Volume 24, Number 7: July 2023
A Detailed Roadmap on How to Retain Patient Dignity in Care
Dignity in Care: The Human Side of Medicine
Harvey Max Chochinov
Oxford University Press, 2022
184 pp, hardcover
ISBN: 9780199380428
Also available: eBook
MSRP: $49.95
Reviewed by Romayne Gallagher, MD
Dignity in Care: The Human Side of Medicine by Harvey Max Chochinov could be called a swan song of his 35-year career in psycho-oncology and palliative care research. Ancient legend has it that mute swans sing a beautiful song in their twilight, having been silent prior to this. Thankfully, Dr. Chochinov and his research colleagues have not remained silent, but have catalogued in more than 300 publications how patients view dignity in serious illness, how it gets trampled on, and how to restore or prevent the loss of dignity through the care we provide.
This brief book asserts that “patients are people with feelings that matter” and explores ways in which we can treat the patient and not lose sight of who they are. "Understanding Patienthood," the first chapter, considers how illness and its treatment affect your sense of self or personhood if you are treated as a diseased body, rather than a person with a disease. Chapter 2 discusses the "ABCD of Dignity-Conserving Care"—attitude, behavior, compassion, and dialogue—and gives numerous examples of ways in which dignity can be enhanced or lost, in how we show our care for the person. Chapter 3, "The Model of Optimal Therapeutic Communication" is an excellent chapter about the development of a model through focus groups and analysis of data from scores of experienced psychosocial clinicians. Chapter 4, "Dignity in Care," provides a detailed look at the model of dignity, the patient dignity inventory, and the dignity-conserving repertoire that clinicians can use in providing this therapy.
I particularly enjoyed his choice of phrases, such as "existential tap" when an illness or injury reminds you that your life relies on your susceptible body. The tone of the work is open, respectful of all, and provides the most compassionate outlook on examples of thoughtless behavior. I valued the discussions of clinicians' involvement in intimate care for potentially dignity-crushing mishaps with bodily functions. Examples of support and connection with the patient’s experience and the inclusion of a practical table of talk tips for intimate hygiene1 is useful for all. This book covers the wide landscape of where care is received, and reflects on the tenor of care provided by all those involved, from booking appointments through to ICU and complex procedures. This book is a testament to the creativity of those providing dignified care for those with serious illness.
I expected more on how to deal with anger, even in its relation to loss of dignity. And, despite being a frequent issue raised by patients and its frequency in the dignity inventory, being a burden to others was a very short section. In the interest of producing an academic text with credit to his clinical colleagues, the reading of text is more onerous than necessary and can disrupt the effectiveness of the stories. Telling these essential stories could have been more effective by crediting people for their contributions in an appendix.
Dignity in Care is useful to anyone working in health care and to informal caregivers. Thirty-five years of research has validated that the "secret of the care of the patient is in caring for the patient," and this book goes a long way to fill in the details.
Reference
Morgan DD, Marston C, Barnard EL, Farrow C. Conserving Dignity and Facilitating Adaptation to Dependency with Intimate Hygiene for People with Advanced Disease: A qualitative study. Palliat Med 2021; 35(7). DOI:10.1177/02692163211017388
New on the Shelf
The Tango of Ethics: Intuition, Rationality and the Prevention of Suffering by Jonathan Leighton, executive director of the Organisation for the Prevention of Intense Suffering, proposes new health metrics in order to measure suffering and its intensity. Available in paperback (list price: $29 USD) and eBook (Kindle, $15.99 USD). Published January 2023.
Note for authors and publishers
If you wish to have your book reviewed, please contact Newsletter Editor Alison Ramsey.
NB: Review copies become the property of IAHPC and are not returned to the author. Only books related to palliative care that have been approved and have an ISBN will be reviewed.