ICBioethics Blog 

Create a Culture of Caring Wherever You Are, Whatever You’re Doing, in 2017

Written by:  Dr. Kathy Gennuso

Barely a week into the New Year, I read the most riveting and gut-wrenching article that dramatically reaffirmed for me what my 2016 end-of-the-year review had reminded me of: At this stage of my career, I am grateful to be so well placed doing what I am doing right now—that is, helping medical organizations to strengthen practitioners’ ethical awareness, communication skills, and focus on their patients as individuals.

With the greatest admiration, sympathy, and respect, I want to acknowledge Dr. Rana Awdish’s horrific experience and what she did about it as chronicled in her recent article, “A View from the Edge: Creating a Culture of Caring” published in the NEJM (N Engl J Med 2017; 376:7-9). I strongly urge everyone in healthcare to read this brave woman’s story.

Due to an extreme medical emergency that cost her the child she was carrying and led to 5 major operations and painful, arduous rehabilitation, Dr. Awdish experienced, all too vividly, what a patient might experience when a “culture of caring” is more like a well-meaning slogan than a purposefully examined, embraced, and ingrained attitude woven into the fabric of care delivery. A solid “culture of caring” requires organizations to be willing to avoid complacency, stay self-aware, be transparent and willing to learn from mistakes, and invest in ongoing, meaningful training and retraining – for the safety and wellbeing of their patients and professionals alike. Our medical practitioners have awesome technical skills today (they did save Dr. Awdish’s life!) but plying them effectively in a “culture of caring” takes empathy and sensitivity to fulfill their pledges to “do no harm.”

What a nightmare to hear your doctor say that he thinks the patient (you!) is “’trying to die on us.’” Imagine the perceived flippancy in “’We’re going to have to find you a new liver, unless you want to live here forever;’” or the adversarial skepticism in “’Are you sure your pain is an eight? I just gave you morphine an hour ago.’” Or the misguided, albeit well meaning, insensitively worded advice after losing a baby: “’You should hold the baby . . . I don’t want to be graphic, but after a few days in the morgue, their skin starts to break down and you won’t be able to anymore, even if you change your mind.’”

Reading about what this woman endured medically and of her recovery was amazing, but realizing what she endured needlessly due to thoughtless insensitivity bred of ignorance was completely maddening! I have been pretty vocal about patient-safety and developing an ethical, patient-focused organizational culture in the past (please see our articles from last year Creating a Culture of Patient Safety is Continuous Collaborative Process and Keeping Patients Safe Starts with Commitment to Building a Culture of Patient-Directed Care ) and about saying we need to do better. But I have to admit that Dr. Awdish’s gripping story surprised even me.

Fortunately, some good did come from her suffering. She chose to tell her story in hopes of making a difference and I believe it will. Her institution listened and earnestly doubled down by training employees on empathy and what is avoidable suffering, by analyzing failures, and by improving processes and procedures. “‘My experience changed me,’” Awdish recounted.  “‘It changed my vision of what I wanted our organization to be, to embody. I wanted the value of empathetic, coordinated care to spread through our system. I share my story openly. I wanted the system leaders and every employee to know that everything matters, always. Every person, every time.’”

That’s right, hospital administrators, doctors, nurses, and technicians, we, the patients, are counting on you – we trust you with our lives. Please remember: Every person, every time, no matter what, deserves your best skills consistently and compassionately delivered within a genuine patient-centered “culture of caring.” All of us, no matter what we are doing, where we are, or what role we are currently in, we can do our part to make this happen as never before.

Work harder to care more — that might make a great (although slightly tardy) New Year’s resolution for all of us!

Mitch Gennuso