Compassionate care is key to coping with lack of resources

I have read with horror the recent stories of people going to Winnipeg emergency rooms and dying under circumstances that could possibly have been prevented. Families have alleged that health-care providers dismissed patients and relatives who reported worsening symptoms.

These stories terrify me because I have seen it happen, and I fear disregarding patients’ concerns is becoming normalized in the name of efficiency.

I live with complex medical issues and disability, and I regularly interact with health-care providers. I am grateful to live in a country that has universal health care, for the life-saving help I have received and for the hardworking people who provide it.

I have also researched health-care culture and lectured in nursing schools at McGill, Western and the University of Ottawa. Seeing the health-care system through the lens of a frequent user and a researcher highlights a concerning gap in the public discourse about health care and how to “fix” it.

For decades, austerity approaches to public services have prevailed, and the narrative that there is not enough money to fund timely health care is the story we have come to accept as true. As part of that, we have been asked to be understanding of years-long waits for surgery, double-digit hours waiting to see a doctors in emergency departments, staff working in desperate conditions and people falling through the cracks in a system that is stretched beyond its limits.

Increasingly, we are also expected to accept that compassionate and individualized treatment is a luxury we cannot afford if everyone is to receive care. This is a nightmare for people who have disabilities, chronic health issues or complex histories. Disqualifying people’s knowledge of their bodies to save time causes undue suffering. It also slows things down when people need more care because their problem was not fully understood. It is inefficient. It is also cruel.

I saw this up close when I recently spent 28 hours in a Winnipeg emergency department. I witnessed things that I worry are not part of the public discourse focused on time, staffing and money.

For the first eight hours of my stay, I sat in the ER waiting room. There were people clutching their chests, people bleeding from visible injuries, people who seemed to be in altered states and people in obvious pain.

At one point, an older woman slowly paced, clutching her abdomen. Her eyes were closed, she was grimacing in pain. She eventually slumped against the wall near me. Her son approached the triage nurse and explained that his mother had recent surgery and was in agony. He said she could no longer bear the pain of sitting and asked if she could please lie down.

“We have no beds, sir, what do you want me to do?” the nurse snapped. The man’s voice quivered as he again said that his mother could not sit and would not be able to stay. The nurse responded that there was nothing they could do and turned away. It was a shocking display.

I saw this degree of viciousness several times during my ER stay. I also saw the same staff at times acting with tenderness and care. What earns some people compassion and others disdain? Why is it subjective? And why is it tolerated by peers and supervisors?

I have often wondered what happened to the woman slouched against the wall in agony and the others whose pleas for help were dismissed. I have thought about the staff who loudly complained to each other about patients, the inhumanity that seemed routine and the acts of kindness and compassion that seemed exceptional by comparison.

Care guided by compassion should not be made to feel like a favour that patients earn by appealing to health-care providers’ emotions.

A culture of ignoring and enabling appalling behaviour is contagious, but I would argue that a culture of compassion and humanity is too. From years of research and discussions with nurses, I have frequently heard that those who listen to and care about their patients are less likely to burn out and more likely to enjoy their work. Similarly, health-care providers whose experiences are validated by their superiors are more likely to thrive.

What would happen if health-care leaders systematically encouraged and supported a model that centred compassion, as well as efficiency? Might we hear fewer of the tragic stories that have made headlines in the past few days?

Stories of good health care and positive outcomes thankfully exist, but they do not negate the horrors. They are evidence of the possibility of doing better and must not be presented as evidence that things are working well enough.

I hope the recent stories of ER deaths spur swift and drastic improvements, and that the focus is on the quality of care, not just the quantity of care providers.

Health care is not a choice between compassion and efficiency. Listening to patients and addressing their specific needs can happen in under-resourced settings. In fact, I would argue that the functioning of understaffed departments is contingent on it. The best way to save time is to address needs before the point of crisis. This is also humane.

Jane Shulman lives in Winnipeg.