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Is it cruel to be kind? An open letter.

Rupal Shah, London GP, co-author of Fighting for the Soul of General Practice- the algorithm will see you now
Melissa Sayer, London GP
Mohammed Abu-Bakra, Consultant Ophthalmologist, King’s College Hospital
Eduardo Szaniecki, Consultant Child and Adolescent Psychiatrist, North Camden Community Team
Andrew J. Wilson, Consultant Haematologist, University College London
Bhavna Batohi, Consultant Radiologist, King’s College Hospital

Kindness was recently mandated by the GMC to be a ‘legal and ethical’ duty of a doctor.1-3

That sounds very positive at first glance. Of course, kindness should be compulsory. In fact, most clinicians already ‘practice’ it on a daily basis.

The thoughtlessness and reductionism behind the guidance only become apparent when you pause and consider its implications, even though neither thinking nor pausing are generally facilitated within current NHS culture. However, a group of us recently did just that in the context of a multidisciplinary meeting for educators from primary and secondary care. This opinion piece is based on the discussion that flowed from our meeting.

Kindness is a disposition that can’t be policed and which grows out of care, attention and connection.

When considering the mandating of kindness, first of all, we ask, ‘What is kindness?’ And how do you measure it? The perception of kindness is socially constructed. Some people may struggle more than others to be perceived as kind. Men, introverts, people whose first language isn’t English may all be disadvantaged here. Also, might kindness be understood to be the same as saying yes to whatever a patient asks for -and avoiding challenge? How do we propose to prove intention? Should a GP talk to a single mother whose child is obese about his weight, although she has come in for something different? Is that kind or not?

Secondly, we ask, ‘What do we need for kindness to grow?’. The new guidance positions kindness in the same way that resilience has been positioned, as an attribute that lies solely within the individual and is within their gift to harness. We would argue that in fact, kindness, like resilience is reciprocal, that it is something generated within interactions between individuals or teams and that it is systems-based. It flourishes in the right conditions, including psychological safety. A culture in which measurables are prioritised and which is fundamentally target driven, impersonal and bureaucratic is not conducive to the growth of kindness.

Thirdly, we suggest that the decision to include kindness -as opposed to creating space for critical thinking and reflexivity- is emblematic of where we are going wrong. We need doctors who have the ability to think broadly about their decision making and the influences on it, including context, values and bias. Medical curricula should include philosophy. We need to have conversations with our learners and with each other about moral responsibility in our current, impersonal context.

Kindness is a disposition that can’t be policed and which grows out of care, attention and connection. To suggest it can be enforced and regulated for is a mistake.

References

  1. Sokol D. Do doctors need to be told to be kind? BMJ. 2023 Aug 25;382:1976. doi: 10.1136/bmj.p1976. PMID: 37625820.
  2. Salisbury H. Helen Salisbury: How the duty of kindness could suppress legitimate debate. BMJ. 2023 Dec 5;383:2859. doi: 10.1136/bmj.p2859. PMID: 38052462.
  3. Hoban B, Professionalism, kindness, and going the extra mile, BJGP Life, November 8th 2023, https://bjgplife.com/professionalism/ [accessed 24/5/24]

Featured image by Ryunosuke Kikuno on Unsplash

The BJGP is the world-leading primary care journal. At BJGP Life we add multi-media comment and opinion for the primary care community.

Ethics of the Ordinary is a regular column on BJGP Life that explores ethical and moral concerns relevant to general practice and primary care.

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Rod Sampson
Rod Sampson
18 days ago
Peter von Kaehne
Peter von Kaehne
17 days ago

As a now quite senior doctor I have often come to conclude that the best way for any vital but failing service to get improved is not ever to prop it up. Some less hard skinned colleagues have seen this as unkind. I think it is the kindest way of improving things – hard early fails instead of soft “kindness” supported slow rot.

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