Essays

Essays January 2017
Open Letters

What’s Old is New Again

Gillian Kernaghan

This letter is part of series of Open Letters from Canadian leaders in Healthcare. To see the complete series please click here  

At a recent Breast Reconstruction Awareness Day at St. Joseph’s Health Care London, volunteers shared their experiences with breast cancer and allowed others to visibly see the outcome of their breast reconstruction.  A participant spoke about the help she received through “their presence because they had walked the same journey.”

The future of healthcare will increasingly be driven by advancements in technology. Care enabled by technology will allow patients to visit healthcare providers from their own home or office or from a geographic distance. Patients will be able to manage their own health and health information through portals and mobile devices. Diagnostics will enable earlier identification of disease and better diagnosis through advanced imaging and genetic testing.   

Healthcare, however, is about people caring for people enabled by technology, enhanced by healing environments.   We focus a great deal on the quality of the care we provide and the quality of our work environment for our staff and physicians.  Do we consider the quality of our presence as we care for people at vulnerable times in their lives?  Do we consider the quality of our presence as we interact with our colleagues day to day?   With all the busyness and multiple distractions, have we lost the ability to be truly present? 

“Presence is more than just being there” says Malcolm Forbes Jr.

We have all had experiences, either with colleagues or as a customer, when the person was physically present but not actually present.  At orientation, I ask new staff what would quality of our presence sound like, feel like and look like.  Consistently the responses speak to verbal and non-verbal communication.  The person stops what else they are doing, makes eye contact, truly listens to both what is said and what is not said.  They reflect back what they have heard indicating a desire to understand.  They invite questions.  

In 1650, six rural French women established the Sisters of St. Joseph’s.  There were founding principles that grounded their work that eventually reached around the world.  One principle was a “contemplative heart.”  For the Sisters their contemplative heart included listening to the spiritual promptings while they listened with their heart to the needs of those they served.  In listening with their heart they listened not only to the words that were spoken but to the needs that were evident in the non-verbal communication of the person for whom they were providing care.  The second principle was “cordial service.”  It is a service that revives or restores the one you are serving. 

“Quality of our presence is revealed through the power of focus” says Izzy Gesell.

As we increasingly integrate technology into healthcare there are providers who are very skilled at using technology in a way that does not detract from the focus on the person.   They use the technology to enhance the interaction by showing patients the trend of their lab results on the computer to assist them in seeing the impact of lifestyle changes or medication compliance.  They use mobile devices such as point of care ultrasound to return to the bedside.  They enter a person’s home through telehealth to provide ongoing speech therapy or mental healthcare while being able to attend to the verbal and non-verbal communication. 

Sadly, we also hear of interactions when the person did not look up from their computer during registration or during a patient interaction.   We order investigations without first truly listening to or properly examining a patient.   The Choosing Wisely initiatives in various countries speak to the importance of listening and examining a patient before defaulting to the use of technology in diagnosis. 

Technology has and will continue to dramatically change the healthcare of the future.  We need to embrace its potential but not see it as an end in itself.  However, we must not lose site of the importance of presence as we serve those in need of care. 

“Empathy is full presence to what’s alive in the other person at this moment.”
John Cunningham

Healthcare requires the practitioners to integrate both the art and science of medicine.  In the days of the founding Sisters of St. Joseph’s there was more art than science.  As science has evolved and will continue to do so we need to ensure we do not lose the art.  The wisdom when to apply technology in the care, diagnosis and treatment of an individual is gained from our foundational knowledge and our focus on their unique circumstances and needs. 

It is with full quality of our presence that we will understand the patient’s values, what are their hopes and dreams …what is alive in them at that moment. Through integrating this understanding with evidence-based care we will achieve truly patient-centred personalized care.  

About the Author

Gillian Kernaghan, MD,CCFP, FCFP, CCPE, President and CEO, St. Joseph’s Health Care London

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