Today was my clinical day. In comparison to my usual clinical days, it was an especially good one.
I did two home visits, one that was a particular success. I met with a senior AHP on leadership stuff. And I had a service user concern to address.
I suppose any service user concerns and complaints are usually thought of as difficult and stressful, and so it may sound a bit weird that I list that under my exceptionally good day. I’ll talk you through…
In my clinical career, I have had one (informal) complaint – and another situation that probably should have been a complaint… Both of these were fairly minor and early on in my career, and I resolved them with support from my manager at the time. On hindsight, I think they both resulted from my lack of attention to relating to the family (these were both in paeds).
At the time, I was very professional – probably too professional. I focused on my duties and responsibilities, and on doing “the right” thing. I focused on identifying the child’s problems accurately; on telling the family the problems openly; on identifying the right interventions; and so on. But, I think I omitted to genuinely relate to the family and identify their emotional needs. I observed and listened to the clinical stuff – but I think I didn’t sufficiently carefully listen to what was happening from the perspective of the family. I think I offered them my knowledge and expertise – but I don’t think I openly and genuinely related to them as people.
I think at the time I was quite proud of my professionalism (it embarrases me to admit…). In Uni we had been told that learning to be “professional” was an important part of our training, and so I thought it was good that I had mastered it to an acceptable degree. It had also been emphasised that being “professional” was important for coping with the job – i.e. not to dwell too much in the worries I saw at work. As well as being professional, I was also very much into being person centred, and I completely and genuinely believed in shared decision making. So while I was proud to be professional, I hope I was not being paternalistic.
My professionalism started to change, however, when I got involved in research. One of my early projects involved me going out to service users’ homes and interviewing them about their lives and experiences. I still remember it vividly. It was like every interview peeled off a layer of my “professionalism”. When the interviewees accounted to me what professionals had said to them…. and how it had made them feel…. I was internally cringing.
Most of the things the interviewees told me were things that I had said – countless times! Sentences and expressions that I had deliberately learnt from colleagues as “professional” – in the sense that they were ‘unemotional’ ways of expressing things. Through the interviews I started to realise that what to me had sounded like appropriately detached expressions sounded awfully cold, distant, and disengaged to a person in the middle of it all. I began to realise that what I had considered respectfully neutral ways of saying things actually came across as uncaring. =(
Through those interviews something amazing happened. I lost most of my “professional” self that I had learnt during my training. The aspiration to be objective and unemotional was replaced by an interest in relating to the person. For me, the person’s experience became the frame within which everything else needed to be understood and considered. Relating to others as people became my default, and being professional became just a shirt that I wear for the clinical stuff. I learnt that feeling emotions in professional encounters was nothing to be afraid or ashamed of.
So today, when I needed to address the concern. While I felt sad that our interactions (it was about interactions, not clinical) may have caused concern, I also felt completely ok to call the family to talk about it. I genuinely wanted to find out what they felt was wrong, and what we can do about this. I felt openly interested in hearing their experiences of the situation, and without a doubt I felt that their experiences needed to be where our journey will continue. I felt comfortable just listening.
And that is why the concern was a positive thing. Because it made me realise what a long way I have travelled from those early years, and reminded me of the significant impact that direct research experience can have on clinical practice.
Ps. Just to be clear, there are of course many ways to understand what being professional means. Many might say that listening and relating is part of being professional. And I fully agree. The point is – I didn’t realise back in the day that I wasn’t listening and I wasn’t relating. I thought I was (and probably was to an extent). But I think back then I felt very much professional but not really relational. Now I feel very much relational (and if I feel too strongly professional I consider it a warning sign that I may be off track!).
What’s your thoughts and take on this? Do post your views below – no need to log-in or anything!