Viv Lucas, Medical Director, Garden House Hospice, Letchworth Garden City, UK, explains the background to his longer article published in the March/April issue of the European Journal of Palliative Care
Recently a hospice inpatient remarked to me how important the attitude of doctors and nurses is, that in the hospice she felt listened to and understood, that if she asked for pain relief she received it quickly. All of this helped lessen her anxiety. I hadn’t said anything to invite these comments, and on that day there was no need to alter her medications, just listen. Of course, we should never underestimate the value of ‘just’ listening. Her words resonated with me because in my 20 years as a hospice medical director I have grown in the conviction that it is the relationships that we have with our patients and their families that is the essence of palliative care. Hopefully this is ‘stating the obvious’ to you, as we say in English. But these relational aspects are often undervalued in contemporary health care where what can be easily measured in terms of interventions and outcomes often obscures what cannot; statistics trump relationships. This view is too narrow when applied to hospice and palliative care. It strikes me that we don’t spend enough time stressing the relational aspects of our care and that this often is the intervention, or an integral part of it.
I often talk to colleagues, patients and families about the hospice being a ‘healing environment’ having spent much time reflecting on what this means, my interest spurred on by having studied for an MA in Medical Humanities at the University of Wales, Swansea between 2002 and 2006. I read a lot; literature and academic works, including a book called, ‘Empathy and the Practice of Medicine’.1 We all acknowledge the importance of empathy when relating to our patients, that as part of our ‘skill’ set we must ‘demonstrate’ it; but do we spend much time really getting to grips with it?
So I began to look in more depth at the concept of empathy, not only from a humanities perspective, but also the neurobiology of it. I learnt that the scientific understanding of the how human interactions are therapeutic has grown. 2 After I heard Sara Booth deliver the Abe Guz lecture on Breathlessness in 2012 at the Palliative Care Congress in Newcastle, I contacted her. In her lecture she stressed the importance of relationships in alleviating breathlessness. We met up, had some great discussions and subsequently collaborated on a paper 3 in which we summarise the healing power of relationships in the context of palliative care, enhancing understanding of the science of the art of caring, of which empathy plays a key part.
1. Spiro H et al. (eds) 1993 Empathy and the Practice of Medicine: Beyond pills and the scalpel. New Haven and London: Yale University Press.
2. Benedetti F 2011 The Patient’s Brain: The neuroscience behind the doctor-patient relationship. Oxford: OUP.
3. Lucas V, Booth S. The importance of placebo effects in enhancing palliative care interventions. BMJ Supportive& Palliative Care 2014;0:1-5. doi:10.1136/bmjspcare-000571.
To read a copy of the full article…
This blog post relates to a longer article, ‘The art and science of empathy’ by Viv Lucas, published in the March/April 2014 issue of the European Journal of Palliative (vol. 21.2). If you already have a web-based subscription to the European Journal of Palliative Care you will be able to download this issue, plus all articles in the journal archive. You can also browse the archive and download articles by taking a 10-minute or 30-minute subscription. Members of the EAPC receive discounted subscription rates to the journal – click here to subscribe online.
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