I Know All Too Well That When You Lose Your Connection With a Patient, Everything Goes Wrong

Current pressures can push doctors and nurses beyond the healthy norms of clinical detachment



Many times, without a cue to tap into some deeper significance, I’ve felt unmoved by death and tragedy ( PA )
Bizarrely, it was a shock to see the man in the photo. The picture stood at the end of the bed where I’d finished examining my patient – a 50-year-old man recently paralysed from a terrible accident and now fighting a chest infection. His photo stared back at me – he was fit, strong, tanned, full of life. It was like seeing an actor out of costume in a pub, prompting a self-conscious doubletake. I felt quite ashamed that, without realising, he had become just another fallen figure on my long list of patients.

The UK now has 28 per cent fewer doctors per patient than the European Union average; when hospital workloads are at their busiest, it can be like a conveyor belt of patients on a list. Consultations are brief, and all about rapid decisionmaking and treatment, with little or no time to form human interactions and to get to know the person lying stricken on their ward bed.

These transactional working practices are contributing to the alarming rates of burnout we are now witnessing among NHS staff. A recent survey by the GMC indicated a quarter of medics feel “burned out”, with around half feeling routinely exhausted. Contributing factors include enormous work pressures and fears over patient safety and complaints. But crucially, many point to ever-shortening interactions producing feelings of helplessness, loss of control and lack of professional identity. Medical conferences distil the current mood. Once filled with inspiring talks and boozy gala dinners, these days they don’t whet the appetite quite so much. Earnest talks on burnout, extreme resilience and doctor-suicide reduction take centre stage, and with good reason.

“Ward-based care” is greatly to blame – I’ve seen this change over the seven years of my own practice. As a very junior doctor, I was part of a team of five doctors run by a single consultant, and a number of patients belonged under our “firm”. We were on board for each patient’s journey – we’d see them arrive very unwell, see them daily on the ward, sometimes assist the boss operating on them. You’d be introduced to their visitors – watch them steadily improve and recover, or worsen, and sometimes die. And behind a professional exterior you would feel satisfaction or sorrow accordingly, healthy manifestations of human empathy. Now, to get more bang for less buck, doctors look after whoever may be on their ward on a given day or week; if “your” patient is moved to a different ward, that’s that.

This system produces far more distant, impersonal care, lacking the feel and knowledge for a patient you see daily. It also erodes a great sense of purpose and satisfaction, which are key drivers that reduce burnout.

In A&E, which contains some of the highest rates of physician burnout, doctors are lucky to see their patients’ blood test results before they’re carted off to a ward to avoid overstaying the four hour target. Having the time to follow up with their patients and see how they got on during their hospital stay seems a bizarre luxury. A satisfying mental feedback loop remains eternally incomplete.

Current pressures can push doctors and nurses beyond the healthy norms of clinical detachment. I once watched a man die in A&E. He walked in, looking a bit pale, then collapsed. After 10 minutes of resuscitation the team stopped. I didn’t have any reaction to it really; one dead person is rather like the next, unless you’ve spoken to them, seen them with their family, seen the hopes and dreams which have gone with them. But then I saw his boots – new hiking boots. He’d probably gone out and bought them that morning, oblivious to what the gods had in store. I imagined him casually browsing, deliberately choosing a pair which would last him years.

“That’s pretty sad, isn’t it?” I said to my registrar.

“They all roll into one for me these days mate – I’m numb to it,” he replied while scrawling in the notes. He was a good doctor, and I knew what he meant. Many times, without a cue to tap into some deeper significance, I’ve felt similarly unmoved by death and tragedy. But I believe we all have this reaction, if we’ve not had time to get to the know the person behind the name. Clinical detachment is good and proper; it’s when the doctor becomes detached from themselves that it gets tricky.

“Are you here to see bed eight?” or “Are you here to see bed six?” I’m frequently asked these questions when visiting a ward during on-call shifts. This Orwellian code is now widespread, lest somebody within 10ft hears a patient’s actual name. “I’m not sure, is that Mrs Smith?” I will pointedly respond. (I had stopped quipping that I’m actually here to see the patient lying in it, since an overrun ward sister called me something even The Independent might star out.) Referring to humans by numbers strikes many as being coldly utilitarian, not to mention historically sensitive, but hustling humanity out the door has become a coping strategy for some overstretched staff.

Increasing workloads, dwindling resources and a hellbent focus on productivity will continue to restrict medics to ever briefer and more anonymous hops on the long patient journey, with some slipping into the abyss of depression and burnout. Too many doctors now view themselves as clock on, clock off operatives – automatons sweating away on the equivalent of an assembly line. Rapid action is needed to preserve the human connections between NHS staff and patients, and can only come with resources fit to match the enormous burden now faced by services.

Meanwhile, the man in the photo will stare us down, urging us to remember that, even though he is hidden behind the barcoded wristband and the hospital gown, he is still human.

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