Reuters Health Information 2007. © 2007 Reuters Ltd. NEW YORK (Reuters Health) Jul 27 - Patients are more than the illness they have, and failure to understand who they are and to treat them with respect is akin to "operating in the dark," a psychiatrist at the University of Manitoba writes in the BMJ for July 28. Even with the time constraints and tight budgets of today's healthcare systems, preserving patients' dignity is still possible, and is critical to keeping patients off the doorstep of despair, writes Dr. Harvey Max Chochinov. Dr. Chochinov writes that attitude, behavior, compassion, and dialogue -- "the A,B,C and D" of dignity-conserving care -- create an empirical framework for maintaining what he calls the core values of kindness, humanity and respect. He presents checklists of practical ways to implement the dignity-conserving care in everyday practice. First, and perhaps most importantly, he writes, clinicians need to recognize that their own attitudes and assumptions affect how they deal with patients and mediate their role in preserving patients' dignity. They need to examine their own attitudes toward and assumptions about patients, and to check their accuracy. For behaviors, he lists suggestions for conducting clinical examinations and facilitating communication that "enhance trust and connection between patients and their healthcare providers." Compassion "refers to a deep awareness of the suffering of another coupled with the wish to relieve it," the author writes. Through compassion, one recognizes the emotional impact that accompanies illness. Showing compassion may require no more than a gentle touch on the shoulder or any communication that "acknowledges the person beyond their illness." Finally, it's only through dialogue that a clinician can realize and understand the non-clinical aspects of a patient's life that affect the physician's approach to his or her illness. Dr. Chochinov is a palliative care specialist, but recommends his framework for every level of education and across all medical subspecialties, multidisciplinary teams, and allied health professions. BMJ 2007:335:184-187
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