John Bell
Geriatrics is not the sexy end of medicine.
It’s very different from working in an acute care ward, bringing people back from the brink of oblivion helped by the latest sophisticated pieces of medical technology. The very old need time, patience and good humour especially when restrictions on their movement means that they have to be helped to do the most basic of things.
So it must have been disquieting for anyone who has an elderly relative in hospital to discover yesterday that of 100 establishments in England visited by the Care Quality Commission, up to 20% failed to meet required standards. Some, like the hospital featured in yesterday’s programme, have been lamentably remiss when it comes to the care of the aged.
Understandably, relatives rage, and monitoring authorities say something must be done, and the guilty parties trot out the ubiquitous mantra ‘lessons will be learned.’
But what are the real lessons that need to be learned?
The vocabulary associated with hospitals has moved somewhat in the past 20 years. Patients are sometimes referred to as ‘consumers,’ the length of stay as ‘through-put,’ care as management. These things, along with a fascination for ticking boxes, and monitoring time taken per task all combine to produce data which - in technical terms - may provide an index of efficiency.
But is that the same as care?
What gives ill and particularly elderly people dignity is not the knowledge that all systems are working, but that their humanity is being affirmed. And that can happen in the simplest of ways, as when a nurse seemingly wastes time by listening to someone who is anxious, or spends longer than usual with someone who has trouble eating, or moves furniture so that immobile patients can see photographs of the people they love.
I’ve always been fascinated by the miracle stories of Jesus, particularly by how in many of them there is an unnecessary detail. He tells parents whose daughter has come back from the brink of death to give her something to eat. He takes a blind man by the hand away from the crowd so that he doesn’t get overawed when his sight returns. He tells a woman who has been crippled that she is beautiful. He lets an old lady who is back on her feet make a meal for him.
It’s quite unnecessary, some might say. Yes, kindness is unnecessary - if you gauge health care in terms of through-put. But if you want people to retain their dignity, you have to ensure that those who care for them have time to be kind.