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I'm sorry to moan but...

I have been visiting terminally ill friends in Edinburgh though I suspect I might have had the same experience elsewhere. Two were in major NHS units, and one in a well-known hospice. Let me say at once that I have no doubt they have been thoroughly investigated, have been on the best therapeutic regimens, have had skilled care from nurses, physiotherapists, occupational therapists and social workers. What distressed me where the so-called “smaller things”. My experiences were those of a visitor (family or friend) and never once did I tell anyone that I was a retired doctor.

In the hospice I had hardly got in the door before I was welcomed by the receptionist, then by a nurse who took me to see my friend, offering me a tea or coffee, then telling that if I wanted to talk to any of the staff I had only to say so because they were all there to help me. A few minutes later she was back, putting her hand on my shoulder as I leant forward to sit closer to my friend- “Are you OK?” she asked. How often must it have been said in a busy hospice – and believe me it was busy – “How peaceful it feels!” When I left, another nurse walked to the door with me, asking if I was upset, if I wanted to speak to anyone, and reminding me that my friend would get the best care they could give. They kept that promise until he died.

In the general hospitals, no doubt looking lost or disorientated like many old men, no-one spoke to me when I went to the wards, no-one ever offered to tell me where my friends were and when I asked a nurse she pointed to a distant bed but said nothing. She had no speech problem because throughout all the time I was at my friend’s bedside she and her colleagues were chatting to each other at different bedsides, perhaps to interest or amuse hard-of-hearing patients because the conversation was all about their friends! On the way out on my first visit I asked if I might speak to someone who knew about my friend. "Sorry, none of us was here when he was admitted.” Quite what that had to do with their condition since admission days before, eluded me. A junior doctor was nearby so I coughed respectfully and asked if he had a minute to update me on my friend’s condition. "Nope! Sorry! Too busy." and he was off.

It struck me that many of the things that had disappointed me would never have come to light on a “tick box “ questionnaire yet they are central to compassionate care. CPD courses and evaluations for nurses or doctors might ensure they are up-to-date and “efficient” but how do you measure courtesy, empathy, compassion and sensitivity?

As you would expect, I think palliative care services have, by and large, got it right but, I wonder, have we failed to find how to teach and demonstrate what the public, and I, feel is missing in some big hospitals? We seem to have a some way to go!

This blog is by Dr Derek Doyle OBE, Honorary President of the Scottish Partnership for Palliative Care. Recognised worldwide for the contributions he has made to palliative care, he was the first Medical Director of St Columba’s Hospice, the first Chairman of the Association of Palliative Medicine, the founding Editor in Chief of Palliative Medicine and Senior Editor of the first three editions of the Oxford Textbook of Palliative Medicine.

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