As a doctor, I find breaking bad news one of the most challenging parts of my job.
Whether it’s telling someone they have terminal cancer, or that a loved one has dementia, it never gets any easier. But we are trained to do this sensitively and compassionately — and face-to-face, so that person feels respected and supported.
Imagine receiving such traumatic news over the telephone, or via Zoom or Skype, rather than in person. How would you feel?
Just this week Health Secretary Matt Hancock made the — frankly — preposterous claim that some patients may prefer to receive bad news over Skype, because they will be at home with loved ones, and not sitting in front of their doctor.
I simply do not buy this —and I have a lot more experience of difficult conversations with patients than Mr Hancock.
I know many people actually don’t want someone else there. They want to digest the bad news alone first, compose themselves and think how they will tell their loved ones. It is only later that they value the opportunity to return with a partner, sibling, son or daughter to ask more detailed questions of their doctor.
As a doctor, I find breaking bad news one of the most challenging parts of my job. Imagine receiving such traumatic news over the telephone, or via Zoom or Skype, rather than in person. How would you feel? (File image)
If family members are present when the news is bad, the patient may feel under immense pressure to remain strong for them.
The focus and attention can too easily be on everyone else and how they feel, rather than the person whom it most concerns.
No one wants to recieve a terminal diagnosis over Skype, with the dog barking in the background, or a neighbour knocking on the door.
There is something psychologically helpful in being in another environment — somewhere that is clinical and detached from everyday life.
Personally, I loathe using Zoom — patchy reception, frozen, static images and people talking over one another. It strips human interaction down to its barest and bleakest.
Of course, I understand why we’ve all had to embrace the new technology — it was vital during lockdown for millions working from home, and allows social distancing to be observed in the workplace and GP surgeries etc. It’s certainly been a lifeline for those communicating with loved ones who are shielding from the virus or separated by flight bans and restrictions on foreign travel.
Just this week Health Secretary Matt Hancock (above) made the — frankly — preposterous claim that some patients may prefer to receive bad news over Skype, because they will be at home with loved ones, and not sitting in front of their doctor. I simply do not buy this —and I have a lot more experience of difficult conversations with patients than Mr Hancock
However, let’s not kid ourselves that it’s an adequate substitute for physical contact.
On Zoom, all the subtle — and most vital parts — of non-verbal communication are absent.
Face-to-face interaction is key to good communication — especially when it comes to the doctor-patient relationship.
And then there is physical contact. I’ve often comforted people by holding their hand — even in these times of Covid.
One woman, who has been my patient for nearly a decade, recently told me that her son had killed himself. She removed her mask and began to sob uncontrollably. I removed mine, too, so we could talk properly.
I stood up to get her some tissues and suddenly she was in front of me holding out her arms. She just wanted to hug me, and she held me for a few minutes, saying nothing.
What was I supposed to do? Push her away with a snippy reminder about social distancing? I know the guidelines for healthcare workers: we can’t touch patients and have to wear masks all the time. On this occasion, though, I thought: ‘Screw the rules.’
At the height of the pandemic, I saw a young nurse take off her gloves and hold the hand of a dying man in distress. Quite right, too. There are times when we all need a degree of physical intimacy to reassure us and show support — a touch that says more than words ever could: ‘I’m here, I’m with you. You are not alone.’
Covid risks turning doctors and other healthcare workers into box-ticking, emotionless avatars.
For me, there was something rather disingenuous about the Health Secretary’s claim that Skype is what patients want. I suspect he is trying to justify the increasing push for doctors to work remotely, with the majority of consultations taking place via the internet becoming a permanent fixture.
This is actually a much bigger issue to do with a lack of flexibility when it comes patients’ needs and preferences, with coronavirus a convenient fig leaf for administrators and managers to achieve their own goals, be it savings in cost or time.
It saddens me that so many of my colleagues are becoming so risk averse because of this wretched virus. We are in danger of forgetting the most powerful thing medicine has to offer — care and compassion.
Why cleaning up is good for you
Litter pickers across the country rolled up their sleeves yesterday to help tackle the huge surge in litter since lockdown measures were eased in Keep Britain Tidy’s Great British September Clean which is backed by the Mail.
This newspaper has long crusaded against the rubbish blighting our streets and beauty spots.
I’m a great believer in the idea that our external world effects our internal one. Cleaning and nurturing our environment helps nurture our minds, too.
Litter pickers across the country (including Michael Gove) rolled up their sleeves yesterday to help tackle the huge surge in litter since lockdown measures were eased in Keep Britain Tidy’s Great British September Clean which is backed by the Mail
Moreover, it brings a sense of agency — that we can be an active, powerful force for good and change in the world when we choose to be.
As regular readers will know, I decided some time ago that rather than allow myself to feel angry about Britain’s litter problem, I’d do something about it. Since then I’ve been going on my own litter picks — armed with a litter picker that a friend bought me — and have found it therapeutic.
Yes, it’s frustrating that people discard rubbish so carelessly (particularly used face masks) on the streets and in parks and the countryside. But this litter pick turned selfish behaviour into something positive. So, let’s all get litter picking now!
Give our children order in this chaos
Millions of children have returned to school after nearly six months of lockdown. While some enjoyed time away from the classroom, others struggled.
Research by Public Health England shows that more than two-fifths of young people said they were lonelier than before lockdown. More than a third said they were more sad or stressed.
The findings were published ahead of the launch of a new initiative as part of PHE’s on-going Every Mind Matters campaign, which provides advice on children’s mental health.
As a campaign ambassador, I’m very concerned about the impact of lockdown on young people. Yes, children are tougher and more resilient than we give them credit for, but this is dependent on stability and routine in their lives — exactly what was missing for many during lockdown.
Given the fluid nature of this pandemic, it is possible some schools may be forced to close temporarily if there is a Covid-19 outbreak, causing more upheaval. Now more than ever, it’s important routines are in place to give a sense of order when the world feels chaotic and confusing.
For more advice go to nhs.uk/oneyou/every-mind-matters
Government policies to cut childhood obesity have had ‘little impact’ and numbers of overweight children have risen, according to a National Audit Office report.
I think part of the problem is that more than half of adults are overweight and we know overweight parents tend to have overweight children.
None of this is helped by those who insist it’s down to genes, or who complain about ‘fat shaming’. Drastic action is needed because we’re allowing a generation to eat themselves to an early grave.
Our MPs are often accused of squandering taxpayers’ money — but this time they’ve surpassed themselves.
It emerged last week that Parliament has hired Challenge Consultancy to design a course on ‘unconscious bias’ for MPs to alert them to their ‘implicit prejudices’.
The company has raked in nearly £800,000 in schooling MPs on ‘woke’ language and history. Now it is estimated unconscious bias training could add another £700,000 to that bill. What a waste of money! Unconscious bias training is an area of psychology that is hotly disputed, and evidence suggests it has no sustained impact on behaviour.
All it does is fuel an industry that promotes victimhood, rather than propose solutions.
There’s no denying many industries are still woefully lacking in diversity, and yes, as a society we should work to address this. But the sort of training planned for MPs is a sham and an obscene waste of OUR money.
Dr Max prescribes… soothing silk sleep masks
A different type of mask from what we’ve become use to of late, but something that I’ve come to rely on for a undisturbed night’s sleep.
The soothing silk also protects the delicate skin around your eyes. So pop one on and imagine you’re in a luxurious spa.