New framework for patient dignity

Clinicians are being offered a new guide to help them maintain patients' dignity, according to this week's British Medical Journal.

Doctors too often dismiss dignity in care because of a lack of time or because they feel a lack of expertise, says the article, which outlines the A, B, C, and D of dignity conserving care guide.

This guide or framework has its origins in palliative care, but can be applied across all medicine, says the author Dr Harvey Max Chochinov, one of Canada's leading palliative care experts and professor at the Department of Psychiatry, University of Manitoba.

Based on empirical evidence, the guide explains how kindness, humanity and respect are core values of medicine, but which are often thought of as the “niceties of care” only offered to patients if time and circumstances allow.

This area of care is referred to as spiritual care, whole person care, psychosocial care or dignity-conserving care, says the article.

Doctors and other health professionals have a profound influence on how patients experience illness and their sense of dignity, argues Dr Chochinov.

The importance of the four parts of the guide – A for attitude, B for behaviour, C for compassion and D for dialogue – is underlined, says the report, by the fact that loss of dignity is one of most common reasons patients seek out physician hastened death.

The guide contains several check points under each part for health professionals to look at and to make sure they are following.

Dr Chochinov says the guide can be applied to teaching, clinical practice and standards, both at undergraduate and postgraduate levels, and across all medical specialties, multi-disciplinary teams, and allied health professionals.

Perhaps changing attitudes needs to pervade all medical school teaching, add Irene Higginson and Sue Hall, a palliative care doctor and psychologist at King's College London in an accompanying editorial. They suggest that “Chochinov's ABCD should be the first mnemonic we teach all professionals entering health and social care, even before airway, breathing, and circulation.”