheets changing, or making sure Mr Bloggs can actually reach his food and water. No matter how busy you are, we can make time for these things, especially if we all get involved.
I’m not ashamed to admit that one of my proudest moments since qualifying was receiving my first thank you card from a patient and their family. Do I remember exactly what I did clinically? Hell no, but I remember how ill the patient was when they came in, and the interactions I had with them and their families as we worked through his acute illness. What a privilege to be able to contribute not only clinically, but also emotionally and practically to someone’s care.
So to me, ‘Politics, Power and Persuasion’ is about less of the big words and top-down instructions from on-high. It’s about the baby doctors like me doing the simple things where we can, and taking proactive action on the important aspects of care that are currently being neglected. As an example, let’s look at how this might apply to one hospital challenge: Discharge Planning.
I’ll set a sample scene: Mrs Jones has been in hospital for three weeks. She was just about managing at home before she went ‘off legs’ and she came in with a UTI. Her daughter lives some 100 miles away and took a week off work initially, but now has had to go back to work. She hasn’t spoken to a doctor about what’s going on since then. Meanwhile, Mrs Jones got better initially, then whilst being assessed for discharge, got a hospital acquired pneumonia. She’s now medically fit for discharge but awaiting a BD POC.
A fairly familiar tale.
As junior doctors, we have a role in promoting and participating in simple aspects of her discharge planning, such as attending multidisciplinary team (MDT) meetings and ensuring an expected discharge date is clear. We can discuss this with Mrs Jones and her daughter (with consent) early on.
But the next step has to be our power, as doctors, to say that Mrs Jones sitting in an acute medical bed for three weeks when she was well two and a half weeks ago is simple not good enough. Why should it take two weeks to get a package of care? If that is not both a powerful and persuasive question, then I don’t know what is. Imagine how much happier patients like Mrs Jones would be, as well as the national budget, if we achieved prompt patient discharges. This is what doctors need to make politicians see.
Domestic virtues, where we look at our patients as people with a home, family, hobbies and a personality, are what we should be pursuing to achieve high quality patient care. If doctors can step up and do our bit locally, and tell those in power, and in politics, what it’s really like for our patients on the ground in order to achieve meaningful change, then I think we can hold our heads high.
Submitted by Karin Purshouse
