Ensuring every patient is treated with respect and dignity

2 MINUTE READ

from Luke’s Journal 2020 | Ageing Gracefully | Vol.25 No.3

“Hi, I’m the doctor in emergency. Do you want us to treat your grandmother aggressively or what? Your family can’t decide so that’s why you’re on the phone.”

“What’s wrong with her?”

“I don’t know but she’s 96.”

Sadly my grandmother’s case is not isolated. Working in medicine it becomes apparent that the worth of the generation that lived through wars, drought and economic crisis can be boiled down to a number. Since when did everyone over the age of 80 automatically earn themselves a label of ‘medical futility?’ When did we give up on the generation that has given so much to us? When did these legends of the past lose the basic right to be informed of their options? The last of the ‘doctor knows best’ generation, elderly patients can be particularly vulnerable in healthcare encounters as they are more likely to accept the advice of treating medical professionals without question or complaint. 

Even though the bedside manner of the physicians involved in Grandma’s care improved, the attitude towards her treatment did not. 

“You need to prepare yourself that this might be it for her. She may never recover.”

I found myself wondering if we were talking about the same person as my grandma sat bolt upright in bed happily drinking her tea and talking about the ride in the ambulance. 

My grandmother may have been 96, but she loved her life. She was certainly more frail and forgetful, but she still had her mind, for which we were grateful.

Thankfully my grandmother did live to fight another day. She returned to the nursing home excited to see everyone, regaling the adventure of the ambulance. 

“When did we give up on the generation that has given so much to us?”

It has only been a few weeks since my grandmother passed. Every breath was on her own terms. She died with dignity and in peace surrounded by family.

The journey to that point has not been peaceful, but my family and I take comfort in the knowledge that she is now at complete peace with her Lord and savior, the ultimate physician and healer. 

Several days before she passed we were once again faced with prejudice directed at grandma’s age. 

“You may want to discuss with the doctor about rationalising things.”

At the time grandma had been sleeping for longer periods of time and eating less. Despite this she remained happy and well, eating and taking her tablets. Once again we were faced with changing her management while she appeared to be coping. Several days later she was reviewed by the GP having refused her medication that morning. We ran into the GP in the corridor who mentioned they may ‘change a few things’. My mother didn’t know what that meant but she trusted the medical team. I approached the doctor to clarify the plan. It seemed that she had ceased all of Grandma’s medications and commenced her on regular oral morphine. 

There was no explanation for us as a family. No discussion about a change to medications. No reasoning was given, nor was there an explanation of the dying process or what we may expect over the next few days, weeks and months. 

While the outcome would have been the same, the process was horrendous, stemming from an apparent disregard for the value of someone’s life due to their age. As a family we constantly felt we were fighting for grandma to die with dignity in her own time.

We all have attitudes, experiences and beliefs that influence the way we practice. It is important to practice self-reflection and self-awareness as to what influences not only our attitude towards each patient but also what influences how we communicate with families and make decisions about a person’s care. 

The concept of Communication Accommodation Theory (CAT) was first described by Howard Giles.¹ CAT encompasses the concept that each person brings their own beliefs, experiences and perceptions to a conversation which influences how words are spoken and received.^2,3 In our communication we can be ‘accommodating’ or ‘non-accommodating’. Accommodating behaviors are when a practitioner adjusts their language, speech, tone and manner to meet the needs of a patient.⁴ Accommodating communication may involve open-ended questions, listening, explaining, inviting input and expressing understanding which create a friendly, polite and compassionate atmosphere. This approach requires the practitioner to see the patient as an individual with their own story and unique needs and has been shown to be is perceived positively by the patients.³

“In my case. the doctor in ED had seen my grandmother … as a member of the over-90s club in whom the discussion of medical investigation and management was futile.”

Non-accommodating communication commonly occurs in cases where the recipient is unable to communicate for themselves or is perceived to be of a different societal group. These encounters are more likely to occur when the patient is seen more as a member of a societal group as opposed to an individual with their own unique story and needs. Non-accommodating communication includes closed questions and use of medical jargon and subsequently leads to the perception of hostility and ‘rudeness’ by patients and families.³ In my case, the doctor in ED had seen my grandmother not as an individual person who enjoyed a good quality of life. Instead they saw her as a member of the over-90s club in whom the discussion of medical investigation and management was futile. 

Age is more than a number. It does not determine a person’s worth. Capacity to make informed decision about one’s own health can be influenced at any age. Patient-centered care means looking at the person beyond the number. 

Every patient needs our time, attention and compassion. 

Every patient should have their medical management thoughtfully considered in light of their physical and mental health. 

Every patient and their family has the right to hear all medical options in order to make an informed decision. 

I want every one of my patients and their families to have the hope that I have. It is my belief that there will be a final day where there will be “no more death or mourning or crying or pain, for the old order of things has passed away” Rev 21:4).

I’ve heard it said: “Few people will see a priest, but most will see a doctor. You may be the only Bible someone reads that day.” We can be a witness, showing our belief through our work, ready to give an account to our colleagues. We can be the difference and ensure every patient is treated with respect and dignity. 

---

References:

1. Giles H. Communicative effectiveness as a function of accented speech. Speech Monographs 1973; 40: 330-1.
2. Farzadnia S, Giles H. Patient-Provider Interaction:
   A Communication Accommodation Theory Perspective. International Journal of Society,
   Culture & Language 2015; 3: 17-34.
3. Baker SC, Watson BM. How Patients Perceive Their Doctors’ Communication: Implications for Patient Willingness to Communicate. Journal of Language
   and Social Psychology 2015; 34: 621-39.
4. Hehl J, McDonald DD. Older Adults’ Pain Communication During Ambulatory Medical Visits: An Exploration of Communication Accommodation Theory. Pain Management Nursing 2014; 15: 466-73.