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Cleverness is not better than kindness



Amid all the hoo-ha about whether nurses should have a year of healthcare assistant work built into their contract, an important thing seems to have been forgotten.

I won’t pretend to know the first thing about how nurses should be trained, though it seems a little hasty to imply – as the government seems to – that a whole profession have lost their drive to care for patients. I’ve known some brilliant nurses, representatives from every stage of the career ladder. The era that they trained in seems irrelevant to their ability to exercise their humanity and to make sick people feel safe and well cared for.

What’s worst in all of the debate is the pejorative way that healthcare assistants’ roles are often viewed. I seem to be harping back to my hospital days a lot recently but I have to say that working on a stroke unit taught me never to underestimate the good that a healthcare assistant can do.

A lot of what we did as doctors was a percentage game – there’s an x% chance that Mrs Smith, with her AF-induced embolism, will benefit from starting warfarin. The risk of bleeds (and the hassle of the blood tests) amount to quite a bit less than x%, according to the best available evidence. So you explain this to her and her family, and if everyone agrees, she goes onto warfarin. But you never get a chance for a 100% gain.

Once, whilst standing at the nurses’ station tinkering with a drug chart, I overheard a conversation that wafted through the Ångstrom-thick privacy curtains. A healthcare assistant was attending to a gent who had suffered a massive stroke two days previously. On Monday he had walked five miles but Wednesday saw him wake up in a pool of faeces that he was unaware he had passed.

Weeping with shame, he was gulping and pleading with the HCA, ‘Please, you shouldn’t have to, it’s too disgusting, don’t. Please, leave me.’ She was calming him, saying quietly, ‘It’s OK, it’s OK, it’s what I’m here for. It’s OK.’ Gradually, the tears were subsiding as she cleaned him.

I wish I could have done something as unequivocally good as that. Perhaps I did and perhaps some of the decisions I made did stop future strokes, or lessened the impact of those that had already happened.

But healthcare assistants are not skivvies and if a task is technically simple, that doesn’t mean it wasn’t valuable beyond measure. However much our technical capabilities grow, cleverness is not better than kindness.

Dr Nick Ramscar is a GP in Bracknell, Berkshire