‘Treat people with kindness’[1]: possibly the UK’s General Medical Council (GMC) has been listening to the Harry Styles song on repeat. It has updated its Good medical practice guidance, which will come into effect on 30 January 2024. In section 23 doctors are instructed that they ‘must treat patients with kindness, courtesy and respect.’[2] Moreover, they must also ‘treat colleagues’ in the same way (section 48).
While respect has been emphasised in previous versions of the guidance, kindness is new. It is not clear what being kind as a health professional adds to behaviour that courtesy and respect omit. Or what the GMC feels was missing from previous guidance that somehow is rectified by inserting ‘kindness.’ The reaction to the addition has been mixed. Writing in the BMJ, a medical ethicist and barrister reminds us that Osler (one of the creators of the modern system of clinical medical education) considered a doctor should have a kind heart.[3]
Chat GPT defines kindness as: ‘a fundamental human quality characterized by the act of being considerate, compassionate, and benevolent towards others. It involves showing empathy and understanding, and it often manifests through actions that promote well-being, happiness, and positive interactions. Acts of kindness can range from simple gestures, such as offering a helping hand, expressing gratitude, or offering a kind word, to more significant actions that contribute to the welfare of others.’
This definition includes many of the attributes that have been linked to professionalism and that are discussed with students, particularly compassion, empathy and contributing to the welfare of patients (others). Apropos of this, one interesting study indicates that the likeability of the recipient affects one’s willingness to be kind more than one’s willingness to be compassionate.[4]
One problem is that I cannot be certain that I am being kind to someone, only the person I am interacting with can assess this. If a doctor declines to prescribe a medication requested by a patient or to make false statements on an insurance form for the patient’s benefit, the patient may consider the doctor to be ‘unkind’ (though probably not using that word). Conversely, a doctor may come across as kind when giving a patient false reassurance or referring them for low value care. The GMC helpfully qualifies that being kind ‘doesn’t mean agreeing to every request or withholding information that may be upsetting or unwelcome’. I suppose this means that it’s not what you say but the way that you say it, but that may not be reflected in patient satisfaction surveys. It may be that ‘decision makers must be sensitive to context and culture’3 when deciding if a doctor has been kind or unkind if it comes to a patient complaint for example. But if the decision makers don’t take the patient’s perspective into account, what does this mean for patient-centredness?
Once we define a doctor’s desired attributes, someone somewhere will devise a scale to measure them. We already have empathy and resilience scales. And, of course, there are already measures of kindness.[5] [6] The ubiquitous objective structured clinical examination (OSCE) could grade for kindness – does the examiner decide this or the patient? Perhaps, along with resilience, we could also test applicants to medical school for kindness… Or conversely, for unkindness if we consider that kindness is a binary concept: one is either kind or unkind. Or are there degrees of kindness?
The current Australian version of Good Medical Practice does not include the word kind, [7] neither does the CanMEDS physician competency framework.[8]
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[3] Sokol D. Do doctors need to be told to be kind? BMJ 2023;382,1976
[4] Kirby JN, Gerrish R, Sherwell C et al. The Role of Likeability in Discriminating Between Kindness and Compassion. Mindfulness 13, 1555–1564 (2022).
[5] Youngs DE, Yaneva MA, Canter DV. Development of a measure of kindness. Curr Psychol 42, 5428–5440 (2023).
[6] Comunian A.L. (1998). The Kindness Scale. Psychological Reports, 83(3_suppl), 1351-1361.
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