Big Things Make A Big Difference

Anne Katz  wrote that small things make a big difference. But I think that her story is about how she helped with many BIG things for her patient.

This lady was due to have radiotherapy and so, to try to help with the effects of radiation on the vaginal wall, was also due to use a vaginal dilator. She was distressed, anxious, and crying.

Ms Katz describes that the patient disclosed that she had a history of childhood sexual abuse. Patients don’t disclose this unless they feel safe. So Ms Katz made a scared patient feel safe.

That’s the first BIG thing.

Really really HUGE, actually!

I know how it feels when patients disclose for the first time. You both know they just did an amazing thing. And you both know that you were there together. Even if their eyes are still crying, the patients are often pleased (they know they’ve done something important) and surprised (often they weren’t expecting to disclose. And they haven’t disclosed on many many other occasions).

Ms Katz says “I took a deep breath and told her that she did not have to use the dilators at all”

That’s the second and third big things.

In my experience, when patients disclose, taking a deep breath and being calm is another BIG BIG thing. It’s modelling being calm. So the patient can see it’s possible to be calm, even in the most appalling of situations. And / or it allows the patient space to disclose that VERY WORST thing that they might think no-one (including them) can ever withstand.

While telling the patient she didn’t have to use the dilators at all is giving her back the control she had taken away from her during the abuse. And now is also having taken away from her with the cancer and in all the cancer treatment.

So it’s a HUGE thing!

Ms Katz goes on to describe a masterclass in gradual, incremental working with the patient. As well as how she’d enrolled a biomedical engineer in making a dilator that wasn’t as huge and scary as this patient feared.

She ends the piece with minimising her role: “while trying to not be self-serving”. Presumably this is cleverly tactical – to try to encourage other people to do similarly small HUGE things – as well as being polite.

But I dont have to be so modest for someone else!


At a time when there is so much lip-service given to being patient-centred, and so many stories of bad patient care, Ms Katz is what it’s all about.

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