What’s in a name?
An interview with Kate Granger, #hellomynameis campaigner
Kate Granger is a final year elderly medicine registrar. She trained at Edinburgh University, graduating in 2005. Originally from Huddersfield, she now lives in Wakefield with her husband Chris. In 2011 Kate was diagnosed with a very rare and aggressive type of sarcoma, and on discovering she was terminally ill she wrote a bucket list which included dinner at Claridge’s and a flight in a glider. Her experiences as a patient led her to begin the #hellomynameiscampaign when she realised that many staff looking after her did not introduce themselves. The campaign has been adopted by over 100 NHS trusts. Kate is a keen musician and she has also written two books, The Other Side and The Bright Side, documenting her story as a patient and doctor.
What prompted you to start the #hellomynameis campaign?
A hospital admission in August 2013 was the original inspiration to start the campaign. I developed postoperative sepsis after a routine stent exchange that necessitated a trip to the emergency department and admission to a urology ward. During that time I became a keen observer of the care I received. Although there were quite a few problems with the care, the thing that distressed me the most was staff not introducing themselves to me. It felt so wrong that such a basic human courtesy could be forgotten. Inspired by a conversation with my husband during which I was told to “stop whinging and do something,” I decided to take to Twitter and start to share my experiences. We hoped that my narrative would inspire and remind healthcare staff about the importance of introductions. Chris [Kate’s husband] coined the catchy hashtag #hellomynameis and it grew from there.
As medical students we are taught the importance of introducing ourselves to patients. Why do you think this courtesy is forgotten?
I think once students enter the NHS environment during the clinical phase of training there is a well documented “compassion drop off.” We all apply to medical school as compassionate and idealistic young people but bad habits can soon develop, especially if we are given negative role models to follow. The stress of beginning work, long hours, challenging workloads, and emotional pressures can have an effect on how we behave towards patients.
What aspects of how communication is taught at medical school would you like to see dealt with?
There is no doubt that communication skills training has come a long way in a short period of time. Actors and simulation have their rightful place in all this to give students the opportunity to try different techniques and discover what works for them. But it’s not real. And everyone knows it. The anger and tears an actor can create may on the surface be convincing, but once that tutorial is over then everyone goes home. Learning to communicate is a lifelong journey that will never end and I fear we are moving towards a culture where we have ticked the box that we’ve attended the “breaking bad news” session and therefore we are deemed competent. Sharing news with another human being that they are going to die from their cancer will be for that patient a one-off, devastating event, after which life will never be the same again. Being the person to break that news in a compassionate way that the patient can understand is a hugely skilled act. I believe we need to try hard to enable students and junior doctors to gain more experience of the real thing by observing more senior clinicians and actively reflecting afterwards.
From your experience as both a patient and a doctor, how has this affected your opinion on patient care?
I think the vast majority of care in the NHS is good or excellent, but the most frustrating aspect for me is the variability. I may see one junior doctor who is fantastic, understands my needs, and communicates well with me. However, the next doctor may fail to introduce themselves and be rude to me. One nurse may be kind and do everything she can to promote my comfort and the next may make me feel as though I’m being difficult asking for analgesia. The problem is you never know which attitude you will be on the receiving end of. Being ill has taught me a huge amount about being doctor. It has really highlighted the role of body language, the use of touch to comfort and reassure, the massive impact tiny acts of kindness can have, and the need to make time for patients and their families within your busy schedule.
What do you think is fundamental to a good patient experience?
I think if you start with the core value that this patient is first and foremost a person, that is a good place to start. I am not defined completely by having cancer; in fact, having cancer is just a very small part of who I am. When healthcare professionals recognise me as the person within my social context I tend to have a better experience, rather than being reduced to “bed seven” or “that girl with DSRCT [desmoplastic small round-cell tumour].” A recognition that patient experience is an accumulation of all the “little things” is also vital. Being comfortable in hospital is about those things like whether your bed sheets are clean, whether water is readily available, that you have access to the toilet, and that you are allowed to sleep. But also the human “little things” like someone sitting down instead of standing over you, someone holding your hand when you’re upset, or someone giving you an extra moment of their time. Valuing and celebrating these aspects of care as what makes the difference to patients is essential. As a patient I hugely value continuity as being so important to my experience. Having been through a very rocky course I cannot imagine having the difficult conversations about when to start and stop chemotherapy with anyone other than my oncologist. I’m incredibly lucky and thankful to have had that constant support from one person who I trust and respect. As the NHS has become more fragmented, especially in primary care, we are losing continuity; that is sad, and I’m sure is impacting on patient experience.
What other simple things could we start to do to improve the patient experience?
In medicine for older people we have huge problems with nutrition and hydration in our patients. For NHS Change Day 2014 I made the pledge that every time I saw a patient I would offer them a drink. This is such a fundamental of care that cannot just be seen as a “nurses’ job” and must be considered everyone’s business. Proactively updating patients’ families about their progress in hospital is also a simple act that can have a huge impact on reducing anxieties and complaints. Those are just two examples from my own field of work, but there are lots of improvement opportunities out there.
Outside work, what do you enjoy doing?
I love to play music—I am a keen flautist and play with a local wind band. I can often be found in my kitchen cooking or baking and we love to entertain friends and family. Chris and I have become avid fundraisers over the past couple of years for a local charity and spend lots of time organising events or completing challenges such as skydiving or swimming the distance of the channel. I also enjoy embroidery, reading, and walking. We have an extensive bucket list of activities that keeps us busy too.Gina Sherpa, first year medical student
1University of Buckingham
Correspondence to: firstname.lastname@example.org
Competing interests: None declared.
Provenance and peer review: Not commissioned; not externally peer reviewed.
Cite this as: Student BMJ 2015;23:h2566