Taking Time and Not Rushing is the Key to Healing
Published: 02/04/2020
In this article we highlight the benefit of companionship and making sure home visits are not rushed. Giving clients time to talk and make them feel they are cared for can have real healing power.
A key essential of ensuring any service is safe, is making sure you have the right number of suitably skilled staff. In the social care sector, the regulator (the Care Quality Commission “CQC”) regularly inspects each care provider to check the service provided complies with applicable law and is safe for clients. Each care provider needs to demonstrate it is not taking on too much work and that it has the right number of suitably skilled carers.
In the private sector the care provider is able to manage demand by not taking on too many clients. They can recruit and add to the carer team to reflect the natural ebb and flo of the business throughout the year.
Contrast this however with the public sector, where the hard-pressed Trusts and local government teams have no control over demand and a budget set in Whitehall. Against this background, it is not surprising to see stories like this in the newspapers “GPs limit appointments to just five minutes due to lack of staff” Daily Mirror 19 Oct 2019. According to the article GPs are limiting patient appointments to five minutes, and then each patient is only allowed to raise “one acute condition”. This shocking mismatch between supply and demand has been a long time coming – with a rising population and many GPs deciding to retire or work part time, no doubt in many cases simply because the demand on their time and number of patients, has become simply too stressful. The worst stress for any professional can be not having sufficient time in the day to do one’s job properly.
Five minute appointments may ensure patients get seen, but it is it safe? Will symptoms or related conditions not be missed? If the condition is complex, how can it possibly be diagnosed, explained and a course of treatment determined, in just five minutes?
Leaving aside safety, the other missing element will be the almost certain non-existent “bedside manner”– despite the best intentions – the GP will simply have no time to talk to the patient as one human to another. At Right at Home we frequently talk to clients and their next of kin who, despite GP or hospital care, have little or no understanding of their condition(s), their prognosis and why medication has been prescribed. When we are sick we all need time to talk to a doctor and at a time when we may alarmed by a diagnosis, not in the best position to understand what we are being told. Feeling rushed and at worse a nuisance, cannot be conducive to the patient feeling their condition has been properly considered and a route back to good health is in-sight.
Ted Jack Kaptchuk is an American medical researcher who holds professorships in medicine and in global health and social. Recent medical studies on placebos indicate that the ritual of the patient seeing the doctor and being listened to, are actually a key part of healing. Even in drug trials where the patients knew they were taking a placebo, distinctly positive results were obtained where the “ritual” was prolonged – with the patient given time to talk and a caring person there to listen to them. The “schmaltzy” mock appointments included some physical contact and twenty seconds of silent thought.
“For his ideas to gain traction with Western doctors, however, Kaptchuk knew he needed scientific proof. His chance would come in the early 2000s in a collaboration with gastroenterologists studying irritable bowel syndrome (IBS), a chronic gastrointestinal disorder accompanied by pain and constipation. The experiment split 262 adults with IBS into three groups: a no-treatment control group, told they were on a waiting list for treatment; a second group who received sham acupuncture without much interaction with the practitioner; and a third group who received sham acupuncture with great attention lavished upon them—at least 20 minutes of what Kaptchuk describes as “very schmaltzy” care (“I’m so glad to meet you”; “I know how difficult this is for you”; “This treatment has excellent results”). Practitioners were also required to touch the hands or shoulders of members of the third group and spend at least 20 seconds lost in thoughtful silence.
The results were not surprising: the patients who experienced the greatest relief were those who received the most care. But in an age of rushed doctor’s visits and packed waiting rooms, it was the first study to show a “dose-dependent response” for a placebo: the more care people got—even if it was fake—the better they tended to fare”.
In a time of cost pressures, it is not surprising perhaps that the NHS has turned away from homeopathy and alternative treatments. In 2017, NHS England issued guidance instructing doctors not to hand out prescriptions for homeopathic treatments, which chief executive Simon Stevens described as “at best a placebo” and “a misuse of scarce NHS funds”.
Visiting a homeopathist myself left me sceptical about the benefits of homeopathy. The practitioner I saw did not convince me of the science, recommending I dose myself with fairly expensive tinctures of plant extracts diluted in clear solutions with a ratio of “1 part to 100 million”. My scepticism however was challenged recently by a friend – a nurse of many years’ experience – who spent time working in an NHS Trust analysing the results achieved by homeopathists commissioned by the NHS. She told me in fact the outcomes achieved were surprisingly good! The latest thinking being that the ritual of the patient seeing the practitioner and being given time to talk to someone who cares and who they believe can help heal them, often does the job.
A key element of the service we provide is companionship. Our dedicated carers are not healers but there is no question the companionship they provide improves the lives of our clients – many of whom are isolated and lonely. There is a deep human need to feel listened to and we all need someone to keep us company, especially when we are feeling fed up or unwell. For this reason, at Right at Home we do not do visits to clients of less than one hour. Our carers, of course, need to make sure all the daily tasks are seen to, but we train then and constantly remind them, that the main purpose of each visit is support and communicate with the client. Taking time – not rushing – and asking the client “how are you today” is a vital part of any visit. In our view this is what “makes a difference” – with a smile and a laugh – our carers make sure each client’s day is a little brighter.
