On the heels of #BellLetsTalk Day last week I have been thinking about mental health, the impacts of COVID19 and what matters to me in achieving or maintaining a healthy outlook. As COVID19 continues and as the annibus horribilis that was 2020 blends with new challenges in 2021, I have become more aware of, and unsettled by, the public and private discourse that is taking place in a vast arena of platforms from social media, mainstream media and in everyday life. It is a discourse that increasingly features disrespect and incivility.

I’ve been invested in healthcare quality for many years and as such, Don Berwick has had and continues to have a substantial influence on my thinking. His views on civility have come to mind a lot over the last few months, and I have been mulling over an address he gave a few years ago at the IHI National Forum. In this address he spoke eloquently of his belief, which I agree with wholeheartedly, that “everything starts with civility.” Civility and kindness are different, but on the same continuum. I see kindness as civility in action.

Is it just me, or has the crisis of COVID19 shone a spotlight on incivility in politics, and in virtually every aspect of life as we know it? That is not to say that civility is absent; I see examples of kindness and of true collaboration every day and they make my heart soar. But I also see what appears to be an increase in the number and tone of uncivil voices that seem to have the biggest megaphone and the loudest voices.

I watch political debates across the continent and observe leaders who seem focused on scoring political “points” through attacking those with opposing views. I watch healthcare leaders with opposing views about how to handle the pandemic and see their views being attacked by the very people and organizations they are trying to help. There is often an almost gleeful response if/when the other is proven wrong; almost a “gotcha” moment.

This is a time when I, as a citizen concerned about my family and community, want strong leadership that is characterized by a desire to collaborate, to join forces and to respectfully work through disagreements so we can come to integrative solutions. I also think that community is key to us finding workable solutions to this crisis we are in, and in fact always. That community can be as broad as the umbrella of global citizens, or as small as a neighbourhood or workplace. The defining feature of community is that it moves #InItTogether from being a hashtag, to being the modus operandi of the group. That requires trust and respect.

So, how do we change this? I hope that we start where we are, where we have influence. We can begin by ensuring that civility is about more than just the absence of bullying, aggressive language or toxic behaviour. Civility is about our relationships and how we interact with each other personally. Civility is often subtle, but the impact of small subtle actions can be tremendous and far reaching. Civility can be as simple as a gesture, a touch, a word; but those small actions go far!

Let me give you an example. I am caregiver to my sister who has had a lengthy complicated journey in healthcare and who has been a “hallway medicine patient.” I share her story with her permission. At one point prior to her diagnosis, she was a patient in the hallway and had multiple drains and lines. One evening, we listened as a staff member yelled to a colleague to “check the abdominal drain in hallway 2.” My sister is a very private person and she was mortified. She felt dehumanized. One of the cleaning staff had been observing us. She was quietly going about her work, tidying the laundry cart, cleaning trays and winding her way between stretchers in the hall. A few minutes later, she was at my side, touched me gently on the arm, then discreetly draped some sheets over the side of the stretcher, covering the bags of fluids, and catheters that were causing my sister such embarrassment. This seemingly small act of kindness and civility moved me to tears and made my sister once again see herself not just as a body part, robbed of her humanity, but as a person worthy of compassion and care.

This may seem like a small issue in the grand scheme of 2021 life, but small changes in how we interact with each other, even those we disagree with, are important. Changing this can and does make a big difference. Civility and kindness are more than just soft issues; to me, they are a requirement if we are to grow as individuals and a society from this pandemic. We should expect it from each other.

It is a moral imperative, I believe, that we have no tolerance for incivility; and that we find ways to focus on kindness.

I have at times spoken harshly, or without kindness and I have often regretted those words and exchanges. I have, however, never regretted when I have acted with kindness.

Maggie Keresteci

Maggie Keresteci

Executive Director, CAHSPR