Treating the mind AND the body. Imogen Mitchell on putting the 'person' back in 'patient'.

1. Through the Patient’s Eyes
@IA_Mitchell
2013/14 Harkness Fellow, Johns Hopkins Bloomberg School of Public Health

2. Cutting for Stone: Abraham Verghese
Dr Stone, Professor Of Surgery:
“My son’s terrible death is not something I will ever get over, but perhaps in time it will be less painful. But I cannot get
over one image, a last image that could have been different. Before I was asked to leave the room in a very rough
manner, I must tell you that I saw my son was terrified and there was no one who addressed his fear. The only person
who tried was a nurse. She held my son’s hand and said, ‘Don’t worry, it will be all right.’ Everyone else ignored him.
Sure, the doctors were busy with his body. It would have been merciful if he had been unconscious. They had important
things to do. They cared only about his chest and belly. Not about the little boy who was in fear….I saw no sign of the
slightest bit of human kindness. My son and I were irritants. Your team would have preferred for me to be gone and for
him to be quiet. Eventually they got their wish. Dr. Stone, as head of surgery, perhaps as a parent yourself, do you not
feel some obligation to have your staff comfort the patient? Would the patient not be better off with less anxiety, less
fright? My son’s last conscious memory will be of people ignoring him. My last memory of him will be of my little boy,
watching in terror as his mother is escorted out of the room. It is the graven image I will carry to my own deathbed. The
fact that people were attentive to his body does not compensate for their ignoring his being”

3. Cutting for Stone: Abraham Verghese
“What treatment in an emergency is administered by ear?”
“Words of comfort”

4. Modern Medicine
• Large leaps in medicine
penicillin, CT scan, cancer treatments, HIV treatment, intensive care
• Life expectancy (years)
1964 2014
Female 74 84.1
Male 67.79 79.7

5. Patient Experience: GP/Regular Doctor

6. Why?
Patient becoming invisible?
Patient is unseen and unheard?

7. Collision of Events
2009

13. Alice’ Mother
“I still believe that either someone or something failed my daughter on that
weekend.
……..a seemingly total lack of clinical assessment and decision making
affording early intervention in order that her deterioration was halted

14. From the Other Side
• Lack of Control
The sense of helplessness
• Fixate
Focus on small things
• Emotional Roller Coaster
Terrified

15. Leigh and Lisa
• Stepped into their Shoes
A young man, with a wife, a 2 year old and one on the way who I thought would die if he did not receive
ECMO
• Closed the loop
He and his wife came back to our ICU to say “thank you”
• Humbled
Fundraising for ICF in rural NSW, in one night raised $30 000

16. My Mother
• Effects of Stress
Sensible people can be too traumatized to think clearly in times of desperation
• Effects of Separation
Why do we need to keep locking families out?
• Extraordinary Trust
Need to always remember how much trust patients and their families put in us
“We are but a guest in patients’ lives”

17. Alice’s Mother
• Loss of Control
Alice’s mother allowed me to step into her shoes and feel the emotion of watching someone struggle for
life and seemingly nothing happening
• Fill the white space
Communication, communication, communication

19. Patient Centred Care

20. Patient Centred Care
providing the best quality care,
which includes the best possible experience for the patient
partnerships based on dignity and respect, information sharing, participation and collaboration to
the extent that people choose
improving the health service by using the knowledge, skills and experience of people who are
using, have used or may use the health service

21. Policy Framework: Patient Centred Care
Australian Safety and Quality Framework for Health Care, 2011:
describes a vision for safe and high quality care for all Australians
safe and high quality care is:
consumer centred | driven by information | organised for safety

22. 22
Patient-centred care and outcomes
Evidence that patient-centred care is associated with improved safety and quality,
lower costs, improved patient and provider satisfaction
Emerging evidence of benefits including:
decreased mortality
improved care
lower length of stay
fewer medication errors
lower infection rates
fewer diagnostic tests and unnecessary referrals
reduced costs

23. Vidant Health, Greenville, North Carolina
• 2011: Partnerships with patients and families
• 2012: Home Care Patient Experience surveys
Improved from 50th to 85th Centile
• Changes related to introductions and the wearing of uniforms
• Appointing patient and family advisors
• 50% reduction in hospital acquired infections in 2 years
• 73% reduction in serious safety events since 2007.
• RN turnover decreased from 15.26% in 2008 to 5.18% in 2011

24. How can we improve the patient and family experience?
3 Simple Things

25. 1st Thing:
Make the Small Things Count

26. 1st Thing: Make the Small Things Count
“Want Drs to sit down, tell them their name and smile!”
“Lisa did not want to leave and was sitting next to my bed trying to share my pillow. One of the
nurses offered to get her a pillow and they closed the curtains and dimmed the lights to allow Lisa
to sleep for a while”
“Wardsman… Not once in my complete state of vulnerability was I self conscious with these guys.
My impression was that they brought a quiet but strong calming presence whenever they were
around which in turn had a calming influence on me”
“They just appeared to care about what they were doing and that I and my family were important to
them at that time. They were human, and were affected and that was reassuring also”

28. 1st Thing: Make the Small Things Count
“he sat down on my daughter’s bed, started to explain the procedure she was about to undergo
but at the same time expected me to read the consent form and sign it…at no stage did he
introduce himself. I assumed he was the orthopaedic registrar”

29. 1st Thing: Make the Small Things Count
Kate Granger: 32 Aged care trainee
July 2011 diagnosed pelvic sarcoma
Chemo
@kategranger 20K followers
http://drkategranger.wordpress.com

30. 1st Thing: Make the Small Things Count
• Admission to hospital via ED
• Noticed multiple doctors, nurses or support staff did not introduced themselves
• When they did it made such a different to the person who was there
• #hellomynameis
• Went viral
• Adopted by a number of NHS hospitals

32. 2nd Thing:
Turn tradition around

33. 2nd Thing: Turn tradition around
• IHI, CEO Maureen Bisognano
“What matters to you?”
• What are your patient’s goals”
mowing the lawn
gardening and being able to kneel

34. Jennifer Rodgers RN
York Hill Hospital
Glasgow, Scotland
“What matters to me”

35. 3rd Thing:
Make time to Listen

36. 3rd Thing: Make time to Listen
• Know your patient
Develop a relationship/connect
Build trust
Acknowledge your own vulnerability
• Understand their story
Make an accurate diagnosis and manage appropriately
• Welcome concerns and complaints
Opportunity to review, reflect and acknowledge that you may have got it wrong

37. “Pretty simple but I felt that she [the ICU nurse] treated me 'normally' and it was like her job
came second to connecting with me. The simple act of speaking to me regardless of whether
she knew i could hear her or not showed she saw me as doing worth her time”

38. And so
• Make the Small Things Count
introduce yourself
• What Matters to the Patient?
what are your patient’s goals?
• Make the time to Listen
know your patient

40. Change the paradigm of the socialisation in medicine
Patients are people