Jay Kuten: Small courtesies ensure healthy outcome

To maximise desired medical outcomes and to minimise mortality, two issues are highly relevant. These are access to primary preventive care and management of chronic illness to minimise complications. Theoretically, access and management are available in New Zealand. Reality and theory are not always the same thing.
The World Health Organisation ranks New Zealand as 41st among developed nations in health care, behind the United States (37). To give some perspective, the US spends 15 per cent of GDP on health care, while New Zealand spends a little over 8 per cent.
Those numbers are easily misleading unless one takes into consideration that there is a vast difference among nations in their GDP. The US spends US$2 trillion ($2.48 trillion) annually on health care, which is roughly 1000 times the entire GDP of New Zealand.
Here we get a pretty good bang for the bucks we spend. Yet it's not enough of a bang and money may have little to do with it.
Medical training, as it necessarily involves objectifying the human body and its dysfunctions, steadily erodes the capacity for empathy. Studies of medical students consistently demonstrate incremental diminution in empathy for each year of training. Nurses and others show a similar pattern. If this trait becomes fixed, the practitioner becomes a detached clinician. However necessary such an experience is to the understanding and development of medicine as science, the recovery of empathy represents a great part of the art of medical practice.
And most patients know the difference only too well, although many are acculturated to accept the lack of a personal touch in their care. In this country, it may become part of the "pull up your socks" ethic.
But impersonal care is not unique to this or any country. I have experienced it here and in the US. In the US, I have recurrent experience with a urologist who has become a friend. But when I am called from his waiting room by an assistant, new at each visit, that person, who is about to perform an intimate procedure, inevitably fails to introduce herself until I ask pointedly: "What's your name?"
The same was true when I came for blood tests at the Wicksteed St facility. The technician, preparing to take my blood, never volunteered a name unless I asked for it.
This may seem of minimal importance until you realise that these small courtesies establish the beginning of care itself. And what is more, treatment outcomes are significantly affected by the attitudes within that relationship. That element is the foundation of trust and it underlies roughly one third of positive benefit of treatment.
A great cardiac surgeon, Dr Denton Cooley, of Houston, Texas, whose patients were among the most seriously compromised, described his practice. He visited each patient the night before surgery to chat briefly and in that meeting assessed the patient's level of confidence in the surgery, despite the context of expectable anxiety.
As Cooley put it, the patient was either with the surgery or not and, anaesthetised, the outcome was partly dependent on the patient's willingness to be a partner in the process.
That is clinical judgment applied at the highest level, where life and death are in balance.
In a less complicated arena, the virtue of small courtesies is still evident. For more than two decades, patrons of New World and its predecessor supermarket were greeted by the friendliness of Robbie Gembitsky, whose passing this year left a noticeable void. Shopping bears little of the trauma of medical care, yet his kindness in greeting made a decided difference in the experience for everyone he met.
It is these small courtesies that form an important basis for development of trust and for enhancing the experience of medical care.
"The secret of the care of the patient is in caring for the patient." (Francis W. Peabody, M.D. Journal of the American Medical Association; 1927; 88:877-882.)