Earlier this month Dr Kate Granger closed the NHS Confederation annual conference with a powerful speech. In it she described being referred to by a nurse as ‘Bed 7’. These two syllables seem to embody uncompassionate care. ‘Bed’ represents all that is awful about hospitalisation, apart from the illness itself. It represents horizontality, frailty, powerlessness and diminished autonomy. It brings to mind the issue of resource, the perennial pressure on beds, and the ‘blockers’ that cannot be housed in the community after they have recovered. And the number, ‘7’, shows how people can become just one of many on the conveyor belt of sickness…a chore, a passing burden…in the minds of those who have forgotten what it is to act with compassion. Then, reflecting on this simple phrase, I realised something – I have may well have committed the same crime.
Can there be any excuse for referring to a patient by their bed number? The following, if not an excuse, may be an explanation.
When I started work in an A&E department I was immediately reminded of the days and evenings I had spent working as a waiter. The comparison seems trivial, but there are real similarities.
As a waiter I received a seemingly never-ending series of requests, backed up by the additional pressure of my customers’ variously expressed frustration or annoyance. I had to decide who should be served first, or who should have their order taken next according to how urgent I thought their need was. Sometimes an unexpected piece of information would arrive which would lead me to prioritise one table above another even though they had taken their seats half an hour later (they had to get to a show, for instance). This might involve debasing myself before the (typically) knife-wielding chef, trying to convince him to let a table jump the queue. Sometimes a problem in the kitchen would force me to go and explain what had happened to the customers, while trying to avoid apportioning the blame to my colleagues. My mind would be teeming with parallel problems, but the hours would pass quickly and by 1 o’clock in the morning the room would be empty, the tablecloths thrown in laundry bins and the tips divided. Then, having eventually gone to sleep while the adrenaline was still subsiding, I might dream about tables, or tumbling forks, or I might see myself holding six plates, unable to move, glued to the carpet, while customers clamoured for food and shouted at me.
So, if we can accept that something as unimportant as a couple waiting for their steak can be compared to a sick patient waiting to be assessed in A&E, other similarities come to mind.
Just as table numbers dictated my movements in the restaurant, in A&E the code by which I organised myself, or was organised by the nurse in charge, related to cubicle numbers. Until I met a patient for the first time they would have no name. Their back story was unknown to me, they were no more than an item on a list, a set of notes in a tray. And until I met them for the first time their ‘handle’ was just a cubicle number. I would have read the initial triage assessment, I would be formulating an approach in my mind, but it would all be under the heading of simple, impersonal number.
Standing outside the curtain, as I responded to questions about other patients, I would signify my intention by saying, “Yes, but I’m just about to see cubicle 9.” If this was overheard it might have sounded insensitive. Sometimes, I am sure, it was overheard. But surely no-one would expect a health care worker to use the term to a person’s face!
It is conceivable that a health care worker might forget to dissociate the person they are just about to see from the label with which their mind has been ‘handling’ them. Perhaps, in an environment where the patient is new (such as A&E), such a slip, such thoughtlessness, might be forgiven. But for the patient on the ward who has already been in hospital for several days, and who has demonstrated that they are a whole person, and who is known to staff, such an error is less understandable. But for some staff the patient will be new. They may have just returned from a three day period off duty, and during handover the name, in the absence of the context of human contact, may not have displaced the easier label…the bed and bay number.
What is familiar to the nurse or doctor, through their many days on the ward, is the patient’s location. In much the same way I knew the floor plan of my restaurant. My allocated sector for the night might include tables 9-18. I would immediately associate table 11 with that difficult approach around the foot of the stairs, or the tight squeeze by the potted palm, while laden with full glasses and plates. The bed number is not just a number, it is a location that the nurse has worked around for days and nights on end. It means something to the nurse, but it means nothing, of course, to the patient.
This (quite possibly flawed) analysis of human behaviour can only serve as an explanation, and is not an excuse for a lack of compassion. The thing that should stop the doctor or nurse translating a mere label into human communication is an understanding that the patient will be hurt by being referred to in such impersonal terms. This requires just a moment’s reflection, reflection that should become habitual for someone working in health care, but a moment that might, possibly, be squeezed out by the pressure of work. Or by laziness. Or by dehumanisation. But it only takes a moment.
(And by the way, if the unfamiliar nurse were to say ‘Hello, my name is…’, the trap would immediately be avoided.)
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