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Independents' Day

Bringing kindness back into medicine

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If someone asked you if you were a kind person, I imagine you’d probably say yes. I liked to think I was. It’s sort of a given I thought, when you’re a doctor.

But I’ve had a couple of hospital jobs in my training where I must admit I had began to grease the cogs along a patient’s journey with more of a sense of irritable productivity, rather than heartfelt affection. The outcomes were the same, I think. But it didn’t sit well with me, and I couldn’t quite put my finger on why.

I realised that it was the glue that was missing in the job I was in

As the months passed, I started to look around me more closely. Something was missing. Nebulous words like culture and compassion floated around in my subconscious as I tried to work it out. Or was I just trying to find a scapegoat for the assembly-line shift worker mentality that had crept up on me?

It was around this time that I stumbled across the book ’Intelligent Kindness’. Before reading this, I thought of kindness as one of those hard to define, soft, sentimental concepts. The sort of fuzzy word that gets sprinkled into a junior doctor’s reference when the supervisor can’t think of much else to say. Something that we find easy to spot as a humbling quality in others. But not so easy to put into words.   

But this book changed my view. Kindness, the authors suggest, is derived from our sense of connectedness with others. It’s linked to the word ‘kin’, and is ’generated by an intellectual and emotional understanding that self-interest and the interests of others are bound together, and acting upon that understanding’.

It hit the nail on the head for me. I realised that it was the glue that was missing in the job I was in. Yet having spent many long night-shifts working side by side, I felt sure the staff were not unkind people. But hearts were being hardened, skepticism creeping in, and imagination silenced. What had gone wrong?

Here’s what I’ve come to understand: in our system, kindness has been relegated to the edges, to the ‘desirable but not essential’ box.  It’s been sidelined to make way for the technology, guidelines and regulation that flood our day-to-day practice; an attribute branded as naive and idealistic. Instead, we cling to an air of professional detachment and independence in the clever, technical business of healthcare.

And yet, having spent some time in hospital accompanying a relative recently, I was reminded that it’s the acts of kindness, or the absence of them, that really colours the experience of being a patient more than anything else.

Like the hostess on the ward, whose ear-to-ear, unwavering smile accompanied her offer of tea every morning, and is now etched in my mind when I recall that admission. Or the radiology administrator, who spent a little extra time rearranging all the outpatient scans for the same day so that we would minimise our time off work. Without us even asking. Looking back now, it was acts like these that made it possible to cope.

The message that resurfaces time and again throughout the book, and the one that seems most pertinent when I look back at my experiences, is really the simplest of all: the best way to nurture kindness in others, is to treat them with kindness themselves.

Working in the NHS, we inhabit an uncomfortable void that’s too easy to forget. Day after day, thousands of us are in touch with existential anxieties that trigger our most primitive feelings. Physically, it’s the ‘damage, the pain, the mess they encounter, the sheer stench of diseased human flesh and its waste products’ as the authors of the book put it, but even more harrowing I think are the emotional extremes. Being flung from one end of the spectrum of power and helplessness to the other, the undercurrent of uncertainty in every decision we face, and grappling with the highly charged emotions of patients, day in day out. And all the while we’re expected to provide kindness unreservedly, often without much exposure to it ourselves.

So what can we do? Throw kindness into another list of expected competencies for healthcare workers? Squeeze it into our documents at every opportunity alongside other evangelised words like ‘compassion’ and ‘altruism’?

I’m not sure. But I’ve come to understand that a simple place to start would be reinstating its importance, to place it on a pedestal alongside the polished clinical competence we all aspire to.

Most importantly of all, staff need to feel kindly treated themselves. They should step into a system where kindness is constantly modelled and valued by their leaders. They need to feel safe, empowered, and able to reflect and learn from mistakes. And not treated as untrustworthy tools tasked with delivering unstinting kindness, in spite of the endless resharpening, rearranging, and occasional finger pointing by the workmen that employ them. Scandals like mid-Staffordshire have shown us the danger that can surface when we let a web of kindness unravel. And whilst this is an extreme example, the dynamics that produced it are still frighteningly present in our system.

It doesn’t need to be a Disneyland crusade of niceness. We’ve all seen it. Kindness is embodied in the simplest of gestures: knowing your name, saying thank you once in a while, and listening to and valuing your opinion.

Because when it comes down to it, before we reach for our pens, pills and power tools each day, we are all trying to connect with and care for anxious people at their most vulnerable. And we need leaders to recognise that psychosocial dynamic. Leaders that understand the emotional labour involved, and dish out kindness themselves in heaps, even at times when we might struggle to do so ourselves.

It’s not really too much to ask. 

Dr Nishma Manek is a GP trainee in London. You can follow her on Twitter @nishmanek

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Readers' comments (8)

  • Well said, Dr. Manek. What you describe can & does happen in ALL walks of life.That's why, with experience & maturity we all have to learn our own personal limitations of giving in order to avoid the otherwise inevitable outcome of compassion fatigue, cynicism & burn out. Who cares for the carer ? Look after yourself !

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  • I like this article a lot...its really well written and its core meaning is correct. The system sometimes hardens us because of the various factors at play during a consultation- fear of litigation, censure, complaint....... its often tough to navigate simple requests when taking these other considerations into account.

    well done Dr Manek and best wishes in your future career!

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  • Azeem Majeed

    Thank you Nishma. A very well-written and thoughtful article.

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  • Thank you for an excellent article. We need to remember to take time to be kind to one another, ourselves, and the patients. It is this gentleness that makes "the system" human. All we need to do is to recall the privilege that we have been given - as doctors, nurses and others - of journeying alongside the vulnerable - and treasure both them and one another (and I suspect that this means us becoming vulnerable in our turn - which is a big ask). Above all to realise that we see before us a person - not a "task", or an Illness - and respect the uniqueness above all....

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  • Is it possible to be 'cruel to be kind'?

    I also think the GP partners has to be kind to each other and the other staff in the surgery. Where I have worked, it is usually like a pack of lions eating a fresh kill and there is a pecking order.

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  • This article really resonated with me. It is often the small acts of 'kindness' that make a huge difference to patients (and staff) at times of stress - or even just as part of everyday interactions.
    Random acts of kindness bring solace or cheer not only to the 'recipient', but also to the 'giver'.
    Who wants to live in a world where tick boxes and targets take priority over simple humanity.
    I fully appreciate that time pressures and ever increasing workloads can numb us into robotically doing our jobs, but my underlying principle (which I am the first to acknowledge I don't always achieve) is to treat others as I would like to be treated myself.

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  • Lovely article! I burst out laughing when you mentioned : Junior dr's reference when the supervisor can't think of anything else : haha. We need more kindness all around agree.

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  • Yes kind to be cruel fits in this
    If we adopt the policy treat a person in front of you as you would like to be treated (unless a person is 'heartless') that's enough for me
    We give induction to the new employee in the practice, treat the patient as if you were on other side of the counter.
    9out of10 staff get the message and one remaining one is not suitable to work with us. It has so far never failed us.

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