Written by Michelle O’Rourke
Care is a word that is frequently used, yet often taken for granted. We can ask someone, “What do you want in your coffee?” and they may reply with, “Milk or cream – I don’t care.” In the world of health care, we tend to use this word as something task-oriented – “I am here to give you foot care.”
The word care finds its roots in the Latin word kara, which means lament – to grieve, to experience sorrow, to cry out with. This understanding expresses an invitation to enter into someone else’s pain before doing something about it. Yet we usually feel more comfortable providing a service or using our knowledge to bring about a change or a cure rather than meeting others in their pain and then journeying together towards their healing and wholeness. It is easy to look at caring as an attitude of the strong towards the weak, or the powerful towards the powerless; “Let me take care of you. I have some area of expertise to offer that you need.”
In palliative care, we try to break through the functional kind of response to suffering by offering more comprehensive and holistic care. This includes asking difficult questions when needed and offering deep listening and presence to the patient, their family and loved ones. We use the term total pain to remind us that there is more to managing pain than addressing the physical manifestation alone. It is also important to determine emotional, psychological and spiritual elements and support those we care for in all of those areas.
Dr. Harvey Max Chochinov, a palliative care physician and psychiatrist from Winnipeg, Manitoba, extensively researched the field of patient dignity. In his work around dignity-conserving care, he encourages us to begin our care encounter with the Patient Dignity Question (PDQ), which is,
“What do I need to know about you as a person to give you the best care possible?”
(www.dignityincare.ca)
In this way, a caregiver is less likely to assume that they know what someone needs or what is most important to them.
Care providers will always approach a patient or a situation with their own inherent beliefs and biases. This is a natural human position. We often look at a situation with empathy, trying to understand the other person’s suffering and how we might want to be treated if we were in their situation. Again, this tends to be a natural response, one born of compassion towards the other. In many cases, our position follows what we might know as the Golden Rule, which is,
Do for others as you would want done for you.
Adapted from www.dignityincare.ca
In health care, this might mean considering if we were the patient, how would we want to be treated? Or what if this was my spouse or child? How would I want them to be treated?
Dr. Chochinov suggests we might offer better patient-centred care if we apply the Platinum Rule instead of the Golden Rule. The Platinum Rule states,
Do for your patients as they would want done for themselves.
Adapted from www.dignityincare.ca
This means looking beyond our own biases and assumptions, getting to know our patients as people, and discovering what is important to them. Given their culture, experiences, beliefs, and values, they may make very different choices around their care than what we might choose for ourselves.
This approach requires the caregiver to develop self-awareness so that they might become aware of their own assumption and biases and whether their responses contain any judgment. We are all encouraged to take time to reflect on our care encounters and ask ourselves if we are truly providing care that is determined by the needs and values of the patient, and not our own.
For more insight and tips on applying the platinum rule when providing care, REGISTER NOW for the webinar on May 2, titled “Providing Care and Applying the Platinum Rule in Palliative Care.”
