Reflections on Care. What patient stories are saying for staff

The following article is reproduced from Paul's column in the Nursing Standard. Subscribers can read here.

I have always been suspicious when people say: ‘It’s the little things that make a difference.’ I know what they mean – that when life and death issues are surging around you as a patient, a touch on the hand or having someone take just a few minutes to listen to your concerns can mean a huge amount.

But the phrase tempts you to think that more ‘little things’ – more hands held, more cups of tea given – equals more caring. In reality, it is the ‘making a difference’ part that really matters.

Take this story from Patient Opinion about having an outpatient cystoscopy:

‘Everyone I met with was very kind. But it was clear to me that there was complete ignorance of my particular needs as a victim of sexual trauma.

‘Two practical suggestions would have made my experience much easier:

• Turn the gurney around so that the patient’s genitalia are not facing the door.
• Nurses, orderlies (three were present with me in a very small operating theatre) should be seated off to one side ready to leap into action if necessary but not, please not, directly overlooking the surgical procedure.’

‘Being kind’ is not enough. The big thing here – the fact that the patient had been a victim of sexual violence – turns out to be the hidden centre around which all the ‘little things’ need to be orientated. Just heaping on more kindness while the patient’s genitalia still face the door is useless.

So for little things to make a difference, we need to ask what it is that will make a difference to this patient, at this time. All too often, the urgent need to get the essential stuff done leaves no space for this. And sometimes the answer – as perhaps in this case – is too painful for either patient or staff to face.