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And the greatest of these is empathy – a series of reflections on the NHS at 70

June 2, 2018

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It is one of the most amazing things about being human that we can find ways of communicating, verbally and non-verbally, about how we feel. At its best, our sense of emotional connectedness is our great strength as, as a species. Its absence lies at the heart of many acts of neglect and cruelty.

Nowhere is that quality more important than in the relationship between caring professionals and those they care for. An empathy which can see, listen too and feel another person’s distress and provide support, reassurance or just a sense of being there. In mental health, but also in physical health, it is the quality, more than anything else, distinguishes outstanding care. It can not be prescribed or, necessarily, planned for but its absence is felt profoundly.

Empathy is a quality which we learn at our mother’s breast. Supported by early parental love and support we learn to make the good attachments which are so fundamental to our sense of wellbeing. So many later problems of mental distress and emotional development can be dated back to early difficulties in making attachments.
Yet empathy is often a quality we neglect in the planning and management of healthcare at the expense of more tangible things such as technical knowledge or the narrow counting of activity and outputs. Yet, to use the words of the poet R.S. Thomas it is “the pearl of great price, the one field that had treasure in it.”

I spent a fascinating evening, last week, with one of our clinical teams which works with children in local primary schools. The team is largely drawn from trainee child psychotherapists, who have come from a wide range of professional backgrounds, clearly motivated by a desire to help children experiencing distress and other emotional and developmental difficulties. They were talking about some of the cases they were dealing with and, in particular, the feelings of both children, families and therapists in dealing with endings. I was humbled by the commitment of the group and by their recognition of the need to make an empathetic connection with the children they were trying to help. When they succeeded in doing so it was for them indeed “the pearl of great price” but it often required great patience and thoughtfulness to reach that point.

It has long been a tenet of the Tavistock clinic, where I work, that you can not see the needs and emotions of those being cared for from those of the individuals who are attempting to provide care. Caring, while being surrounded by distress, is an emotionally demanding task. However willingly people come into working in healthcare the fact needs to be recognised alongside the conflicting emotions relating to a sense of the recognition that it is not always possible to provide more than “good enough” care.

When we look at the use of resources in the health and care services it is essential that we factor in sufficient time and support to allow the impact of caring responsibilities to be processed and the capacity for empathy to be restored. There are a variety of approaches for how this time can be organised: Schwartz Rounds and Balint groups are some of the best known. However, what ever approach is taken, there must be mainstream ownership and proper recognition of this activity in the allocation of resources. This is so crucial at a time, when rightly, there is a focus on issues of productivity and the proportion of time which is spent on the delivery of care.
The voice of service users and carers is also crucial. It provides the narrative for understanding what it means to live with the distress of illness and disability and should set our benchmark of what constitutes good and bad care. In essence, it helps set a common language of empathy.

I have long believed that stories, as much as quantitative facts and data, are an essential ingredient of education for health and care practitioners. They always form for me the most important part of Board meetings, setting the tone and context for other discussions. When things go wrong it is the story of what happened and the emotional impact it has had on all concerned which makes the biggest difference in defining what needs to change.

As we approach the 70th birthday of the NHS let us remember more than anything else the sense of empathy which motivates our collective desires to set up and maintain a health service for all. A sense of empathy which can feel out for the suffering of others, knowing that, at some time, we too will need its support and care.

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