This past month has been one that I would not wish to repeat again. However, with all situations lessons can often be learnt and making time for reflective thought can lead to improvements in the future. Over the past month, a close member of my family was unexpectedly taken into hospital and sadly died two weeks later.
Times like this are never easy and I don’t wish to dwell on the emotional side of loss, but one thing I know as I move forward is that I would certainly approach requests from staff for emotional leave far more sympathetically. It is almost impossible to estimate the emotional impact on each individual when crises arrive in their lives. This difficult time has taught me that.
What I would like to consider here is the importance of good honest communication in times when patients, or their loved ones, may have questions they need answering. There is no substitution for provision of prompt, honest answers, despite the complexity of the question and the gravity of the response required. I found immense difficulty getting through on the phone to the hospital ward, even before I spoke to anyone. On more than a few occasions, I left messages asking for a call back and never got one. On other occasions I would get through only to be told there was no one available to speak to me and I should phone again later. I did, only to go through the same thing again.
The lesson I learnt here was that it is always vital to have someone available to answer a patient’s question and make sure that, if this is not possible immediately, a specific call-back time is arranged and carried out.
Having someone available is one thing; answering the questions is totally another. It may come as a bit of a surprise to some, but when a patient or relative asks a question they do not always expect, or want, to hear good news in the answer. What they want is a clear, understandable answer that allows for decisions to be given with confidence and preparations to be made for poor prognostic outcomes, if necessary. The last thing that is needed at this stage is a ‘smoke and mirrors’ reply.
An example often used in optical circles is the answer to the question posed by someone with age-related macular degeneration (AMD), especially wet AMD, namely ‘will I go blind?’ So, often an answer is something along the lines of ‘no, you will always have vision to the sides’. We all know that the patient may well suffer severe central visual loss, despite treatments available nowadays, giving rise to serious visual impairment, which result in major restrictions on lifestyle.
Giving the true answer may be hard for the clinician and result in needing to spend longer outlining the prognosis and signposting the individual to other services. While the patient may be hoping for a better answer, what the patient really wants is the truth. Understanding the outcomes of the answer allows the patient and their relatives to take ownership of the situation. Fudged answers, and less than factually true answers, may allow the clinician to avoid emotionally stressful conversations but do the patient a great disservice and, in my opinion, highlight profound clinical deficiencies in that clinician.
No one likes to impart bad news but that is one of the responsibilities we take on as clinicians. Luckily, as optometrists, we rarely get called upon to answer the ultimate questions, ‘will I die?’ or ‘is my relative going to die?’ But we do often get asked questions like, ‘will I go blind?’ How we answer those questions defines our true clinical abilities.
In my case, even when my relative was within one day of death, I still could not get a meaningful answer to very fundamental questions. Answers like, ‘your relative is poorly’, or ‘your relative is very poorly’ were commonplace. Questions like ‘will they die?’ were met with answers like ‘they have a lot of things wrong with them’, or ‘they have lived a long time.’
No one was willing to give a meaningful answer. I likened these answers afterwards to being given the elements of an equation including the equals sign by the clinician and being expected to work out the solution for myself. That is not what a patient wants at any stage. All that happens is the patient realises the clinician either does not know what is going on or is trying to evade responsibility. This instils grave doubts as to the clinician’s competence in the patient or family member’s mind.
What I have learnt from this whole experience is that when a patient or family member asks a question in the practice, I will always ensure they get a timely answer, which is full, honest, meaningful, truthful and in a way they can understand. I personally can confirm that is all they want. That way they know they have been treated with the respect they deserve.